Efforts to mitigate the economic impact of the COVID-19 pandemic: potential entry points for neglected tropical diseases – Infectious Diseases of…

Global efforts

The determinants and risk factors behind COVID-19 and countless other communicable and non-communicable diseases lie well beyond the purview of the health sector alone [24]. Possible synergies between COVID-19, non-health sector, and NTDs prevention and control programmes were explored in a previous piece, stressing the need for well-defined programmes that will set the stage for a multi-sectorial approach [23].

Many countries failed to respond effectively to COVID-19, a fact that calls for a transformation of their surveillance and public health response systems in a post-COVID-19 world. Thus, investments in such systems should top the list of priorities of the major development and economic recovery initiatives. However, health services and integrated disease surveillance-response systems will need to undergo profound changes in order to find more effective ways of coping with future emerging and re-emerging diseases, epidemics, and pandemics. NTD control programmes should actively participate in defining innovative integrated surveillance-response systems, as they cannot afford to be left behind yet again [25].

According to the World Bank, the immediate priority for policy-makers should be to address the health crisis and contain the short-term economic damage [26]. Preserving the financial sector will be key towards promoting recovery as a well-functioning financial system can help firms stay alive and ultimately retain jobs. Sustaining economic activity is expected to free up funds to support the health system.

The World Bank committed early in the COVID-19 crisis to providing important additional financial resources for the worlds poorest countries. In a press release dated April 2, 2020 [27], the World Bank stated that it would be prepared to deploy up to USD 160 billion over the next 15months to help countries respond to the COVID-19 pandemic and support economic recovery. A USD 12 billion fast-track package (in the form of low interest loans and grants) was announced to strengthen the COVID-19 response in LMICs and shorten the time to recovery [28] (Figs. 2, 3). Strengthening health systems is among this initiatives top priorities. As part of this funding, interventions ranging from laboratory rehabilitation to equipping health centres with WASH infrastructure can be supported. Another World Bank effort is the Health Emergency Preparedness and Response Multi-Donor Fund (HEPRF). The objective of this umbrella funding scheme is to help countries develop strong public health capacity, including preparedness, disease surveillance, laboratory and diagnostic capacity, human resources, as well as emergency response operations [29]. The World Bank statement does not specify any amounts as it is waiting for pledges to be made by donor countries. Japan has already expressed its intention to become the founding donor of the new HEPRF [29].

World Bank Fast Track Package COVID-19 response per region. Thus far, USD 1.5 billion have been earmarked [27]

COVID-19 Global EU response per region. Current allocation of EUR 5.55 billion per region so far [31]

The United Nations Development Program (UNDP) leads the UNs socio-economic response to the COVID-19 pandemic [30]. For its work, the agency relies on a network of over 3100 partners. A total of 52 countries are contributors to UNDPs core budget in 2019. UNDP is working with over 50 governments across the world on Integrated National Financing Frameworks (INFFs) to align the COVID-19 response with the Sustainable Development Goals (SDGs). At the outset of the COVID-19 pandemic, in March 2020, UNDP presented a 3- to 6-month response budget of USD 500 million covering three thematic areas: (i) health systems support (USD 150 million); (ii) inclusive and integrated crisis management and response (USD 250 million); and (iii) social and economic impact needs assessment and response (USD 100 million). Whether donors and partners will live up to these expectations remains to be seen.

The European Union (EU) is the largest international donor, providing about 57% of the total global development assistance, while accounting for only a fifth of the global economy. The EU reacted swiftly to assist LMICs in their response to the COVID-19 pandemic [27], allocating EUR 15.6 billion with an emphasis on Africa (EUR 3.25 billion) (Fig.3). Three priority areas have been identified: (i) emergency response; (ii) research, health, and water systems to combat the spread of coronavirus; and (iii) addressing the socio-economic consequences of the COVID-19 crisis, including, in the longer-term, support for a recovery phase [31].

Team Europe is another EU response to COVID-19 supporting the most vulnerable and fragile populations in LMICs and conflict zones [32]. It targets primarily the informal sector of society, with a focus on Africa. Together, the European Commission, the European External Action Service, EU Member States, and financial institutions are launching a EUR 20 billion package to combat the COVID-19 pandemic and its consequences. The package combines resources from existing programmes (EUR 11 billion) with support from financial institutions such as the European Investment Bank and the European Bank for Reconstruction and Development (EUR 5 billion), and from EU Member States (EUR 4 billion).

