If influenza viruses could think, right now they would undoubtedly be wondering: What the hell is going on with our hosts? They used to be so gregarious and touchy-feely, but now they hardly get together at all. It’s a disaster! Indeed, although face masks, hand hygiene and social distancing were not intended to combat the flu, our old tormentor has also taken a big hit. In some European countries, the influenza virus has been completely wiped off the map by the drastic measures against SARS-CoV-2 (although they are not close relatives, by the way).
But not all of our old germs are being pushed aside by the new kid on the block, or have suffered from the COVID-19 public health response by way of collateral damage. On the contrary: the emergence of Sars-Cov-2 is giving some viruses and bacteria a golden opportunity to launch a new offensive. And they are greedily taking advantage of it.
Because the coronavirus is attracting so much attention, we are losing sight of other germs, many of which are more dangerous and deadly than Sars-Cov-2. For example, according to a report by UNICEF and the WHO, vaccination programs are being disrupted or discontinued in as many as 68 countries. And, even when programs are continuing to operate, access to clinics has been hampered by lockdowns and disruptions to public transportation. Sometimes, parents have simply not dared to visit clinics for fear of infecting themselves or their children with coronavirus. As a result, 80 million small children worldwide are now at increased risk of measles, tetanus and diphtheria.
In recent months, western nations have seen fierce public debates about whether the cure for coronavirus is worse than the disease, calculated in terms of economic damage or lost years of life. But, although we believe that the lockdowns in Europe and other affluent nations were necessary to prevent an even bigger catastrophe for both public health and the economy, the story is quite different for poorer countries. According to WHO director Tedros Ghebreyesus, the indirect damage resulting from missed vaccinations could be far greater than the effects of Covid-19 itself.
If you are a wealthy and prosperous nation with high life expectancies and an aging population, you can afford to resort to drastic measures against a virus such as this one, with its relatively low mortality rate. After all, other more serious threats to public health have long been eliminated. But that trade-off is completely different for developing countries where malaria is often still endemic and where diseases like polio, tetanus and diphtheria are still far from eradicated. Moreover, these countries also have younger populations, which are far less vulnerable to coronavirus. Covid-19 is not a rich people’s disease, but the lockdown against it is a rich people’s remedy: you can only afford it if you are, collectively, healthy and wealthy enough.
For too long, the WHO’s recommendations against Covid-19 have been tailored to the wealthy countries that are the organization’s main donors. Discussions about available intensive care beds and ventilators, for example, are simply meaningless if you don’t have decent hospitals to begin with. Unfortunately, policymakers in poor countries have been too quick to adopt the strategies of the rich west, with dire consequences. Advising people to stay at home, while understandable, is particularly tragic when it prevents parents from having their children vaccinated, because measles and diphtheria pose a far greater danger to small children than coronavirus.
The same western set of priorities, unfortunately, has also cropped up in the world of development aid. In April, billionaire and philanthropist Bill Gates announced in the Financial Times that his foundation would give “total attention” to the fight against Covid-19. If that were literally true, it would be a disaster, because the Gates Foundation spends hundreds of millions of dollars every year on effective campaigns against HIV, measles and polio. Fortunately, it turned out to be an overstatement (or maybe Bill changed his mind): on June 4, the Gates Foundation announced that, over the next five years, it will invest $1.6 billion in GAVI, the vaccination alliance that administers life-saving routine vaccinations to children in developing countries.
For western countries in March and April, it was, quite understandably, a case of getting all hands on deck against the novel and highly aggressive virus. But, now that we have come to know our enemy better, it is time to set our priorities in order again. In recent decades, the world has made tremendous progress in the fight against a variety of deadly infectious diseases. Many of them have long faded from memory in western countries, which means that we have also forgotten how horrible they can be. The WHO estimates that vaccination saves two to three million lives every year, especially among small children. The number of measles deaths has fallen by 73% since the turn of the century, and the number of malaria deaths has been halved: from 800,000 to 400,000.
If western governments and development organizations continue to narrowly focus on this single virus, those tremendous gains could be lost again. The UN expects that the direct and indirect consequences of COVID-19 will push tens of millions of people into extreme poverty, from which many of them had only just escaped. This threatens to reverse decades of economic, health and social progress. In the Lancet, researchers have predicted that six months of disrupted maternal and child care could lead to the additional deaths of 253,500 children and 12,200 mothers. And that was the most favourable scenario. The grimmest forecast puts excess infant mortality at upwards of one million.
It doesn’t have to come to that. Both governments and individual citizens can help to keep regular health care going in poor countries—for example, by providing extra support to organizations such as UNICEF. Another option is to support charities that have previously proven to be extremely effective in the fight against poverty and disease, as shown for instance in the rankings produced by GiveWell.
The world has been on the right public health course in recent decades. We should not allow the coronavirus crisis to distract us from other, more deadly germs.
(Written together with Mirjam Vossen, published at Areo Magazine on Aug 19, 2020)