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The next global health emergency is already here – and it isn’t a pathogen Leading expert reveals

A mother in Somaliland cradles her malnourished child as drought and famine hit the region CREDIT: Eddie Mulholland

The next global health threat is here – and it’s not a deadly new pathogen, but rocketing food and fuel prices, a leading expert has warned.

Growing food shortages will not only cause starvation, but also put vulnerable populations at greater risk of existing and deadly pathogens, said Peter Sands, the executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria.

“The mental framing in global health is around a brand new pathogen, but it increasingly looks like we’re facing a crisis where the poorest people are unable to heat and feed themselves,” Mr Sands said. “For some, tragically, there will be starvation. But much larger numbers will be more vulnerable to existing pathogens.”

The warning from a leading figure in global health policy comes amid concern that price hikes and worldwide economic turmoil fed by the aftermath of Covid and Russia’s invasion of Ukraine will badly hit the health of many of the world’s poorest.

Rickshaw drivers queue for fuel in Sri Lanka as rampant inflation pushes the cost of food and basic necessities sky high CREDIT: ISHARA S. KODIKARA /AFP

Mr Sands is a senior British banker who now leads the fund that invests more than £3bn a year to defeat three of the deadliest infections facing humanity. Each year, TB kills 1.5 million people, malaria kills 650,000 people, and Aids-related illnesses kill 680,000 people.

But rampant inflation, food shortages and an economic slump may worsen the effects of those diseases.

People who are malnourished or underweight are more likely to contract TB and are more susceptible to reinfection or relapse. While, undernutrition increases risk of death from malaria and aggravates the effects of HIV by further decreasing the immune system.

The World Health Organization says nutrition-related factors contribute to around 45 per cent of deaths in children under five years of age.

‘In one year, we lost eight years of progress’

Mr Sands warns the food and nutrition crisis comes at a time when the battle against HIV, TB and malaria is already struggling.

“The sad truth is that Covid-19 has been the worst thing that has happened to the fight against HIV, TB and malaria since the Global Fund (an alliance of governments, private sector partners and other investors) was created twenty years ago,” Mr Sands explained.

The pandemic reversed progress made across three of the world’s deadliest diseases, he said. “Deaths from malaria in 2020 increased 12 per cent, that meant, in absolute terms, we were back at the level of deaths we had seen in 2012,” he said, “In one year, we lost eight years of progress.”

In September, the fund's annual report for 2020 showed that the number of people treated for drug-resistant tuberculosis in the countries where it operates fell by 19 per cent. This meant around one million fewer people with TB were treated in 2020 compared with 2019.

While the number of HIV-positive people receiving antiretroviral treatment continued to grow in 2020, those joining prevention programmes declined 11 per cent, and tests dropped 22 per cent.

However, lessons have been learned from the pandemic too, Mr Sands added.

The system for distributing insecticide bed nets to malaria hotspots adapted to meet social distancing regulations, which led to greater coverage, he said. The original model saw nets sent via trucks to villages, but the new model sent volunteers house-to-house by motorbike.

“This gave us better coverage, as there had always been some households who wouldn’t travel into the village,” Mr Sands said.

He added that self-testing with remote consolations for HIV patients has also increased, while digital adherence support tools are being used by TB patients undergoing lengthy treatments.

World faces ‘daunting’ challenges

Mr Sands believes that the pandemic shone a spotlight on the importance of investing in global health. “There’s clearly greater recognition that investing in global health is not just a development issue, there’s a strong element of self interest,” he said.

But he said September’s Global Fund replenishment will be an “acid test” to the degree to which that recognition translates into funding decisions.

The UK is a founding member of the fund, and the third largest public donor, with a total contribution of £4.43 billion to date.

“We are looking for $18 billion to fund the next three years of our activity, all for protecting people from infectious diseases,” he said. “The UK has not made any announcements about the pledge. We are absolutely looking to the UK to increase its pledge by 30 per cent to £1.82 billion.”

A mobile medical unit offering testing for TB, HIV and Covid-19 in South Africa CREDIT: Jerome Delay/AP

The $18 billion aims to reverse setbacks in its global efforts on disease testing, prevention and treatment caused by the pandemic, the Geneva-based aid body said. About $6 billion would be invested to improve pandemic preparedness by supporting healthcare workers, strengthening laboratories and funding diagnostic tools.

“The investments to fight big diseases – HIV, TB, malaria and now also Covid – are primarily the same. It’s the same laboratory network, primary healthcare facilities. It isn’t like the things you do for pandemic preparedness is a discreet silo,” Mr Sands said.

The world is now facing a “daunting combination of challenges”, which includes the resurgence of infectious diseases like HIV, TB and malaria, and uncertainty about the prospect of Covid, he said.

“Covid is not going away, and we don’t know what the next variants will look like,” Mr Sands said. “Then there’s the impact of the war on energy and food, and the increasing frequency of climate change diseases. It’s a daunting combination of challenges.”