“We saw with the Ebola virus disease outbreak in West Africa that we lost more people to malaria, for instance than, we lost to the Ebola outbreak. Let us not repeat that with COVID-19.” – WHO Regional Director for Africa

8 May 2020 — As COVID-19 disrupts the response to a whole host of preventable diseases, such as measles and malaria, the United Nations is working to ensure that essential health services remain accessible during the pandemic.

Analyses from the 2014-2015 Ebola outbreak in West Africa indicate that more people died from measles, malaria, HIV/AIDS, and tuberculosis due to health system failures than from Ebola, according to a World Health Organization (WHO) report, which highlighted the urgent need to maintain essential health services while simultaneously fighting COVID-19.

Matshidiso Moeti, WHO Regional Director for Africa, recently urged all countries in the region to not lose focus on their gains made in health as they adapt to tackle this new threat.

“We saw with the Ebola virus disease outbreak in West Africa that we lost more people to malaria, for instance than, we lost to the Ebola outbreak,” he said. “Let us not repeat that with COVID-19.”

A new analysis by WHO and partners suggests that in a worst-case scenario if malaria prevention and treatment services were severely disrupted as a result of COVID-19, the number of malaria deaths in 2020 in sub-Saharan Africa could double from 2018, a level not seen in 20 years. “We must not turn back the clock,” said Mr. Moeti.

Elian, who recently celebrated his first birthday, has so far received three doses of a malaria vaccine in a pilot programme started last year in Kenya, where 70 per cent of the population is at risk of malaria, a major killer of children. “When your child is healthy, everything else seems to fall into place,” said Elian’s mother recently.

“The malaria vaccine introduction and programme will help us learn more about the potential of this prevention tool to change the trajectory of malaria – a disease that has held Kenya and Africa in its grips for ages,” said WHO Representative Rudi Eggers at the initial launch.

a child is vaccinated in a tent

The development of a vaccine after a 30-year effort “represents a dream come true for many people - scientists, public health experts and leaders, health care workers, community advocates, public and private partners, and the people, children and families who have suffered from the disease,” he explained, applauding Kenya’s actions to continue delivering essential malaria control and immunization services.

According to WHO, measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800,000.  There are increasing concerns about another resurgence this year, especially if vaccination rates fall due to COVID-19. 

Outbreaks of polio, diphtheria and yellow fever are also very worrisome, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in 2013.

New WHO guidelines on immunization and COVID-19 recommend that Governments temporarily pause preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease. At the same time, WHO urges countries to prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza for groups most at risk.

Smallpox is the first and only disease to be permanently eradicated worldwide. Until it was wiped out, smallpox plagued humanity for at least 3 000 years, killing 300 million people – 4 million people annually - in the 20th century alone. 

On 8 May, the world commemorates the 40th anniversary of smallpox eradication, which is a reminder of the power of international health cooperation to do significant and lasting good. “Together in solidarity, we can beat COVID-19,” WHO says.

HIV/AIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has warned that while new HIV infections fell by 40 per cent since the peak in 1997, hard-won gains are in danger of being reversed by the COVID-19 pandemic sweeping the globe.

Overstretched health systems, lockdowns, loss of livelihoods and fewer employment opportunities could increase unprotected sex, sexual violence and exploitation, transactional sex and sex work, leading to an increase in new HIV infections, the agency explained, urging countries to remain steadfast in their HIV prevention efforts and ensure that people can continue to access the services they need.

“COVID-19 is impacting almost every country and community, but the global HIV epidemic hasn’t gone away,” said Winnie Byanyima, UNAIDS Executive Director. “People are still having sex. People are still using drugs. During the COVID-19 pandemic, everyone must be given the tools they need to be safe and to protect themselves from HIV.”

Pregnancy in pandemic

Interviews with expectant mothers around the world show that pregnant women are living in a kind of limbo, suspended between hope and fear.

Reem Salama, 27, in Egypt, said that coronavirus ruined all her plans: “Now, I have to be careful which hospital I choose and make sure no cases were reported there.” She has stopped receiving antenatal check-ups because COVID-19 cases were reported in the village where her doctor is located. Instead, she speaks to health workers by phone.

There is currently no evidence that pregnant women are at greater risk of infection from COVID-19 than the general population, or that the virus increases risk of miscarriage. Yet the impacts on health systems could very well imperil women.

The pandemic is limiting sexual and reproductive health services around the world. Women report being reluctant to seek care from health facilities for fear of exposure to the virus, or they face barriers to health care due to lockdown-related restrictions. As access to skilled, quality maternal health care goes down, risks to mothers and their newborns go up.

“For us pregnant women, especially for me, expecting twins, I feel scared,” said 25-year old Enxhi Merkaj in Albania. “How I am going to deliver? I am anxious.”

pregnant women in Georgia

Supporting moms and their babies

Iliana Colonna, a midwife coordinator from the Infermi Hospital in Rimini, Italy, recalls that at the beginning of the coronavirus epidemic, staff in her midwifery department were shaken by the fear that they may get infected.

“Our priority became tackling that fear by adhering to guidelines, including those from WHO, and putting a new structure in place that would allow us to continue the vital work we do,” explained Ms. Colonna.

About 40 midwives were promptly trained in the effective usage of personal protective equipment and infection prevention measures.

“Soon, all the midwives felt safe in exercising their duties and their thoughts turned to questions of how to make expecting women, COVID-19 positive and negative alike, feel safe in our hands and offering them the possibility of a positive vaginal birth experience,” she said.

To support postpartum mothers, her department took several steps: coronavirus-infected mothers have their newborn’s crib at a 1-meter distance and they must practice respiratory hygiene, including wearing a mask when breastfeeding, and hand hygiene.

The WHO guidance on breastfeeding during COVID-19 has been very useful, she said, explaining that breastfeeding is particularly effective against infectious diseases, including respiratory diseases, because it strengthens the immune system by transferring antibodies from the mother to the newborn.

“To dispel the mothers’ fears, we also have a psychologist communicating with the women over video calls,” she said. “The midwives also maintain a direct line of communication with all expecting women over mobile phones, which allows them to maintain a one-to-one relationship despite physical barriers.”

The United Nations Children’s Fund (UNICEF) has issued an urgent appeal to Governments and health care providers to save lives in the coming months by helping pregnant women to receive antenatal checkups, skilled delivery care, postnatal care services, and care related to COVID-19 as needed. (See also a story on how to navigate pregnancy during the COVID-19 pandemic.)

WHO, UNICEF and the International Federation of the Red Cross have published guidance for countries on how to maintain community-based health care in the context of COVID-19.  It includes practical recommendations on sustaining essential services at the community level.