Collateral Damage of COVID-19 on Low- and Middle-Income Countries

There is an urgent need for equitable distribution of vaccines in conjunction wi

There is an urgent need for equitable distribution of vaccines in conjunction with continued health interventions and coordinated global action to mitigate the impact of the pandemic on public health and the economy. (Photo: O. Brandenberg, Swiss TPH)

The COVID-19 pandemic has had a major impact on both human health, the economy and society at large. There is no doubt that the disease and control measures indirectly effect people’s health and well-being, particularly in lowand middle-income countries where the crisis has amplified and deepened existing inequalities. To mitigate the collateral damage, Swiss TPH worked on a myriad of projects to support vulnerable populations around the globe.

While the COVID-19 pandemic has affected health systems around the world, individuals living in lowand middle-income countries (LMICs) have been hit the hardest. These countries that often have a weak health infrastructure, high disease burden, and lack of access to treatments and vaccines, face immense threats to their livelihood.

In addition to impacting human health and well-being, economic activities have contracted around the globe as a result of the pandemic and measures to contain it. The immediate result was a severe disruption of global trade and supply chains, a near-complete stop of other disease control activities and restricted primary healthcare services in many countries. The economic shock presents a particular threat to residents in LMICs, who lack the social safety nets that often exist in wealthier countries.

While lockdowns and quarantines implemented by countries to interrupt the spread of COVID-19 have had a disastrous impact on even the strongest economies by halting social and economic activity, many LMICs suffered the most. "What we have seen is that many people in LMICs have been disproportionately affected by the pandemic," said Jürg Utzinger, Director of Swiss TPH. "To support the most vulnerable people and communities, cooperation and rapid, fair and equitable access to global public goods, such as vaccines, is needed."

Support to COVID-19 efforts through Swiss government funding

To assist in the public health response to the COVID-19 pandemic, the Swiss Agency for Development and Cooperation (SDC) supported the re-allocation of funds within existing projects that are implemented by Swiss TPH in various parts of Africa, Central Asia and Eastern Europe. Activities included the creation of a national call centre, procurement and distribution of personal protective equipment, the training of primary healthcare workers, a new diagnostics laboratory, among other activates.

"It was excellent to see Switzerland actively engaging in the public health response to the pandemic," said Kaspar Wyss, Head of the Swiss Centre for International Health and Deputy Director of Swiss TPH. "We were grateful for this opportunity to rapidly implement local and national initiatives to support COVID-19 relief efforts."

Albania The Health for All Project (HAP) supported chronic care patients as well as those with COVID-19. The project also provided funding to the UN Development Programme to procure ventilators.

Chad The Support Project for the Health Districts in Chad (PADS) assisted with training health workers and the dissemination of communication tools to inform to the local community about COVID-19 and how to contain it.

Ethiopia The Jijiga One Health Initiative (JOHI) laboratory at the Jigjiga University became the first COVID-19 diagnostic lab in the Somali Regional State of Ethiopia, contributing to pandemic control in Ethiopia.

Kosovo The Accessible Quality Healthcare project provided behavioural change communication support, as well as proactively countered false and misleading information.

Moldova The Healthy Life Project provided personal protective equipment to health and community workers, and provided evidence-based guidance via phone consultations.

Tajikistan The Enhancing Primary Healthcare Project supported with the procurement of personal protective equipment and trained health workers.

Tanzania SDC supported the Health Promotion and Systems Strengthening project (HPSS) with building up and operating a national call centre to provide COVID-19 information.

Ukraine The Medical Education Development Project launched an online course on topics such as newborn support and infection control in outpatient practice during the pandemic.

Mitigating the impact of COVID-19 on neglected tropical diseases

At present, 1.5 billion people are infected with intestinal worms, which represents nearly 20% of the world’s population. Although the situation has improved for many neglected tropical diseases (NTDs) over the past 15-20 years because of large-scale prevention, control and elimination efforts, the global burden of NTDs is still considerable. COVID-19 is expected to render the lives of millions of people affected by NTDs even more precarious as a result of the diversion of funds and human resources to address the pandemic.

In a publication in Infectious Diseases of Poverty, researchers drew the attention of the NTD community towards the emerging economic opportunities that arose as a response to tackle the pandemic. "The publication serves as a starting point for the NTD community to seek financial support in order to sustain and revitalise control and elimination efforts pertaining to NTDs," said Peter Steinmann, public health specialist at Swiss TPH. "It also provides a compass for NTD programme managers, researchers, decision-makers and other stakeholders to navigate the rapidly evolving funding landscape."

Malaria modelling

Over the past 20 years, there have been large investment into malaria prevention and treatment, resulting in the prevention of 7.6 million deaths. The progress the world has made in the fight against malaria is one of the greatest success stories in global health. Currently, however, these successes are threatened by the pandemic, as the virus places an additional burden on already fragile health systems.

"Early on in the pandemic, we supported malaria control efforts in various African countries by using models calibrated to their malaria situations and estimated the potential indirect impact that COVID-19 would have on malaria if malaria interventions, including the distribution of long-lasting insecticidal nets (LLINs) and the access to health services, were disrupted," said Emilie Pothin, Group Leader at Swiss TPH. "We were grateful to be able to contribute to the effort that encouraged countries to continue the planning and the implementation of the LLIN campaigns despite the pandemic."

Pandemic-induced hunger and poverty

The onset of the pandemic in early 2020 caused a sharp decline in living standards and rising food insecurity in LMICs. A study published in the journal Science Advances provided novel insights into the collateral damage of the pandemic, and urged the international community to take action to mitigate the impact on hunger and poverty. The study showed that in addition to increasing food insecurity, the pandemic and accompanying containment measures undermined other aspects of household well-being and reduced access to health services.

"Even though the world has witnessed the power of science, innovation and industry in rapidly developing and approving new vaccines, people in LMICs will have to wait much longer before their populations will have access to the vaccines," said Günther Fink, an economist at Swiss TPH. "In the meantime, families in low-income settings will struggle with extreme poverty and hunger."

Hope on the horizon

Despite these realities, there is hope on the horizon. Society has seen a major commitment from health and social workers, unprecedented inter-agency collaboration and high-levels of leadership from countries coming together to leverage their experiences gained in other infectious disease outbreaks. Communities have also band together like never before to support one another during these unprecedented times.

"There is a press need for equitable vaccine distribution, coupled with continued health measures and coordinated global action to mitigate the public health and economic impact of the pandemic," said Utzinger. "COVID-19 anywhere is COVID-19 everywhere, as the virus knows no borders. The world must come together and lay the groundwork for radical transformation of health and social protection systems, so that we emerge from this crisis stronger than before."

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