The Asian Development Bank (ADB) announced a USD 20 billion package (in the form of loans, grants, and technical assistance) to address the needs of its LMIC members as they respond to COVID-19 [33]. Thus far, approximately USD 4.6 billion have been earmarked. Priorities include health and economic measures ranging from strengthening governments alert and response capacities to addressing the COVID-19 pandemics economic and financial impact, and supporting various government measures targeted at poor people and vulnerable groups affected by COVID-19 through the loss of jobs and out-of-pocket health care expenditures. Eleven countries have already benefitted: Indonesia, the Philippines, and India are targeted to receive USD 1.5 billion each in sovereign projects [33].

The Asian Infrastructure Investment Bank (AIIB), of which the Peoples Republic of China is the largest shareholder, created a USD 5 billion crisis recovery fund to support countries and businesses during the COVID-19 pandemic. With a recent capital injection, this programme can be tailored to respond to local needs [34].

Other initiatives are considerably smaller but nevertheless relevant. A case in point is the European Institute of Innovation and Technology (EIT). It will make available EUR 60 million for entrepreneurs under the EIT Crisis Response Initiative to support 44 countries (Israel, Turkey, and 42 EU and Non-EU European countries) [35] in the launch of new innovation projects to tackle COVID-19 related challenges. A total of EUR 9.85 million are earmarked for health.

The Center for Global Development recently published an analysis on how international development agencies are responding to the COVID-19 crisis [14]. Included in the analysis is a WHO appeal for an estimated USD 675 million for a COVID-19 Preparedness and Response Plan, which saw donors pledge and commitment of around USD 320 million to date. The WHO also tracks partner funding and has already identified EUR 7.4 billion earmarked for COVID-19 response funding from 79 donors [36].

Development agencies are molding their aid packages according to their Governments priorities. The German Federal Ministry for Economic Cooperation and Development (BMZ) is funding a EUR 1 billion emergency COVID-19 support programme targeting seven areas, with health and pandemic control heading the list (EUR 200 million) [37].

The speed and scale of the response required by the COVID-19 pandemic highlighted how the fragmentation in current health systems significantly impaired our ability to respond effectively in times of crises. Fragmentation leads to duplication, inefficiencies, poorer outcomes, and an unsatisfactory experience of care. There is growing evidence that integration of services in the health system and across sectors increases the resilience of systems [38, 39]. Until recently, integration efforts have tended to focus on improving coordination between primary and secondary care, or on strengthening relationships between health and social services. It is now widely recognized that social determinants, such as housing, education, employment, and social connectedness have a greater impact on health and well-being than health and care services [40]. The focus is starting to shift towards integrating health and care with a much broader range of services, rooted in communities strengths, and needs. This is known as integrated community care (ICC). The importance of ICC is reflected in the WHOs vision for primary health care that is based on three pillars: (i) an integrated health service delivery system; (ii) active community participation; and (iii) actions addressing broader social determinants of health [41].

The evidence shows integration works best when aimed at people with severe, complex, and long-term needs [42, 43]. It offers a new opportunity for managing morbidity and long term disabilities in the community, through greater coordination between health, social and community care. This is something that has not yet gained wide attention from the NTD community, and yet it may be worth exploring through further research. Perhaps even mass drug administration (MDA) campaigns related to some NTDs would benefit from integration with other activities beyond drug delivery [44]. Disease control programmes are part of complex health systems [45] and as such creating parallel funding, planning cycles, and additional reporting and data information systems need to be avoided [46].

ICC as a way to strengthen health systems and achieve Universal Health Coverage (UHC) would arguably make countries more resilient to shocks such as COVID-19, but whether these initiatives garner sufficient support from the main stakeholders and decision makers remains to be seen. This is particularly relevant in resource-constrained settings, which also harbour the very same highly vulnerable population groups most affected by NTDs [47]. NTDs may impose a considerable economic and social burden on individuals, families, and households, often related to loss of productivity but also abandonment of agricultural land due to morbidity, disability, and stigma [48, 49]. In addition, there are the direct costs of diagnosis and treatment and, even if diagnostics, drugs, and vaccines are offered free of charge, direct nonmedical costs such as transportation and accommodation which can easily add up to 20% of annual household income, propelling a previously stable household into an untenable debt [48]. It is ultimately the decision of the governments of endemic countries to make UHC including NTDs a domestic policy priority. To be effective, NTD control needs to be part of the national health plans and budgets and, ideally, also feature in those of other sectors [50].

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Efforts to mitigate the economic impact of the COVID-19 pandemic: potential entry points for neglected tropical diseases - Infectious Diseases of...