The University of the West Indies, HEU, Centre for Health Economics, International AIDS Economic Network (IAEN), and the Pan Caribbean Partnership against HIV and AIDS (PANCAP), invite you to participate in a virtual discussion on “The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response”, Wednesday, 21 July 2021 from 9:00 AM – 11:00 AM Eastern Time.
Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
On Tuesday, the global death toll attributed to the coronavirus topped one million people. The largest share, by an order of magnitude, was reported from the USA. This bleak milestone has been extensively covered by the worlds’ media. However, in terms of the daily number of confirmed cases there seems to be a plateau, or at the very least, the numbers are not rising as rapidly. To put Covid-19 into perspective, in 2017 there were 620,000 deaths from malaria, 794,000 from suicide and 954,000 from HIV and AIDS.1 This is the greatest death toll from a pandemic for centuries.
In this blog I want to turn to, and revisit, some fundamental issues:
- How many coronavirus cases have there been?
- How many of the cases matter and how much?
- What does excess mortality look like?
- One major concern has been the link between HIV and Covid-19. It seems there is some clarity on this – and good news, as discussed in a special section.
- Finally, in the conclusion, I ask what is the impact of the virus?
The reason for this revisit is because of the way data are portrayed. Each evening in the UK we are informed by newsreaders of the number of new cases and the number of deaths. One graph shows the new cases recorded since the epidemic began. At first sight is deeply concerning, there are far more new cases reported at present than there were in April at the height of the pandemic. On the 25th September there were 6,878 new cases, well above the previous peak of 5,505 on the 22nd April. It should be noted this is data for the United Kingdom, it can be disaggregated for the four nations: England, Scotland, Wales and Northern Ireland.
This pattern is seen in several other European countries. How concerned should we be? There is a sense of real worry because the northern hemisphere is entering the winter, and no one is quite sure what this means. Normally there will be many respiratory illnesses and indeed with schools having reopened and students returned to university, (where many students are now, unbelievably, locked in)2 there is a sense that there will be an inevitable increase in cases. At the same time, the number of deaths and hospitalisations has fallen dramatically and may well remain low.
This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.
The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.
I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.
The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.
The second edition of HIV and AIDS: A Very Short Introduction, by Alan Whiteside, has just been published by Oxford University Press.
HIV/AIDS: A Very Short Introduction provides an introduction to AIDS—the most serious human epidemic in centuries—tackling the science, politics, demographics, and devastating consequences of the disease. The first case was identified in 1981; by 2004 approximately forty million people were living with the disease, and about twenty million had died. The outlook today is a little brighter. Although HIV/AIDS continues to be a pressing public health issue, the epidemic has stabilized. The worst affected regions are Southern and Eastern Africa. Elsewhere, HIV is found in specific, often marginalized populations. Although there remains no cure for HIV, there have been unprecedented breakthroughs in understanding the disease and developing drugs
You can find out more on the Oxford University Press website.
WATERLOO – Laurier professor Alan Whiteside is providing his extensive expertise in HIV and AIDS research to lead a training and mobilization project advocating for African-led scholarship. Whiteside will be the lead researcher on a grant to Laurier from the Bill & Melinda Gates Foundation to build research and publication capacity among African researchers. The grant will support Whiteside’s training and mobilization project advocating for African-led scholarship in support of the African Journal of AIDS Research.
I wish I knew a more productive way of writing than my current style. At the moment it seems that I allow deadlines to creep up on me, and then there is a period of frenetic activity before the article, blog, book or whatever is submitted. I never feel completely satisfied. This is hypocritical, given that the advice I give my students is: “done is good enough”. One thing that became clear over the last few weeks is that I do my best work with other people. I was very fortunate last month in that Gemma Oberth, whose Ph.D. I examined some years ago, and who now lives and works in Cape Town, asked if she could come and spend a period of time writing with me. She was visiting her parents in Toronto and so it was a simple matter for her to travel up to Waterloo. (Having said that though, travelling from Toronto to Waterloo is never a simple matter, the traffic can be horrendous.) This was absolutely great. We were able to settle down, plan out an article, do the research, and actually get close to a final draft. We then exchanged versions over email and submitted it to a journal within a week of her departure. It now goes out to peer review and I will be interested to see what the reviewers think of it. Personally I found this method of writing to be easier than most.
Every academic establishment goes through the rewarding period of convocations when degrees are conferred on successful students. Wilfrid Laurier is no different, though here in Canada, there is a tendency for shorter ceremonies over a longer period. For about a week, there are two ceremonies a day, one in the morning and one in the afternoon. I was pleased to be invited to give the convocation address at one of the events. It is reproduced below. I spent a great deal of thought over it, trying to work out the pitch of the presentation, what was really important, and what the students might even recall. The addresses come before they have to walk across the stage and receive their degrees so I suspect most are not paying close attention. I hope you find it interesting. I was complimented by a couple of the students and their parents afterwards so at least I must have reached five or six people.
There are sparrows living in the terminal building at National Airport in Washington. Clearly they have found an ecological niche and are making the most of it. I don’t know if they spend all their time in there or if they manage to get in and out. This is the sort of question that I would ‘Google’, but I was unable to connect with the internet. I was too tired to do battle with the technology, especially since I had just 40 minutes before boarding my flight to Toronto. Instead I sat in the boarding area and contemplated. There was an elderly gentleman sitting in there playing snatches of music on a French horn. This was designed to keep the waiting passengers amused I think. Unfortunately he was not very good and did not play any piece for long enough. One of the gate staff walked over, plonked himself in an empty wheelchair next to me, and gently rolled himself back and forth in time to the music while texting furiously. These are the vignettes of the departure gate.
There are many places in Ontario named after English towns. Not far from Waterloo, there is a Norwich and down the road, the small town of Stratford hosts, perhaps predictably, an excellent Shakespeare festival. The other day I told a colleague I needed to leave the meeting we were at: I was travelling to London.
“Oh”, she responded, “So am I”.
The difference was she had to drive for an hour while my journey was to Pearson Airport, Amsterdam, and a connection to Heathrow.
Since the first case of Ebola appeared last year, the virus has infected nearly 10,000 people. The epidemic is concentrated in Liberia, Sierra Leone, and Guinea — post-conflict countries with incredibly weak health systems. It stands to have severe health, social, and economic consequences and is arguably the most pressing challenge to global health security the world has faced in decades.