IOP Speaker Draws on Experience in AIDS, TB, and Malaria Prevention to Talk COVID-19

Peter A. Sands — the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria — discussed the global response to the coronavirus pandemic at the Harvard Kennedy School’s Institute of Politics Thursday.

Atul Gawande, a surgeon and professor at Harvard Medical School, moderated the talk, entitled “Catalyzing Global Leadership To Contain the Impact of COVID-19.”

In 2019, donors to the Global fund pledged $14 billion in the next three years to end epidemics of AIDS, tuberculosis, and malaria.

Sands said the Global Fund allocates aid “by disease burden, and the inverse of ability to pay” — in other words, to the most impoverished countries with the highest rates of disease. It then encourages the countries to use the aid to independently craft a disease prevention plan.

“We’re focused much more on prevention because you can't get rid of an epidemic simply by treating the people who get ill. You have to drive the prevention side a bit harder,” Sands said.

Based on his experience with impoverished countries and epidemics, Sands reflected on how wealthy countries have grappled with the COVID-19 pandemic.

“The reality is that the richest countries in the world have actually spent trillions of dollars in their response to COVID, but most of that has been on mitigating the socioeconomic, domestic consequences,” he said.

In comparison, they have spent only “tens of billions” on tools to fight the virus itself.

Sands said it was difficult to speculate about the possible impact of COVID-19 in the next six months, given how differently the pandemic has impacted disparate parts of the world.

He noted that the response should not be based solely on a vaccine, but also the development of therapeutics and diagnostics to be used in the interim.

“If we lose those healthcare workers between now and when we get a vaccine, we won't have anybody to distribute the vaccine anyway,” Sands said.

This is a particular concern in regions with low ratios of healthcare workers tooverall population, like some countries in Africa, he said.

Sands and Gawande also discussed the importance of systems of healthcare delivery in disease response — both for coronavirus and the diseases the Global Fund focuses on, such as AIDS.

“You've got to build a system, because if you don't have a system, nothing functions,” Sands said. “In many countries, the fundamental infrastructure and capabilities that have been used to do the COVID response, have been those that have been put in place for HIV, TB, and malaria.”

At the same time, though, Sands said it is important that healthcare providers not lose sight of individual patients’ well-being.

“COVID is going to force us to get even more system-oriented,” he added. “But I want to make sure that as we do so, we keep that laser-sharp focus on what is the difference we’re making to people's lives.”

Sands concluded by reflecting on how COVID-19 has shifted wealthier countries’ perspective on the effects of disease — now, instead of looking “outward,” they have been forced to turn “inward.”

“Whereas malaria was in a sense for the rich countries, somebody else’s problem, but one they wanted to help deal with, this is a problem that is on the doorstep of the rich countries in the world,” he said.