TDespite the fact that HIV and Sars-CoV-2 are very different viruses, the Covid-19 pandemic has drawn striking parallels: governments are too slow to respond; a marked impact on minority communities and a lack of understanding of why; a government response that has leaned toward excessive surveillance and victim blaming, rather than taking every measure imaginable to help people stay safe and healthy. I watch with growing dismay as the world repeats the mistakes of the initial response to HIV.
Stories about vaccine nationalism fill the headlines, while Boris Johnson celebrates that the UK has vaccinated more people than the rest of Europe combined. As of mid-January, only 25 doses of the Covid-19 vaccine had been administered in all the world’s poor countries, compared with 39 million in the richest.
In the mid-1990s, an effective treatment for HIV, antiretroviral therapy (ART), was discovered, and the trajectory of the pandemic transformed in predictable and completely unpredictable ways. For the first decade or so, ART saved the lives of millions of people Around the world, even people with late-stage HIV could be up and out of wards in a matter of weeks. The science of treatment has improved to such an extent that now, for many, HIV medication means just one pill a day with no significant side effects. A person living with HIV who is diagnosed early and has quick access to treatment. can live as long as anyone else.
This downright miraculous news should be enough to create a moral imperative for fair access to treatment around the world. However, the speed in the development of new drugs was not matched by a similar speed to ensure that everyone could have access to them, with treatment out of the reach of the world’s poor.
A decade after ART was first available, we arrived at the public health version of the holy grail: the knowledge that it is as effective in preventing HIV as it is in treating it. In 2006, a group of Swiss experts argued for the first time a controversial position that is now wise: effective HIV medication means that a person soon reaches a point where the amount of the virus in the blood is so low that it is undetectable , after which they are not infectious and cannot transmit it. In the UK in 2019, the virus was undetectable in the blood of 89% of all living with HIV, and they couldn’t transmit it.
However, despite the overwhelming public health good that access to HIV treatment provides, it is far from equally available worldwide. Governments and non-governmental actors, driven by powerful HIV activism and the devastating impact of a pandemic, finally ensured that cheaper generic versions of HIV drugs were available to the world’s poorest countries. But not before HIV and AIDS overwhelmed the health systems of many countries in Africa. It is a sign of shame that while HIV was a death sentence before 1996 and increasingly treatable thereafter, deaths peaked in 2004-5. Such a disaster was only possible because of deep global inequalities in healthcare.
It’s as simple as this: if we had to treat all the people who have HIV in the world, there would be no more HIV to transmit. We have known it for 15 years. We have had the treatment and the knowledge, but neither the international will nor the necessary resources. It was easy for international investment in HIV to fall as the epidemic faded from the headlines and from the public eye. And the result? In 2019, 1.7 million people contracted HIV worldwide, of which around one million live on the African continent and 65,000 in Europe and North America combined. Everything can be prevented.
The global fight against HIV has taught us to fight a pandemic. The more HIV treatment that is available, the better people’s health, the fewer people will be able to transmit the virus and consequently, the fewer people will be able to contract it. This is the kind of virtuous circle that should inform all public health responses, including those to Covid-19.
In the race to vaccinate the population before new vaccine-resistant variants of Covid-19 take hold, a national approach ignores how pandemics actually play out in a globalized world. The speed with which the virus spread across the continents in early 2020 demonstrates this perfectly. Unless we take an international approach to vaccination, coordinate the launch of a vaccine on all continents at the same rate, and pool resources to make it possible, we are doomed to fail. We must start celebrating each vaccination with the same sense of success and hope, whether it takes place in the UK or in any other country in the world. The alternative, in which we vaccinate the UK population while large parts of the world remain unvaccinated, is both an inexcusable moral failure and a miscalculation that will inevitably lead to new variants of Covid-19 re-entering the UK. .
The Covid-19 framing has been wrong from the start. A pandemic is not a classification table. Vaccinating the population faster than in other countries should not be a source of pride. Instead, it is evidence of a global failure to understand the very nature of a pandemic: an act of massively short-sighted self-harm. Let’s not regret this failure in a generation. It is not too late to change course.
• Deborah Gold is Executive Director of National AIDS Trust
George is Digismak’s reported cum editor with 13 years of experience in Journalism