25 years of health gains lost in just 25 weeks of Covid-19

For decades, it seemed that people were getting richer and healthier, and it looked like the world was closer to eliminating certain diseases by 2030.

This was all before the world was hit by a pandemic, which seems to have undone all the efforts over the years.

In just 25 weeks, the Coronavirus has undone 25 years’ worth of work in the health sector. Lives have changed so much just as the world was about to celebrate decades of fighting and almost winning the war against certain diseases.

In its 2020 Goalkeepers report, the Bill and Melinda Gates Foundation finds that progress has not only stopped, but there has been regression in areas like getting people out of poverty and improving conditions for women and children around the world.

Vaccination coverage, seen as a good indicator for how health systems are functioning, is dropping to levels last seen in the 1990s, the report says.

The report further shows there was a drop in immunisation coverage and that in 2019, 84 percent of children worldwide had been vaccinated for diphtheria-tetanus-pertussis (DTP), a basic vaccination directly linked to reduction of childhood mortality. This year 70 per cent, or an estimated 14 million children around the world were vaccinated, meaning those who missed one or more doses of the vaccine will be at higher risk of mortality in coming years.

The pandemic has also set the world back on matters surrounding HIV transmission, malnutrition, gender equality, education and many more. Even if the world manages to get the coronavirus under control soon, it could take years to recover.

Vaccines 

The risk of outbreaks of vaccine-preventable diseases continues as the pandemic grows in many areas around the world and Kenya is no different. 

At the beginning of this year, Kenya’s immunisation programme was on a positive trajectory. The country was preparing to begin reducing its support from Gavi, the Vaccine Alliance, and fully self-financing its domestic vaccine purchases by 2027. 

To boost vaccination coverage, campaigns were launched for Human Papillomavirus (HPV), Measles-Rubella, Meningitis A, yellow Fever in high-risk counties of Baringo, Elgeyo Marakwet, Turkana and West Pokot, and Pneumococcal vaccine.

But, the efforts made were negated by Covid-19, which was first reported in the country March, due to disruptions to health services, including routine immunisation.

Perhaps the biggest setback for immunisation efforts in Kenya is the suspension of polio vaccination campaigns to focus on Covid-19. An announcement by the Global Polio Eradication Initiative (GPEI), the body that supports the vaccination in East Africa and the rest of the world, said it would divert its resources to the pandemic, leaving polio campaigns in Kenya in limbo.

According to a statement on its website, GPEI called on countries to postpone mass campaigns until June, after which the decision would be reviewed. This was to divert resources to “prioritise support for the response to Covid-19”.

Paediatric and infectious diseases specialist, Dr Christine Chege, said the healthcare disruptions caused by Covid-19 could have a devastating impact on child mortality.

Dr Chege, a lecturer at Kenyatta University, said the drop in vaccination will especially affect measles because it is highly infectious and the coverage needed to achieve herd immunity is over 90 per cent. 

“During the 2017 strike, we saw pockets of measles outbreak in the country and a longer interruption of vaccine programmes will reveal more. As Covid-19 has taken hold, it has been vital that immunisation efforts against measles continue,” she said.

HIV

Since the coronavirus has no cure, testing positive will require the immune system to battle the virus and win. Due to this, checking the spread of HIV in the country is paramount, given that Covid-19 weakens the immune system.

According to findings of the Kenya Population-based HIV Impact Assessment (Kenphia) 2018, the worst-hit counties are in western and northern Kenya: Homa Bay, Kisumu, Siaya, Migori, Busia, Turkana, and Kisii.

The study, conducted between June 2018 and February 2019, showed that Nyanza region had more HIV prevalence than the rest of the country. While the national HIV prevalence stood at 4.9 per cent, Nyanza was way above the average.

Kisumu stands at 17.5 per cent while Siaya and Migori are at 15.3 per cent and 13 per cent respectively, according to the report.

Despite this, Kenya has made great strides in the fight against HIV. The danger, however, is that a global scarcity of an antibiotic known as Septrin has driven fears of weakened immunity among patients, setting back efforts to end Aids by 2030. 

The stock-out has affected 1.6 million people with HIV in the country. Septrin is recommended for all HIV patients to ward off opportunistic infections including respiratory complications like pneumonia and is known to reduce susceptibility to malaria infections.

Mothers are also not going for clinics during the pandemic, putting even more children’s lives in danger. Dr Abdulkadir Abdullahi, a medical officer at the Kenyatta National Hospital obstetrics and gynaecology department, said women were going without a critical drug used to prevent mother-to-child HIV spread during birth. “Without it, we will have more newborns with HIV and that will undo all the gains made so far in the fight against HIV,” he said.

He, however, said all was not lost, and that the country could still recover just as it did after the strike in 2017, which would take time.

Dr Simon Kigondu, a gynaecologist in Muranga County, said the country can get back on track if there were concerted efforts. “There needs to be more effort by the government to recover from this by ensuring that 91 per cent of pregnant women with HIV have access to antiretroviral medicine to prevent transmission of the virus to their baby and also in preventing 11,000 new HIV infections among newborns,” he said.

