Tale of two pandemics
Follow the science and do not forget one at the cost of the other

Shobha Shukla *

Covid-19 has posed innumerable health, economic, and social challenges for all, including people living with HIV. It has exposed the fragility of health systems around the globe and has diverted political attention and funding from other infectious diseases like TB and HIV. The opening session of the 11th International IAS Conference on HIV Science (#IAS2021) held virtually from Berlin, saw a lively panel discussing the tale of the two most horrendous recent pandemics in the history of our civilisation: Covid-19 and HIV/AIDS.

Here is a glimpse of what the scientists, politician and activist had to say:

Intersectionality of Covid-19 and HIV

Dr Anthony Fauci, Director of National Institute of Allergies and Infectious Diseases, USA, said that we cannot forget HIV just because we happen to be in the middle of Covid-19. Decades of investment and science in HIV research, albeit as yet unsuccessful in developing an HIV vaccine, has played a major role in the development of highly successful Covid-19 vaccines in a very short period of time. But the fact that we have a Covid-19 pandemic does not lessen the importance and devastation associated with the HIV pandemic that has resulted in substantial mortality and morbidity during the last 40 years.

Dr Fauci said that in terms of preparedness for future pandemics (which will be there) we are better prepared in some respects, but in others we are not. To deal with any emerging outbreak there is a public health response and there is a scientific response. The public health response for Covid-19 has been fragmented in many countries. It was characterised by a disturbing degree of divisiveness when there was a politicisation of how one approaches an outbreak. When you are dealing with a pandemic, the common enemy is the virus, and not the people you may have disagreements with. A global pandemic requires a global response in a synergistic way, and not just an individual country response.

Fortunately, the scientific response has been tremendous and resulted in the rapid development of effective and safe vaccines, said Dr Fauci. The challenge now is to get equitable distribution of these vaccines throughout the world. The rich countries of the world have a moral obligation to ensure that the low and middle income countries are able to access these life saving vaccines in real time.

Dr Fauci shared that an important lesson learnt is to have a global system so that life saving scientific interventions can be rapidly distributed to people in real time without them having to suffer unnecessarily.

Lessons learnt from HIV to address inequalities in the Covid-19 response

Dr Soumya Swaminathan, Chief Scientist at the World Health Organization (WHO); former Director General of Indian Council of Medical Research; former Secretary, Department of Health Research, Ministry of Health and Family Welfare, Government of India; and former head of National Institute for Tuberculosis Research, said that the HIV response was successful when affected communities were actively engaged. When anti retroviral therapy (ART) was not available for many people living with HIV in Africa, they rallied around and fought for access to treatment. A record 27 million people living with HIV are now on ART globally. Unfortunately we are seeing a sort of repeat of the same with inequity in the distribution of Covid-19 vaccines.

Dr Soumya Swaminathan said that it was the community-led and community-based health delivery solutions that worked in Covid-19 as well. Countries with strong primary healthcare systems, where community health workers play an important role, have better managed to keep the pandemic under check. Role of political leadership is also critical. Countries where there has been a strong scientific evidence based data led response to the pandemic, where data is collected, disseminated and used transparently to inform the public- those are the countries that have done well in managing the pandemic. We have to redouble efforts to scale up infection control measures and vaccinations, and at the same time not take the focus away from diseases like HIV and TB that still kill millions every year.

Trust, transparency and proper communication with the public are extremely important in dealing with any public health challenge, rightly said Dr Swaminathan. We saw stigma for people affected with Covid-19 just as we saw it in those affected by HIV or TB. In countries where people generally have a higher trust in the government and in public health authorities, there has been more public acceptance of preventive social measures, and vaccination as well. Also, the data that has been available in many countries is far removed from the ground reality. This brings out the importance of investing in data systems (especially for mortality and cause of death statistics) to really understand the burden of any disease.

But along with having the scientific tools- whether for diagnostics, treatment, or prevention (including vaccines), we also have to focus on making them accessible to all and the private sector plays an important role in delivering these tools, said Dr Swaminathan.

