As Papua New Guinea stands on the edge of the precipice of an unchecked Covid-19 outbreak, and other Pacific island nations face economic devastation trying to keep the virus from their shores, health professionals have warned the broader health impacts of the fight against the novel coronavirus could be as devastating as the virus itself.
Efforts to combat endemic diseases such as tuberculosis, HIV/Aids, and malaria could be derailed by counter-Covid measures, dramatically increasing deaths across the developing world, a study published in the Lancet has found.
“In developing countries, in circumstances of crisis, the indirect effects are far worse than the direct effects. There’s no doubt that will be the case with Covid-19,” Professor Brendan Crabb, chief executive of the Burnet Institute and chair of Pacific Friends for Global Health, told the Guardian.
The Pacific region has – so far – successfully prevented a widespread outbreak of Covid-19, with low infection numbers and few deaths.
But there remain widespread fears that if the virus were to gain a significant foothold in the region it could devastate island communities, which have limited public health infrastructure, and populations with high rates of comorbidities.
While Melanesia’s largest nation Papua New Guinea has recorded only 63 cases, 52 of those – more than 80% – have been in the last two weeks. The capital Port Moresby, where tens of thousands live in crowded, unofficial settlements, has been forced back into lockdown in an effort to arrest the spread, with a curfew enforced and face-masks mandated.
Health authorities concede testing regimes are weak and the country’s health system could soon be overrun. “It would take a small miracle to keep a lid on it in PNG,” Crabb, an infectious diseases specialist, told The Guardian.
Port Moresby general hospital – the country’s largest – has launched a public appeal asking for donations of face masks, gloves, protective face shields, and hand sanitiser. The hospital is even asking for pillowcases, blankets, mattresses and laundry detergent.
Public health systems across the Pacific are fragile and were already at or near full capacity pre-coronavirus. Now they face being overwhelmed if cases break out across island nations. Existing healthcare may be compromised or abandoned if Covid-19 counter-measures need to to be prioritised.
“If you have a system that is already running at capacity, already stretched, any sort of assault on that system, an economic assault or a disease like Covid, it becomes impossible to deliver what you were,” Crabb said.
Crabb cited HIV, tuberculosis, and malaria as specific illnesses whose treatments will be interrupted by Covid-19 counter-measures. But he said more broadly, sexual and reproductive health services will suffer, as well as child and maternal health services, and treatment for gender-based and family violence.
“We have systems that are incredibly fragile, and anything that comes in to upset those systems, like Covid, is not only bad in and of itself, but will have a knock-on effect onto the health system more generally. We will see those situations get dramatically worse.”
A study published in the Lancet medical journal found deaths due to malaria in countries where the disease was prevalent could increase by up to 36% over five years, because of interruptions to net campaigns and other interventions.
HIV deaths could rise 10% because of poorer access to antiretroviral drugs, and tuberculosis deaths could increase by 20% because of interruptions to diagnosis and treatment.
“These disruptions could lead to a loss of life-years over five years that is of the same order of magnitude as the direct impact from Covid-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics.”
Crabb said it was incumbent upon Australia, and other wealthy countries on the Pacific Rim, to assist neighbouring island states as they also faced the threat of economic ruin.
“We must see this happening, and not let it happen, the consequences are a huge increase in suffering and poverty. This could bring fragile countries to their knees. States that are close to failed states, that’s clearly the potential, it doesn’t take too much of a disruption to turn our region into a highly insecure place.”
Tourism- and import-dependent economies across the Pacific face potential collapse from Covid-19 economic and travel shutdowns. The pandemic is the “job-killer of the century”, Fiji’s prime minister said.
Tim Costello, executive director of Australia church group Micah, said Australia needed to increase its aid commitment to help the Pacific deal with the health, social and economic challenges exacerbated by Covid-19, citing UN estimates which said an economic contraction of 20% would push an additional 1.2m people in the Pacific and Timor-Leste into extreme poverty - an increase of over 40% on pre-Covid-19 levels.
Costello said with absolute poverty defined as living below $1.90 a day, Australia needed to act: “20% of that population pushed into absolute poverty, sub-Saharan African levels of absolute poverty on our doorstep”.