Rising from the COVID-19 crisis: Hopeful lessons from the fight against HIV

The role of leaders has never been more key. The COVID-19 epidemic has caused a profound crisis. It is also providing an opportunity for leaders across the world to transform how we ensure people’s health. UNAIDS has been asked to share learning from four decades of experience in the AIDS response to help do so.

Today, millions of people, around the world, are alive and thriving because of the actions already taken to push back AIDS. Despite this, AIDS is not finished, nor can victory be assumed: today 25.4 million are on life-saving HIV treatment; 12 million more need to get on treatment. We are not on track, indeed, the COVID-19 epidemic threatens to knock progress on AIDS off course. We need to apply insights from the successes and the challenges in tackling AIDS. Doing so can help us overcome the COVID-19 pandemic; it can also enable us to finish the fight against AIDS, ensure the health and rights of all, and equip ourselves to manage the challenges to come.

Our experience from HIV and AIDS has provided many insights. Here are just six.  

Firstly, the power of collaboration. Pandemic responses require an approach that goes well beyond health. The most successfully strategies to support people living with HIV and to reduce new cases of HIV have involved multisectoral action across ministries, including on education, social protection, economic policy, law reform, and public information. Tackling COVID-19 will likewise require a whole-of-government approach, and a willingness to make radical changes to pre-existing ways of working. That collaboration needs to be international too. Solidarity across borders has been at the heart of progress in responding to HIV. No one ministry, and no one government can solve any pandemic alone.

Secondly, the power of community. Community-led responses have been critical to HIV response. The same holds for communities during the COVID-19 pandemic. They hold the key to flattening the curve, to supporting people impacted by the pandemic, to ensuring equal distribution of commodities and to ensuring recovery. We know that ultimate success will hinge on how we involve affected communities as part of governance and policy, service delivery, and monitoring and accountability.

In battling COVID-19, we need to harness the power of communities and support community-led responses by funding community organizations, designating community organizations as essential to the response, and ensuring the civic space to facilitate their potential. Boosted by the HIV response, strong community systems are in place in many countries. There is a skilled workforce that is already providing, or is fully ready to provide, community-led service delivery on COVID-19, as well as HIV, but they need to be paid fairly. There is a need also for governments to change national policies that prevent communities realizing their full potential due to lockdown practices, restrictive social contracting policies and constraints on their operations.

Thirdly, the importance of rights. Many countries’ initial HIV responses were top-down and rights-disregarding. In too many cases, the same mistakes which were made in the earliest damaging days of HIV are being remade in response to COVID-19. The HIV response only started to win once rights and voice were put at its heart. Building on the lessons learned in the HIV response, UNAIDS has supported the work of human rights defenders in all regions to ensure that the rights of everyone are fulfilled in the COVID-19 response. We have provided joint guidance and policy and material support on rights. Aspects of these lessons have already successfully been applied in some COVID-19 responses, though there is still a great deal of catching up to do. We need to ensure that the rights of everyone, especially the most marginalized and vulnerable, are respected, protected and fulfilled, including by putting an end to criminalization. We will beat AIDS, and we will beat COVID-19, while — and indeed by — valuing the rights and dignity of every person.

Fourthly, life-saving science as a public good. In pushing back AIDS, it was the mass production of medicines by generic manufacturers, and assertiveness by developing countries in using them, which unblocked the twin obstacles of prices that had been much too high and volumes that had been much too low. We have aimed high on realising everyone’s right to the fruits of the best science in fighting AIDS, and have not accepted business as usual.

Now, as we face COVID-19, leaders, experts, and civil society organisations from across the world have united in a call for a People’s Vaccine. There needs to be prior international agreement that any vaccines and treatments discovered for COVID-19 will be made available to all countries, making it impossible for any single company or country to monopolize them. This will enable the multilocational simultaneous mass production required to ensure that new vaccines are produced at the speed and scale that will be needed. Developing countries must not be priced out or left standing at the back of a pharma queue.

The normative argument has been won, but the success remains at risk from backdoor deals between countries and pharmaceutical companies. It is vital to maintain a collective approach. This is not just a case of it being the right thing to do, it is also ultimately in everyone’s enlightened self-interest too: pandemic vaccines and treatments depend on mass use, so no one is safe until everyone is safe.

Fifthly, universal health care as an investment that we can’t afford not to make. We have seen with HIV how removing financial barriers to accessing prevention, treatment and care has been key to enabling huge progress in usage, and that the costs of tackling threats to health are much less than the costs of not tackling them.

COVID-19 has highlighted again that health care is a shared investment that we all benefit from, and excluding anyone from health care hurts us all. Many countries have reported severe shortages of the necessary equipment, medicines, and human resources to tackle the threat of COVID-19. Now is the time to guarantee people’s health through stepped up national public investments in strong health systems. It is time too for ambitious international action to help facilitate the fiscal space needed, by raising not cutting aid, by going further on debt cancellation, and by carrying out ambitious tax reforms.

The costs of health cannot be left to individuals. Already every year, one billion people are blocked from healthcare by user fees. This puts everyone at risk: viruses can’t be contained if people can’t afford testing or treatment. It is everyone’s interest that people who feel unwell should not check their pocket before they seek help. As the struggle to control an aggressive coronavirus rages on, the case to end user fees in health immediately has become overwhelming.

Sixthly, crises as opportunities. Whilst it is often assumed that crises make bold actions impossible, the AIDS crisis taught that they can instead generate possibility. The AIDS crisis was the context in which countries like Thailand introduced universal healthcare, led a number of countries in every continent to repeal discriminatory laws, shifted norms on intellectual property, and spurred action on debt cancellation to free up vital resources. Amid the pain and fear, the COVID-19 crisis generates an opportunity for bold, principled, collaborative leadership to change the course of the pandemic and of society.

Like AIDS, COVID-19 necessitates bold action, but also provides the impetus for doing so. Like COVID-19, AIDS once seemed that it would overwhelm us forever. Our progress in pushing back AIDS gives us reason to hope. Conversely, the continuing challenges we face on HIV and AIDS, and the risk of progress being knocked off course, remind us that there is no quick fix.

The world’s leaders, working together across society, can beat both pandemics. But this will demand of leaders that we take politically difficult decisions that redress the structural inequalities which hold back all who have been economically or socially excluded; and it will demand too that we embrace a progressive multilateralism in which know-how is shared, investments in our common future are shared, and power is shared, too. The prize is a secure and prosperous society where all are safe, and where all belong. I am optimistic that together we will win