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Rich countries put billions into global Covid responses. Low-income countries wish they could spend it on bigger problems.

“Unfortunately, people from certain countries who are afraid have a much greater impact on resource availability,” said Lucica Ditiu, executive director of the Stop TB Partnership. “Fear will always make money.”

Ditiu and others ask whether donors fixated on Covid-19 are spending large sums of new international aid efficiently and whether they are listening to local experts. While the health leaders noted that it was important for the world to respond to Covid-19, they said the unique threat Covid posed in rich countries led low-income countries to follow suit by prioritizing Covid over other diseases.

That, they said, has likely led – and will continue to lead – to more deaths in their country than a more nuanced approach would have.

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization dedicated to ending diseases that pose deadly threats in developing countries, has also invested billions in the fight against Covid-19. He said he recognizes the power dynamics in the game.

“When we talk about pandemics, there are actually two sources of inequality and one of them is getting a lot of attention; the other doesn’t,’ he said.

The first point of inequality is widely seen and reported, he said: who gets the vaccines, therapies and supplies needed to fight a disease outbreak — especially if there isn’t a large supply to go around.

“But the second and perhaps more insidious inequality is who gets to say what is defined and treated as a pandemic? What things are we focusing on with the full force of the global kind of 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 pose less of a threat to people living in rich countries, we start to use other languages, such as endemic. and epidemic.”

Disease in the developing world

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

The WHO registered about 1.5 million dead of TB in 2020, as well as more than 1.2 million of HIV and malaria combined.

Officially there were about 1.8 million Covid-19 deaths in the same time frame, though public health experts say this figure — like many during the pandemic — is likely an undercount.

Still, the existing epidemics appear to be a bigger problem for some in developing countries than Covid-19.

“Unfortunately, if you look at the number of people infected with TB, it’s a huge number compared to Covid,” said Choub Sok Chamreun, who works on HIV, malaria and TB responses – as well as building community health care – in Cambodia. “They forget the other diseases.”

He noted that while wealthy countries distributed booster doses to young and healthy people last year in spite of the… WHO warns it could prolong the pandemicdeveloping countries were locked into social distancing and waiting for the arrival of vaccines.

Those who have worked to end TB in developing countries have been amazed to see a Covid-19 vaccine developed in a matter of months as they waited a lifetime for improvements to TB vaccines. “If they pay attention to TB, like” [Covid-19]I think we can easily end TB,” said Sok Chamreun.

Concerns about priorities don’t just come from health leaders in developing countries. Last month, John Nkengasong, head of the US Emergency Plan to Fight AIDS, or PEPFAR, said told Science magazine that a generational campaign by the United States to fight AIDS in developing countries is in danger of failing.

“When you talk about a pandemic, the first thing that leadership in the PEPFAR partner countries thinks now is COVID. They forget that there is a silent pandemic of HIV/AIDS going on,” he said. “If we take our eyes off that ball, the profits we’ve made over the past 20 years can be eroded very, very quickly.”

Donors respond

Donors to developing countries said much of the funding for Covid-19 response to developing countries was distributed separately – and in addition to – existing funding.

And some donors, such as Sands’ Global Fund, said they had directed funds not only specifically to Covid-19, but also to the impact of the pandemic, such as reduced preventive care. Countries have started to use more of the money for secondary effects than direct Covid-19 responses, Sands said.

At the same time, Covid-19 was a new disease from the start, and the magnitude of the threat it posed is still unknown. Health experts warn that uncontrolled spread increases the risk of new and potentially more dangerous variants, especially in lower-income countries where vaccination rates remain low. Others have pointed to the looming threat of long-term Covid, a still mysterious syndrome.

Atul Gawande, the assistant administrator for global health at USAID, defends the US development agency’s efforts.

“For our Agency and our work around the world, we do not have the luxury of focusing on just one public health crisis at a time — not even in an unprecedented global pandemic,” he said in a statement to POLITICO. “Ultimately, we hope to make COVID-19 a manageable endemic respiratory disease and part of our ‘regular’ global health functioning. But for now, we will continue to treat it as a public health emergency of international concern, as defined by the WHO.”

Gawande said it would be wrong to label US efforts to help developing countries as short-sighted. He pointed to the Biden administration’s Global Health Worker Initiative, which aims to strengthen a workforce that can work to end multiple diseases at once. Meanwhile, existing Covid-19 programs funded by the United States are being expanded to also address diseases such as tuberculosis, a USAID spokesperson said.

‘A missed opportunity’

Still, health advocates working in developing countries said the process should have worked the other way around, with new programs aiming to combat Covid-19 piggybacks on existing disease-control campaigns.

Many 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, said that integrating systems would not only have strengthened the work already done, but also Covid response would have been more effective.

“It’s not easy, but if you have a structure, why not start there and build on it?” he asked in an interview in March, as governments scrambled to increase low Covid-19 vaccination rates in low-income countries. “It’s a missed opportunity if we start all over again instead of looking at what we have.”

Bush said the work to stop rare tropical diseases was similar to Covid-19’s responses: reaching distant communities, solving last-mile delivery problems and achieving high treatment coverage rates.

“We have different ways to deliver and mass treatments,” he said. “There are models — not that you can just transplant, but that can be adapted and adopted.”

Others striving to fight long-lasting plagues endorsed Bush’s point. “Investing in existing malaria platforms could be the fastest and most cost-effective way to scale up Covid testing and treatment,” said Martin Edlund, CEO of Malaria No More.

Ditiu, who has worked to coordinate TB care, said the issue of silo responses predates the Covid-19 pandemic. She said it’s all too common for a group that responds to one disease to set up a new framework for fighting it, not realizing that another organization had already created something nearly identical in the region.

Some proponents hope their message gets across. In June, the World Bank’s Board of Directors signed a new Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, which will allocate resources to low- and middle-income countries to help them improve disease surveillance, laboratory systems, health personnel, emergency communications and involvement of the community.

The WHO is also negotiating an agreement between member states to make commitments 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 their biggest threat,” she said. “Donors must be humble enough to really listen to the country’s plans and priorities.”

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