The fight against COVID-19 should not cloud the burden of African endemic diseases

The US Foods and Drugs Administration (FDA) approved the first long-acting drug combination for HIV (which would mean monthly injections that can replace daily pills) this year. This breakthrough was hardly noticed or celebrated in the news. This is amidst many proofs that the landscape of discourse about global health has almost fully revolved around COVID-19 in recent times. 

The narrowed conversation driven by the impacts of the current pandemic is driving neglect of already neglected diseases across the world, especially in Africa. While malaria, tuberculosis (TB) and HIV/AIDS are still among the major causes of death in Africa, the existing refocusing of already limited resources on COVID-19 could lead to millions of excess deaths and disabilities through Malaria, HIV/AIDS, Tuberculosis and Neglected Tropical Diseases (NTDs) mortality and morbidity. For example, 14 African countries experienced a more than 50% decline in services, ranging from the provision of skilled birth attendants to the treatment of malaria cases in May-July 2020 alone.

The Neglect of Neglected Tropical Diseases and COVID-19 (NTDs)

The NTDs are a collection of infectious diseases such as leprosy, river blindness, trachoma, rabies, etc. They constitute a threat to more than half of the world’s population and affect about a quarter of the world’s population across Latin America, Asia and especially Africa. The burden of each of the diseases differs. About 120 million people worldwide are affected with lymphatic filariasis while about 1.5 billion people which is the loss to 20% of the world’s break-in are living with intestinal worms.

The NTDs thus represent a significant burden for the affected population groups, especially if one considers that these diseases are prevalent where other infectious, vaccine-preventable, and nutrition-related diseases are endemic. 

The success already achieved in NTDs controls through preventive, control and elimination currently faces a setback in the light of the current pandemic. The odds of sustaining NTDs prevention, control, and elimination has gradually reduced, with disease rebounds to be expected as a result of the diversion of funds and human resources to address the COVID-19 pandemic. The World Health Organization (WHO) recommended in 2020 that NTD surveys, active case detection activities, and mass drug administration (MDA) campaigns should be postponed in the short term. 

Unless control programs are restored quickly, disease transmission and burden will progressively return to the pre-control level during this break-in intervention. Hence, the ongoing COVID-19 pandemic has direct and indirect impacts on NTDs, and these are likely to revert progress made over the past 10 to 15 years. Also, the longer it takes to intervene, the larger the rebound and, as a result, the higher the rate of new infections. 

Excess deaths from Malaria than COVID-19?

Sub-Saharan Africa accounts for 94% of global malaria deaths, with Burkina Faso, DR Congo, Mozambique, Niger, Nigeria and Tanzania alone representing up to half of the global deaths in 2019.

COVID-19 induced fear of accessing health care centers, lockdown restrictions and disruptions in the supply chain of essential malaria drugs, and reduced number of personnel in rural areas of Africa have delayed malaria prevention campaigns as well as treatment during the current pandemic. The WHO has identified that these disruptions to current control efforts of malaria, if not addressed, could result in deaths from malaria being more than from COVID-19 in sub-Saharan Africa.

The precise mode of interaction between malaria and COVID-19 is still laden with several unconfirmed theories. A study indicated a possible role of pre-existing immunity or cross-immunity between evidence. On the other hand, when considered in numbers, malaria prevalence appears as a significant factor negatively associated with COVID-19 mortality.

Missing Cases of Tuberculosis

Tuberculosis kills 1.4 million people worldwide, with 25% of those mortalities occurring in Sub-Saharan Africa. The pandemic has harmed TB case tracking, as well as supply networks and aids used to fight the disease, resulting in millions of missed diagnoses. According to WHO models, a reduction in global notifications of 25-50 percent for just three months might result in up to 400,000 more TB fatalities, similar to 2012 mortality.

There is still conflicting evidence on the response of TB infected patients to COVID-19, much as there is with malaria. While the previously cited study revealed no link between COVID-19 mortality and tuberculosis, a South African population cohort study indicated that the probability of COVID-19 death increased roughly three-fold for patients with present or past tuberculosis and two-fold for persons living with HIV. 

Bottom Line 

New approaches to these disease eradication and control programs, such as integrated therapy, which targets numerous NTDs at once, and integrated surveys, may be required. Additionally, there may be chances to use COVID-19 surveillance in NTD programs to prevent future COVID-19 outbreaks.

Africa’s fight against the current pandemic must not be allowed to undermine the progress that has been achieved in control programs of African endemic diseases.