How COVID-19 Fractured Medical Aid Delivery

 

COVID-19 has fundamentally changed our understanding of many aspects of health care, and offers us a different lens through which to view medical humanitarianism. The pandemic has had a significant impact on medical aid; going beyond the obvious financial implications of an economic crisis and extending to personnel, supplies, and disease control.

Foreign-aid budget cuts, due to the devastating economic impact of the pandemic, have created a massive funding deficit. The United Nations’ global COVID-19 humanitarian response plan is projected to cost 10.3 billion U.S dollars, of which only a fraction has been pledged so far. In the U.S. alone, funding for global health has mostly flattened since 2010, and the current administration’s proposed budget for 2021 aims to cut global health funding to its lowest levels since fiscal year 2008. The funding that does exist is suffering from delays in allocation that could be critically damaging in a crisis of this magnitude. Similarly, in the U.K. the global aid budget is expected to decrease by £2.9bn this year secondary to the economic impact of the COVID-19 crisis. Overall aid commitments from the largest government donors were $16.9 billion, which is significantly lower than the $23.9 billion within the same period last year.

As financial support declines, the overall need for assistance has increased exponentially.  The United Nations expects 1 in about 45 people in the world to need humanitarian assistance- the highest figure in decades. As migrant workers are laid off due to shutdowns, global remittances, essential to developing countries, and in some cases exceeding the amount of foreign aid, could plummet by 20 % this year. The number of acutely hungry people globally could nearly double from 135 million to 265 million. Consequently, the downstream effects of malnutrition on health could take decades to mitigate at unimaginable cost.

Postponed vaccination programs and lockdown induced delays in vaccine shipments are leading to worsening of vaccine preventable diseases.  While vaccination programs are on hold due to concerns over COVID-19 transmission, this strategy is having the opposite of its intended lifesaving effect: for every coronavirus death averted in this manner, up to 84 deaths due to vaccine preventable diseases could occur. The cessation of planned treatment, interruptions of public transportation, and diversion of staff to COVID-19 programs have also interfered with the management of non-communicable and chronic diseases.

Similarly, an unintended consequence of travel restrictions is the limitation of humanitarian aid – flight bans, lockdowns, and border closures significantly impact both the transfer of material goods as well as personnel. Organizations may also feel compelled to pull their staff and volunteers due to concerns of exposure. In conflict zones, the situation is even more dire. In Northeast Syria alone, about two million people are without tools to manage the pandemic due to border restrictions.

For those with funding and the ability to access crisis areas, another challenge becomes the prioritization of spending.  It is tempting to transfer funds towards controlling the spread of the virus. However, such efforts may be counterproductive. An article looking at Yemen in particular urged that shifting focus towards COVID-19 at the expense of other primary health support programs will “undermine existing health system strengthening efforts, worsen the humanitarian crisis and will accentuate the impact of COVID-19.” The UN Population Fund warns that diverting resources from sexual and reproductive health can lead to a rise in pregnancy complications, maternal deaths, and unsafe abortions. This difficulty in identifying what to prioritize further highlights the complex challenges facing medical aid efforts.

The various issues discussed above have placed a tremendous burden on the current humanitarian model. There have been suggestions about how we can reimagine a better medical humanitarian system. These include enabling affected people, community and local actors to lead the response to COVID-19. This is the right time to be open to new ideas about eliminating barriers to local organizations, and creating fruitful engagement between those within and outside the formal system. It is also essential to think beyond the constraints of the current system, forward to a post-COVID-19 world. Medical aid delivery should be designed to withstand a global pandemic such that a future crisis does not result in deprivation on the entire system. This is a challenge we must accept in our collective quest to alleviate suffering.

Authors

Nardos Makonnen, MD is an Emergency Medicine resident at the University of Virginia, and a member of the Global Health Leadership Track

Amita Sudhir, MD is an Associate Professor of Emergency Medicine at the University of Virginia and has been serving as a volunteer consultant and educator for COVID-19 care in low resource settings

The authors have no competing interests

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