Looking back to move forwards
The fight against HIV provides hopeful lessons on how we could emerge from the current COVID-19 crisis. Both necessitate bold action – and hold the promise of a secure society in which all individuals are safe
The COVID-19 pandemic has caused a profound crisis. It also provides an opportunity for leaders around the world to transform how we ensure people’s health. UNAIDS can share learning from four decades of experience in the AIDS response to help do so.
Today, millions of people around the world are alive and thriving because of the actions taken to push back AIDS. Yet AIDS is not finished, nor can victory be assumed: today 25.4 million people are on life-saving HIV treatment; 12 million more need to receive treatment. We are not on track. Indeed, the COVID-19 pandemic threatens to knock progress on AIDS off course. Applying insights from the successes and the challenges in tackling AIDS can help us overcome the COVID-19 pandemic – and enable us to finish the fight against AIDS, ensure the health and rights of all, and equip ourselves to manage the challenges to come.
Here are just six insights from our experience from HIV and AIDS.
First, the power of collaboration. Pandemic responses must go well beyond health. The most successful strategies to support people living with HIV and to reduce new cases of HIV have involved multi-sectoral action across ministries, including on education, social protection, economic policy, law reform and public information. Tackling COVID-19 likewise requires a whole-of-government approach, and a willingness to radically change existing ways of working. That collaboration must be international. Solidarity across borders has been at the heart of responding to HIV. No one ministry, and no one government, can solve any pandemic alone.
Second, the power of community. Community-led responses have been critical to the HIV response. The same holds for communities during the COVID-19 pandemic. They hold the key to flattening the curve, supporting affected people, ensuring equal distribution of commodities and ensuring recovery. Ultimate success hinges on how we involve affected communities in governance and policy, service delivery and monitoring and accountability.
In battling COVID-19, we must harness the power of communities and support community-led responses by funding community organisations, designating them as essential and ensuring the civic space to facilitate their potential. Boosted by the HIV response, strong community systems are in place in many countries. A skilled workforce already provides, or is fully ready to provide, community-led service delivery on COVID-19, as well as HIV. Workers must be paid fairly. Governments must change national policies that prevent communities from realising their full potential due to lockdowns, restrictive social contacting policies and constraints on their operations.
Third, the importance of rights. Many countries’ initial HIV responses disregarded rights. Too often, the same mistakes from the earliest damaging days of HIV are reappearing in responding to COVID-19. The HIV response only started to win once rights and voices were put at its heart. Building on those lessons, UNAIDS has supported the work of human rights defenders in all regions to ensure everyone’s rights are fulfilled in the COVID-19 response. We have provided joint guidance and policy and material support on rights. Aspects of these lessons have successfully been applied in some COVID-19 responses, although there is still much catching up to do. We must ensure that the rights of everyone, especially the most marginalised and vulnerable, are respected, protected and fulfilled, including by ending criminalisation. We will beat AIDS, and we will beat COVID-19, by valuing the rights and dignity of every person.
Fourth, life-saving science as a public good. The mass production of AIDS medicines by generic manufacturers, and assertiveness by developing countries in using them, unblocked the twin obstacles of prices much too high and volumes much too low. We have aimed high on realising everyone’s right to the fruits of the best science in fighting AIDS.
Now, as we face COVID-19, leaders, experts and civil society organisations globally have united in a call for a People’s Vaccine. There must be prior international agreement that any vaccines and treatments for COVID-19 will be made available to all countries, making a monopoly impossible for any single company or country. This will enable the multi-location, simultaneous mass production required to ensure that new vaccines are produced at the needed speed and scale. Developing countries must not be priced out or left at the end of a pharma queue.
Success remains at risk from backdoor deals between countries and pharmaceutical companies. It is vital to maintain a collective approach – because it’s the right thing to do, but also because ultimately it is in everyone’s enlightened self-interest: pandemic vaccines and treatments depend on mass use, so no one is safe until everyone is safe.
Fifth, universal health coverage as an investment that we cannot afford not to make. We have seen with HIV how removing financial barriers to accessing prevention, treatment and care has been key to huge progress, and that the costs of tackling threats to health are much less than the costs of not tackling them.
COVID-19 has again highlighted that health care is a shared investment benefitting all. Excluding anyone hurts us all. Many countries report severe shortages of necessary equipment, medicines and human resources to tackle COVID-19. We must now guarantee people’s health through stepped-up national public investments in strong health systems and take ambitious international action to facilitate the needed fiscal space by raising – not cutting – aid, cancelling more debt and making ambitious tax reforms.
The costs of health cannot be left to individuals. Every year, user fees block one billion people from health care. This puts everyone at risk: viruses cannot be contained if people cannot afford testing or treatment. It is in everyone’s interest that people who feel unwell should not check their pocket before they seek help. As the struggle to control an aggressive coronavirus rages, the case to end user fees in health immediately has become overwhelming.
Sixth, crises as opportunities. The AIDS crisis showed that crises can generate possibility, rather than make bold action impossible. It led to universal health coverage in Thailand, the repeal of discriminatory laws in countries on every continent, new norms on intellectual property and debt cancellation that freed up vital resources. Amid the pain and fear, the COVID-19 crisis generates an opportunity for bold, principled, collaborative leadership to change the course of the pandemic – and of society.
Like AIDS, COVID-19 necessitates bold action, and provides the impetus for taking it. AIDS once seemed it would overwhelm us forever. Our progress in pushing it back gives hope. Conversely, the continuing challenges we face on HIV and AIDS, and the risk of progress being thrown off course, remind us that there is no quick fix.
Our leaders across government and society can beat both pandemics. But this demands we take politically difficult decisions that redress the structural inequalities that hold back all who have been economically or socially excluded; and that we embrace a progressive multilateralism in which we share know-how, investments in our common future and power. The prize is a secure and prosperous society where all are safe, and where all belong. I am optimistic that together we will win.
