COVID-19 has killed more than 6.3 million people and a recent World Health Organization (WHO) report estimates deaths directly or indirectly due to the pandemic as high as 15 million. This “excess mortality” is calculated as the difference between the number of deaths that have occurred and the number that would have been expected in the absence of the pandemic. The WHO’s report noted that “deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic.”
We ask our experts about the impact of COVID-19 on people affected by neglected tropical diseases (NTDs), viral hepatitis, and polio and other vaccine-preventable diseases.
NTDs – Dr. Patrick Lammie, Director of the NTD-Support Center
Health care services and programs focused on combating NTDs – a group of 20 diseases including lymphatic filariasis (LF), intestinal worms, leprosy, and onchocerciasis – have been heavily disrupted due to the COVID-19 pandemic. Despite significant progress toward controlling and eliminating NTDs in the years leading up to the pandemic, most NTD control and elimination activities, including mass drug administration (MDA) to treat and prevent diseases, were stopped in April 2020, at the start of the pandemic. According to official WHO statistics, the number of people who received preventive chemotherapy with NTD drugs dropped from 1.05 billion in 2019 to 752 million in 2020, a decline of 28%.
Throughout 2020 and 2021, The Task Force’s NTD-Support Center worked with the NTD community and the Improving Community Health Outcomes through Research, Dialogue and Systems Strengthening (iCHORDS) Community of Practice to develop protocols and support four operational research studies to help programs safely restart activities in endemic countries. The aim was to assess how to safely conduct MDAs, which involve large gatherings of people, and community surveys for LF, schistosomiasis, and onchocerciasis in countries such as Kenya, Benin and Nigeria.
Thanks to these studies and guidance from WHO, most NTD programs restarted activities in late 2020 and early 2021. While requiring additional resources, safely restarting activities was possible with extra precautions such as PPE and safety training for staff. Since then, governments have reported challenges of sustaining the expense and logistical effort of running programs in the context of COVID-19 and, in some cases, needed a re-prioritization of annual budgets to restart MDAs at all.
Another challenge is misinformation related to COVID-19 and MDA activities. Health workers reported that some community members were hesitant to wear masks or observe other precautionary measures due to misinformation about virus transmission, which was particularly prevalent in rural areas. For example, in some cases, due to lack of information some communities did not believe COVID-19 existed. Based on research supported by the NTD-Support Center, we have recommended that local governments use social media engagement and social mobilization, such as radio announcements and community leaders as champions, as tools to combat misinformation and facilitate NTD program activities.
Viral Hepatitis – John Ward, Director of the Coalition for Global Hepatitis Elimination
COVID-19 revealed weaknesses in health systems to maintain routine care during emergency situations, and this was certainly true for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) services during the pandemic. A survey conducted by CGHE found that in the early stages of the pandemic, more than 80% of providers reported disruption to testing and treatment, with some citing greater than 50% decline in patients receiving treatment. HBV and HCV screening in the U.S. decreased immensely with a 65.6% decline at the lowest point, compared to pre-pandemic levels.
Conversely, the pandemic highlighted opportunities for strengthening hepatitis services. For example, COVID-19 expanded capacity for virologic testing in many countries where previous viral diagnostic testing didn’t exist, which could increase access to testing for viral hepatitis if countries commit to repurposing these resources. Increased testing capacity in health systems for COVID-19 also presents an opportunity to integrate hepatitis and COVID-19 testing, increasing awareness and response to HBV and HCV.
Currently, The Task Force’s Coalition for Global Hepatitis Elimination is working with the global community to develop a framework for how partners can capitalize on the transformations in public health and clinical care coming from the response to the COVID-19 pandemic, maximizing health system improvements for hepatitis elimination efforts.
Polio – Fabien Diomande, Director of the Polio Surge Capacity Team
The measures necessary to control the COVID-19 pandemic impacted polio eradication and other vaccine-preventable diseases due to pausing vaccination campaigns and disrupting essential health services.
Many routine vaccination campaigns for polio were paused until the end of 2020 through to the beginning of 2021 which means many children missed vital polio vaccinations. Numbers from Nigeria demonstrate the magnitude of this: they had to cancel National Immunization Plus Days in April 2020 in two states which resulted in 4.4 million children under 5 missing immunization against the poliovirus.
Not only does this leave children exposed but it puts added strain on the health system to vaccinate these children at a later date. Emergency vaccination campaigns in response to polio outbreaks were also postponed in 2020, which meant the outbreak spread more. For example, in West and Central Africa, 23 outbreak response efforts in 11 countries were postponed.
The roll-out of a new oral polio vaccine, approved by the WHO in 2020, was also delayed until 2021. The new vaccine is preferable to the existing one because trials have shown that it will reduce cases of vaccine-derived polio.
Despite all of this, we are seeing progress, but the ultimate impact of delayed vaccinations is still unknown. For example, from 2020 to 2021 the number of wild poliovirus cases decreased from 140 to six but as of June there have been 12 wild poliovirus cases reported in 2022. And vaccine-derived poliovirus cases, which spread when there is low vaccination coverage in a community, increased both in 2020 and 2021.
Disease Control and Elimination Campaigns – Kris Saarlas, Director of the Health Campaign Effectiveness Coalition
The pandemic caused many health campaigns to be suspended, postponed or canceled in 2020. These are time-bound, intermittent activities that either prevent or respond to disease outbreaks; control, eliminate or eradicate targeted diseases; or achieve other health goals such as improving child nutrition.
With the onset of the pandemic, The Task Force’s Health Campaign Effectiveness Coalition tracked health campaigns impacted by the pandemic. So far, a total of 310 campaigns in the database were disrupted. As of May 2022, 136 have come back and 80% are expected to be back by the end of 2022.
One of the good things out of the pandemic is that it has spurred the public health community to coordinate and build on current health campaign platforms and country expertise during delivery of COVID-19 vaccines. As more campaigns get back on track following COVID-19-related delays, many countries may require innovative campaign delivery approaches to catch up on intervention coverage efficiently, effectively, and rapidly. It has presented a unique opportunity to rethink how we plan and implement campaigns to better align with primary health care strategies and reach communities so that campaigns come back better than before.
Photo caption: Vaccination of under 5 for polio mOPV2 Supplementary Immunization Activities in Nairobi, Kenya in May 2021. Photo courtesy of Catherine Chacha Meng’anyi, Kenya FELTP.