{"id":49716,"date":"2021-03-01T11:48:22","date_gmt":"2021-03-01T10:48:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49716"},"modified":"2021-03-04T17:06:21","modified_gmt":"2021-03-04T16:06:21","slug":"to-end-covid-19-we-must-end-discrimination-and-inequality","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/01\/to-end-covid-19-we-must-end-discrimination-and-inequality\/","title":{"rendered":"To end covid-19, we must end discrimination and inequality"},"content":{"rendered":"<p class=\"standfirst\">We have seen before how inequalities prolong crises, writes Mandeep Dhaliwal, which is why all countries must help to end this pandemic for everyone, everywhere<\/p>\n<p><!--more--><span style=\"font-weight: 400\">Six years ago, 193 countries committed to <\/span><a href=\"https:\/\/www.un.org\/sustainabledevelopment\/inequality\/\"><span style=\"font-weight: 400\">reduce inequalities<\/span><\/a><span style=\"font-weight: 400\">, including a target to ensure equal opportunity by eliminating discriminatory laws, policies, and practices as part of the sustainable development goals and the pledge to leave no one behind.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite this pledge, the effects of widespread discrimination continue to play out in real time, harming people\u2019s health and human development. Covid-19 is exposing and deepening existing inequalities, and disproportionately impacting marginalized and vulnerable communities that are, too often, left without access to critical tools and services. Unless this changes, the world will not be free of covid-19 and its devastating consequences. Put simply, this pandemic won\u2019t be over anywhere until it\u2019s over everywhere.<\/span><\/p>\n<p><b>Countries with weak systems for health are being left behind<\/b><\/p>\n<p><span style=\"font-weight: 400\">The fact that vaccines are being rolled out a year after the virus first emerged is a scientific triumph, but the very nature of this rollout reveals stark inequities. Nearly <\/span><a href=\"https:\/\/www.npr.org\/sections\/goatsandsoda\/2021\/02\/14\/966418960\/you-think-the-u-s-has-vaccine-issues-130-countries-havent-even-started-vaccinati\"><span style=\"font-weight: 400\">130<\/span><\/a><span style=\"font-weight: 400\"> nations <\/span><a href=\"https:\/\/www.nytimes.com\/2021\/02\/24\/world\/ghana-covax-vaccine.html\"><span style=\"font-weight: 400\">have yet to receive<\/span><\/a><span style=\"font-weight: 400\"> a single covid-19 vaccine dose, with <\/span><a href=\"https:\/\/apnews.com\/article\/ghana-first-covax-vaccine-f8058eed5b2935d1d22931ef321e807b\"><span style=\"font-weight: 400\">Ghana<\/span><\/a><span style=\"font-weight: 400\"> and<\/span> <a href=\"https:\/\/www.unicef.org\/press-releases\/c%C3%B4te-divoire-becomes-second-african-country-and-first-french-speaking-country\"><span style=\"font-weight: 400\">C\u00f4te d&#8217;Ivoire<\/span><\/a><span style=\"font-weight: 400\"> just beginning to receive their first shipments. It&#8217;s estimated that poorer countries will only be able to vaccinate <\/span><a href=\"https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/act-accelerator\/covax\/covax-interim-distribution-forecast.pdf?sfvrsn=7889475d_5\"><span style=\"font-weight: 400\">3% of their populations through Covax<\/span><\/a><span style=\"font-weight: 400\"> by the end of the first half of 2021. According to current projections, Africa and Latin America will likely be unable to achieve widespread vaccination <\/span><a href=\"https:\/\/www.wsj.com\/articles\/faltering-covid-19-vaccine-drive-in-developing-world-risks-prolonging-pandemic-11613557801\"><span style=\"font-weight: 400\">before 2023 or 2024<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Delaying access to vaccines will have serious health and development consequences for low and middle income countries (LMICs). Twenty one countries in Africa now have case fatality rates that are <\/span><a href=\"https:\/\/apnews.com\/article\/africa-100k-coronavirus-deaths-2afd198dccff5f62f0eaa01da501956e\"><span style=\"font-weight: 400\">higher than the global average<\/span><\/a><span style=\"font-weight: 400\">, and that\u2019s often due to overstretched and under-resourced systems for health. As the director of the Africa Centers for Disease Control and Prevention, John Nkengasong, puts it: \u201cPeople are dying because of a lack of basic care.\u201d Other, entrenched public health issues threaten to compound the situation: just as the west Africa region works to fend off a second wave of covid-19, Guinea has now officially declared that it\u2019s also dealing with a new <\/span><a href=\"https:\/\/fortune.com\/2021\/02\/16\/ebola-outbreak-west-africa-covid-2021\/\"><span style=\"font-weight: 400\">Ebola outbreak<\/span><\/a><span style=\"font-weight: 400\"> that has already claimed five lives.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Similarly, the covid-19 pandemic has set the global AIDS response back even further. As just one example, the scale-up of HIV treatment was <\/span><a href=\"https:\/\/www.unaids.org\/en\/resources\/presscentre\/featurestories\/2020\/november\/20201130_hiv-treatment-target-for-2020-to-be-missed\"><span style=\"font-weight: 400\">50% lower in the first half of 2020<\/span><\/a><span style=\"font-weight: 400\"> than in the first half of 2019.<\/span><\/p>\n<p><span style=\"font-weight: 400\">These inequities impact us all.