Dr Kigondu said the country also has to do more on early infant diagnosis by ensuring that the percentage of HIV-exposed babies tested for HIV before eight weeks of age, is higher than 67.3 per cent, which was the case in 2018.

Malaria 

At the beginning of this year, the world celebrated a breakthrough in the treatment of deadly malaria. In what was seen as a game changer, scientists discovered a microbe that fully prevents mosquitoes from Plasmodium falciparum infection.

However, the celebrations have been dampened by a pandemic that has threatened to hit the already-fragile health systems and vulnerable populations in Kenya. This year’s World Malaria Day was unlike any other as decades of progress made in malaria tracking, diagnosis, treatment, prevention, and research stand to be lost.

The World Health Organization (WHO) has warned severe disruptions to insecticide-treated net campaigns and in access to antimalarial medicine could lead to a doubling in the number of malaria deaths in Africa this year compared to 2018.

The WHO modelling analysis shows that essential malaria control services have gone down during the Covid-19 period. "Under the worst-case scenario, in which all insecticide-treated net campaigns are suspended and there is a 75 per cent reduction in access to effective antimalarial medicine, the estimated tally of malaria deaths in sub-Saharan Africa in 2020 would reach 769,000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago," states the WHO.

The Economic Survey 2020 shows that malaria and diseases of the respiratory system collectively continued to be the leading causes of outpatient disease incidence, accounting for 39.9 per cent all incidence.

In Kenya, there are an estimated 3.5 million new clinical cases and 10,700 malaria-related deaths each year and the country has not taken stock of the damage of malaria during Covid-19, which means the number could be higher.

Experts have always said that ending malaria will save millions of lives, build resilient health and surveillance systems, and create a healthier, more equitable future that leaves no one behind.

Environment 

Face masks, personal protective equipment (PPE) such as gloves, face shields, protective goggles, hazmat suits and hand sanitisers are meant to save people from the pandemic. However, they now pose a great danger to people and the environment. 

Dumpsites in Nairobi and other major cities across the country tell a story of a struggle not only against an invisible enemy, but also medical waste.

Speaking in one of the Covid-19 daily briefings, Health Chief Administrative Secretary Rashid Aman said people were not correctly disposing of face masks and this was gradually becoming a health hazard.

He said the Health ministry had set guidelines on the disposal of face masks, which some people were ignoring.

These masks are non-biodegradable and will remain in the environment for a very long time to come, considering their production includes the use of plastics.

It is estimated that every year, some 13 million metric tonnes of plastics enter the oceans. Currently, around 150 million metric tonnes of plastics circulate in marine environments. The World Economic Forum estimates that by 2050 “there will be more plastics in the ocean than fish”.

Going forward, the National Environment Management Authority has said it will send officers to seal loopholes in medical waste management.

Gender-based violence

The restrictions imposed in response to the Covid-19 pandemic has made it harder for victims of gender-based violence to report abuse and seek help, and for service providers to respond efficiently. 

There were 8,416 sexual gender-based violence cases reported between January andJuly 2020 compared to 6,229 in the same period last year.The increase in cases is significantamong young girls between the ages of 10 and 17 years.

Sexual and other forms of violence against women have devastating consequences including injuries and serious physical, mental, sexual, and reproductive health problems. Victims also risk sexually transmitted infections, HIV, and unplanned pregnancies, which may lead to unsafe abortions or even death.

Health Chief Administrative Secretary Mercy Mwangangi said during an emergency such as the Covid-19 pandemic, women and girls are at particular risk of harm when social and structural support systems around them collapse.  

“Many face disintegrations of their families and other social networks and are susceptible to mental and physical trauma, malnutrition, disease, long-term disability, poverty, and especially violence from both intimate partners and other perpetrators. They often lose their livelihoods, educational opportunities, homes, and other assets. Additionally, like in Covid-19, there is a strain of health system infrastructure,” said Dr Mwangangi.

She added that prevention, preparedness, and resilience were increasingly recognised as crucial to equipping communities to avoid and respond to crises, endure their effects and get on the path to recovery. 

“For sexual and reproductive health, this means that it should be included in the primary healthcare system in addition to plans to address both risk reduction and emergency response and recovery,” she said.

Maternal health

The Coronavirus response is impacting the availability of essential health services, especially for pregnant women and newborns.

An analysis of data from the official weekly telegram-letter of the Ministry of Health showed an unusually high number of institutional maternal deaths reported in the East African region during the four weeks (Week 16 to Week 19) of the year, compared to data from the same period in 2019.

The Lancet has reported that during the Covid-19 pandemic, reductions in breastfeeding prevalence will plausibly occur due to limitations in the provision and use of health services and disruptions to the enabling environment.

It also reported that there will be limitations in the availability of skilled health workers and increased reluctance by women to visit hospitals, which could lead to lower coverage of antenatal care, postnatal care, and facility and community-based lactation support and counselling.

“Although some determinants of breastfeeding could be positively affected by the pandemic, we hypothesise that there is negative social, economic, corporate, and health-system forces affecting the mother's decision to breastfeed that should be considered,” the report shows.

The result is a decline in early initiation of breastfeeding, which is considered the child's first natural vaccine (colostrum)—and, in turn, exclusive breastfeeding.