Multilateral and inclusive response to global health challenges

Jens Spahn, Federal Minister of Health, Germany, said that HIV has taught us that a multilateral response, that includes people and affected communities, is the way to get through it, and this applies to Covid-19 response as well. What we have learnt from HIV is that universal health coverage is the key. Primary healthcare makes a big difference in fighting all these diseases. But we are yet not there. That is why Germany, Ghana, and Norway have asked for a global action plan for healthy lives.

It is one thing to have a drug or a vaccine, but you still need to be able to deliver and administer it in all countries. And for that you need a working healthcare system. So, besides multilateral cooperation on certain diseases, we also need strong primary healthcare systems in every country, said Germany's Health Minister Jens Spahn. While the world coming together very quickly to speed up the Covid-19 response is a humanitarian help, it is in our own national interests to vaccinate the world, because no one is safe until everyone is safe. That should be the motto of our engagement. If we put our heads together and really want to make a difference to science and public health, we can. I accept that there is not yet equitable access to Covid-19 vaccines, but it would be there soon within months and not within years, he said.

Jens Spahn rightly underlined that there is no vaccine against hate or fear that we have seen manifesting during these pandemics. The demonstrations against Covid-19 control measures- the fears and blunt aggression in people’s eyes- reminds us that liberal democracy is about having a good sober debate which presumes that the other person might be right too. I do hope that we leave behind us all the hatred, false information and the nationalist view that many had, and learn from the good that happened- having a vaccine in a very short a time within a pandemic situation.

Personal experience as a Covid survivor as well as a black woman living with HIV

Yvette Raphael, Executive Director of APHA (Advocates for Prevention of HIV), South Africa, shared her experience of not only living with HIV as a black woman since last 20 years, but also as a Covid-19 survivor. She said that "I carried 3 burdens- being black, being a woman and being poor. My journey started when I was diagnosed with HIV in the midst of HIV denialism and lack of political will in South Africa at that time. My involvement with HIV struggle started due to my experiencing stigma myself for being HIV positive. Never did I imagine that I would be infected with HIV and also recover after getting very sick from Covid-19 infection only a few days ago. Never did I imagine I would be at the centre of fighting for the rights of people living with HIV, fighting for access to HIV treatment and also be in the forefront of fighting for the research and development agenda."

She added that many countries and governments have spent billions of dollars on Covid-19 response, while diverting resources from HIV and TB - like TB is the poor cousin of HIV and Covid-19 is the rich aunt. We did not act how we should have acted! The biggest mistake was to not have proactively engaged the HIV sector globally and make community leaders part of the Covid-19 response. Leadership is needed at all levels. Community action and information must be available in real time for local responses and for communities to be able to act, embrace the science, and innovations while protecting human rights. Advocates and scientists must speak through to power. Now is the time to start planning for the next pandemic today, as it might be there tomorrow, alerted Yvette.

"Most of us have lost so many family members, friends, leaders globally to Covid-19 (as well as to HIV). I see faces where scientists see statistics. For us, our own lived experiences matter more than mere data. Treat people not as numbers, but as human beings so that HIV does not become a forgotten pandemic" was Yvette's important message to remember while we shape global health responses.

Germany's Angela Merkel speaks at IAS 2021

It would be pertinent to end this piece with some of the remarks made by Angela Merkel, the Federal Chancellor of Germany, (and a scientist herself) during her welcome address at #IAS2021. “The Covid-19 pandemic is not the first event to teach us that infectious diseases know no borders. AIDS has sadly been proof of this for decades. Infectious diseases confront us with global challenges. So the fight against these diseases is only conceivable in the form of worldwide cooperation. During the Covid-19 pandemic we have seen how international cooperation has enabled multiple effective vaccines to be developed in record time. However, we have also witnessed how in the shadow of the pandemic, the achievements made in the fight against HIV have slipped from our grasp. AIDS must not be allowed to fade into the background due to Covid-19. In fact the international community must redouble its efforts to reach the global SDGs relating to HIV, because the ongoing fight against AIDS too can succeed through global cooperation. Germany stands ready in its capacity as a hub for science and research to partner with others so that together we can continue to make progress in the fight against AIDS and other infectious diseases.”

And as the US President Joe Biden told Dr Fauci, no matter what, we must follow the science. We may not be right all the time but if we are not, we are going to correct it and we are going to go in the right direction. That is going to be a pathway to ending this terrible pandemic.