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Though HIV and Sars-CoV-2 are very different viruses, the Covid-19 pandemic has highlighted striking parallels: governments being too slow to respond; a marked impact on minority communities and a failure to understand why; a governmental response which has veered into overpolicing and victim-blaming, rather than taking every conceivable measure to help people stay safe and healthy. I watch with growing consternation as the world repeats the mistakes of the early response to HIV.
Stories of vaccine nationalism fill the headlines, while Boris Johnson celebrates the UK having vaccinated more people than the rest of Europe combined. By the middle of January, just 25 doses of the Covid-19 vaccine had been administered across all poor countries in the world, compared with 39m in wealthier ones.
In the mid-1990s, effective treatment for HIV, antiretroviral therapy (ART), was discovered and the trajectory of the pandemic was transformed in ways predictable and entirely unpredictable. For the first decade or so, ART saved the lives of millions of people around the globe – even those ill with late-stage HIV could find themselves up and out of wards within weeks. Treatment science improved to such a degree that now, for many, HIV medication means as little as one pill a day with no significant side-effects. A person living with HIV who is diagnosed in good time and has swift access to treatment can live as long as anyone else.
This frankly miraculous news should be enough to create a moral imperative for fair access to treatment worldwide. However, the speed in developing new medications was not matched by a similar speed in ensuring everyone could get access to them, with treatment out of the reach of the global poor.
A decade after ART first became available, we hit the public health version of the holy grail: the knowledge that it is as effective at preventing HIV as it is in treating it. In 2006, a group of Swiss experts first argued a contentious position that is now received wisdom: effective HIV medication means that a person soon reaches a point where the amount of the virus in their blood is so low as to be undetectable, after which they are not infectious and cannot pass it on. In the UK in 2019, the virus was undetectable in the blood of 89% of all those living with HIV, and they could not pass it on.
Yet, despite the overwhelming public health good that access to HIV treatment provides, it is far from equally available worldwide. Governments and non-governmental actors, spurred on by powerful HIV activism and the devastating impact of a pandemic, eventually ensured that cheaper generic versions of HIV medication became available to the world’s poorest countries – but not before HIV and Aids had overwhelmed the healthcare systems of many countries in Africa. It is a mark of shame that while HIV was a death sentence before 1996 and ever more treatable thereafter, deaths peaked in 2004-5. Such a disaster was only possible due to deep global inequalities in healthcare.
It’s as simple as this: if we were to treat everyone across the world who has HIV, there would be no more HIV to pass on. We’ve known this for 15 years. We’ve had the treatment, and the knowledge, but neither the international will nor the resources needed. It was easy for international investment in HIV to fall as the epidemic fell off the front pages and out of the public eye. And the result? In 2019, 1.7 million people acquired HIV worldwide, of whom around a million live on the continent of Africa, and 65,000 in Europe and North America combined. All of it preventable.
The global fight against HIV has taught us how to fight a pandemic. The more HIV treatment is available, the better people’s health, the fewer people who are able to pass the virus on, and consequently the fewer people who acquire it. This is the type 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 misses the way pandemics actually develop in a globalised world. The speed with which the virus spread across continents in early 2020 perfectly demonstrates this. Unless we take an international approach to vaccination, coordinating a vaccine rollout across every continent at the same rate, and pooling resources to make that possible, we are doomed to failure. We must begin to celebrate each vaccination with the same sense of success and hope, whether it takes place in the UK or any other country in the world. The alternative – in which we vaccinate the UK population while huge parts of the world remain unvaccinated – is both an unforgivable moral failure and a miscalculation which will inevitably lead to new variants of Covid-19 re-entering the UK.
The framing of Covid-19 has been wrong from the very start. A pandemic is not a league table. Vaccinating the population quicker than other countries should not be a source of pride. It is instead evidence of a global failure to grasp the very nature of a pandemic – a stupendously shortsighted act of collective self-harm. Let us not regret this failure in a generation. It is not quite too late to change course.
• Deborah Gold is chief executive of the National Aids Trust
Source: The Guardian
Keyword: ‘Vaccine nationalism’ echoes the disastrous mistakes made with HIV | Coronavirus