Rich countries are pouring billions into the global Covid response. Low-income countries would like to spend it on bigger problems.

“Unfortunately, scared people from certain countries have a much bigger impact in terms of resource availability,” said Lucica Ditiu, executive director of the Stop TB Partnership. “Fear will always bring money.”

Ditiu and others ask whether Covid-19 fixated donors are effectively spending large amounts of new international aid and listening to local experts. While health leaders have noted that it is important for the world to respond to Covid-19, they said the unique threat Covid poses to rich countries has prompted low-income countries to follow suit and prioritize Covid over other diseases.

This, they say, has likely led – and will continue to lead – to more deaths in their countries than a more subtle approach could have.

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization that works to end diseases that pose a deadly threat to developing countries, has also poured billions into the fight against Covid-19. He said he recognizes the power dynamic in the game.

“When we talk about pandemics, there are actually two sources of inequality, and one of them gets a lot of attention; the other is not,” he said.

The first point of disparity is widely known and reported, he said: who gets the vaccines, therapeutics and supplies needed to fight an outbreak, especially when there aren’t many of them.

“But the second and perhaps more insidious disparity is who is to say what is defined and treated as a pandemic? What are the things we will focus on, using the full power of the world’s scientific and financial resources? he asked. “The harsh reality is that we tend to talk about things as pandemics when they pose a threat to people living in rich countries, and the moment they cease to pose a threat to people living in rich countries, we start using a different language. such as endemic. and an epidemic.

Disease in developing countries

Diseases such as HIV, tuberculosis and malaria combined have likely killed more people than Covid-19 since 2020, with deaths from older diseases. concentrated in a relatively small number of low-income countries.

WHO has recorded about 1.5 million deaths from tuberculosis in 2020, as well as more than 1.2 million from HIV as well as malaria combined.

Officially there were about 1.8 million deaths from Covid-19 in the same time frame, although public health experts say that figure – like many during the pandemic – is likely an underestimate.

However, for some in developing countries, the current epidemics are proving to be a bigger problem than Covid-19.

“Unfortunately, if you look at the number of people infected with TB, it’s a large number compared to Covid,” said Chub Sok Chamreun, who works on responses to HIV, malaria and TB, and building a health system in Cambodia. “They forget about other diseases.”

He noted that while rich countries have given out booster doses to young and healthy people in the past year in defiance of WHO warns it could prolong pandemicdeveloping countries are stuck in social distancing and waiting for vaccines to arrive.

Those who have been working to end TB in developing countries have been amazed to see that a Covid-19 vaccine was developed in a matter of months when they have been waiting their whole lives for better TB vaccination. “If they pay attention to tuberculosis, how [Covid-19]“I think we can easily end TB,” Sok Chamryn said.

The concern about priorities does not only come from health leaders in developing countries. Last month, John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief, or PEPFAR, told Science magazine that the United States’ longstanding campaign against AIDS in the developing world is in jeopardy.

“When you talk about a pandemic, the first thing that the leaders of PEPFAR partner countries think about right now is COVID. They forget that there is a hidden HIV/AIDS pandemic going on,” he said. “If we get off this ball, the gains we have made over the past 20 years could be eroded very, very quickly.”

Donors respond

Developing country donors said that most of the Covid-19 response funds in developing countries were distributed separately and in addition to existing funding.

And some donors, such as the Sands Global Fund, said they were specifically directing resources not only to Covid-19, but also to the side effects of the pandemic, such as reduced preventive care. Countries have begun to spend more money on spillovers than direct responses to Covid-19, Sands said.

At the same time, Covid-19 was a new disease from the beginning, and the extent of the threat it posed is still unknown. Health experts warn that the uncontrolled spread increases the likelihood of new and potentially more dangerous options emerging, especially in low-income countries where vaccination rates remain low. Others point to the looming threat of pulmonary Covid, a still-enigmatic syndrome.

Atul Gawande, Assistant Administrator for Global Health at USAID, defends the US development agency’s efforts.

“For our agency and work around the world, we do not have the luxury of focusing on just one public health crisis at a time — even in the face of an unprecedented global pandemic,” he said in a statement to POLITICO. “Eventually, we hope to make COVID-19 a manageable endemic respiratory disease and become part of our ‘regular’ global health system. But for the time being, we continue to treat it as a Public Health Emergency of International Concern as defined by the WHO.”

Gawande said it would be wrong to view US efforts to help developing countries as shortsighted. He pointed to the Biden administration’s Global Health Workers Initiative, which aims to strengthen a workforce that can work to beat multiple diseases at the same time. Meanwhile, according to a USAID spokesperson, existing Covid-19 programs funded by the United States are expanding to also tackle diseases such as tuberculosis.

“Missed Opportunity”

However, health advocates working in developing countries say the process should have worked in reverse, with new programs targeting Covid-19 in addition to existing campaigns to fight the disease.

Many of those who have long worked to improve health care in low-income countries, such as Simon Bush, director of rare tropical diseases at Sightsavers in Ghana, say systems integration would not only strengthen the work already done, but would also make an answer. on Covid more efficient.

“It’s not easy, but if you have a structure, why don’t you start maybe with it, develop it?” he asked in an interview in March when governments go out of my way to increase low vaccination rates against Covid-19 in low-income countries. “It’s a missed opportunity if we just start from scratch and don’t look at what we have.”

Bush said the work to combat rare tropical diseases is similar to the response to Covid-19: reaching out to remote communities, addressing last-mile delivery issues and achieving high treatment coverage rates.

“We have different methods of delivery and mass treatment,” he said. “There are models – not something that can be simply transplanted, but something that can be adapted and adopted.”

Others who are working to fight long-standing epidemics echoed Bush’s point. “Investing in existing malaria platforms could be the fastest and most cost-effective way to scale Covid testing and treatment,” said Martin Edlund, CEO of Malaria No More.

Ditiu, who has worked to coordinate tuberculosis care, said the issue of disparate responses predates the Covid-19 pandemic. She said that too often a group responding to one disease creates a new structure to deal with it, not realizing that another organization has already created something almost identical in the region.

Some defenders hope their message gets through. In June, the World Bank Board of Directors approved a new Pandemic Prevention, Preparedness, and Response Financial Intermediation Fund that will channel resources to low- and middle-income countries to help them improve disease surveillance, laboratory systems, health workforce, emergency communications, and collaboration with the population.

The WHO is also negotiating an agreement among Member States to set obligations to developing countries in preparation for the next global pandemic.

Ditiu said she hopes these efforts will set a new tone. “For most countries, Covid-19 is not the biggest threat,” she said. “Donors need to be humble enough to really listen to the country’s plans and priorities.”