<\/span> <span style=\"font-weight: 400\">Unequal vaccine distribution could allow the pandemic to spread relatively unchecked in resource poor countries that must contend with multiple, overlapping crises, <\/span><a href=\"https:\/\/www.wsj.com\/articles\/faltering-covid-19-vaccine-drive-in-developing-world-risks-prolonging-pandemic-11613557801\"><span style=\"font-weight: 400\">slowing overall global economic recovery and prolonging the pandemic<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><b>We have seen before how inequalities prolong crises<\/b><\/p>\n<p><span style=\"font-weight: 400\">Inequalities, fueled by stigma and discrimination, have for decades obstructed proven solutions in HIV prevention and treatment. For example, at least <\/span><a href=\"https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2020_global-aids-report_en.pdf\"><span style=\"font-weight: 400\">92 countries<\/span><\/a><span style=\"font-weight: 400\"> still criminalize HIV transmission, exposure, or nondisclosure, and at least <\/span><a href=\"https:\/\/www.unaids.org\/en\/resources\/presscentre\/pressreleaseandstatementarchive\/2020\/december\/20201214_bhutan-law\"><span style=\"font-weight: 400\">68 countries<\/span><\/a><span style=\"font-weight: 400\"> and territories criminalize consensual same-sex sexual relations, exacerbating stigma in such a way that hinders key populations\u2019 access to prevention and care. Research shows that punitive laws and discriminatory policies <\/span><a href=\"https:\/\/hivlawcommission.org\/wp-content\/uploads\/2017\/06\/FinalReport-RisksRightsHealth-EN.pdf\"><span style=\"font-weight: 400\">fuel HIV transmission<\/span><\/a> <span style=\"font-weight: 400\">among key populations, which includes people living with HIV, gay men and other men who have sex with men, sex workers, transgender people, people who use drugs, and people in prisons and other closed settings.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The covid-19 pandemic and accompanying response measures are also compounding inequities for marginalized groups, particularly in LMICs, disrupting access to HIV and other services and threatening decades of progress. Women and key populations, for example, are reporting an <\/span><a href=\"https:\/\/www.undp.org\/content\/undp\/en\/home\/librarypage\/hiv-aids\/HIV-Health-and-Development-Annual-Report-2019-2020.html\"><span style=\"font-weight: 400\">elevated risk<\/span><\/a><span style=\"font-weight: 400\"> of domestic and family violence, increased social isolation, and difficulties accessing HIV and health services.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Typically, marginalized communities in high income nations have not been spared either: a <\/span><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/70\/wr\/mm7005a1.htm?s_cid=mm7005a1_w\"><span style=\"font-weight: 400\">new report<\/span><\/a><span style=\"font-weight: 400\"> from the US Centers for Disease Control and Prevention<\/span><span style=\"font-weight: 400\"> confirms that gay, lesbian, and bisexual people experience stigma and discrimination in their lives that \u201ccan increase vulnerabilities to illness and limit the means to achieving optimal health and wellbeing,\u201d leading to higher covid-19 risks overall.<\/span><\/p>\n<p><b>We need global solidarity to support strong systems for health, for everyone<\/b><\/p>\n<p><span style=\"font-weight: 400\">Ensuring that discriminatory laws, policies, practices, and inequalities do not hinder lifesaving tools from reaching all who need them requires strong systems for health and inclusive governance built on trust. <\/span><a href=\"https:\/\/www.devex.com\/news\/opinion-lessons-from-the-hiv-epidemic-can-teach-us-resilience-in-the-face-of-covid-19-97926\"><span style=\"font-weight: 400\">As with HIV<\/span><\/a><span style=\"font-weight: 400\">, covid-19 responses should be grounded in data, evidence, and human rights, and communities are central to ensure people have continued access to the services they need to survive.<\/span><\/p>\n<p><span style=\"font-weight: 400\">That is why in July 2020 the United Nations Development Programme (UNDP), World Health Organization, UNAIDS, and the O\u2019Neill Institute <\/span><a href=\"https:\/\/www.unaids.org\/en\/resources\/presscentre\/pressreleaseandstatementarchive\/2020\/july\/20200722_covid19-law-lab\"><span style=\"font-weight: 400\">launched the COVID-19 Law Lab<\/span><\/a><span style=\"font-weight: 400\"> to support evidence and rights based legal frameworks for covid-19 responses. It is also why UNDP and the Global Fund work with community led organizations, <\/span><a href=\"https:\/\/undp.medium.com\/living-through-lockdown-dfdf94972daa\"><span style=\"font-weight: 400\">such as those in Panama<\/span><\/a><span style=\"font-weight: 400\">, to ensure marginalized groups have access to HIV services during covid-19.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But there is still much more to be done\u2014we need to walk the talk on global solidarity to prevent millions more deaths. It is critical that countries increase funding and support for international cooperation. We must marshal the full strength and capacity of the multilateral system to deliver equity\u2014now.<\/span><\/p>\n<p><span style=\"font-weight: 400\">On this <\/span><a href=\"https:\/\/www.unaids.org\/en\/2021_ZDD_campaign_end_inequalities\"><span style=\"font-weight: 400\">Zero Discrimination Day<\/span><\/a><span style=\"font-weight: 400\">, all countries must bring the pledge to leave no one behind to life by investing in strong systems grounded in data and equity to help those most in need, and to help end this pandemic for everyone, everywhere.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Mandeep Dhaliwal<\/strong> is the director of HIV, health, and development at the United Nations Development Programme. Twitter <\/span><\/i><a href=\"https:\/\/twitter.com\/Mandeep_Dh\"><em><span class=\"css-901oao css-16my406 r-poiln3 r-bcqeeo r-qvutc0\">@Mandeep_Dh<\/span><\/em><\/a><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We have seen before how inequalities prolong crises, writes Mandeep Dhaliwal, which is why all countries must help to end this pandemic for everyone, everywhere [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/01\/to-end-covid-19-we-must-end-discrimination-and-inequality\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":419,"featured_media":49717,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-49716","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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