4 infectious diseases that should not be forgotten during COVID-19

While the world is waiting for lockdowns to end and for life to return to something like normal, the global health community is working to rein in the novel coronavirus. It is, of course, vital work. But does the current focus on COVID-19 risk pushing aside other health crises in the minds of the public?

As of late May, COVID-19 has caused over 346,000 deaths, and there have been approaching 5.5 million confirmed cases. The economic ramifications have been huge. But when the world eventually moves past this crisis, some experts predict coronavirus will not simply go away – rather, they say it could become endemic with seasonal outbreaks.

This would mean the new disease would join the ranks of influenza and other, more deadly, pathogens that have been around for much longer.

While we’ve eradicated smallpox and are close to doing so with polio, some of these pathogens are proving more challenging to combat.

TB tops the list

The World Health Organization says tuberculosis (TB) is the world’s deadliest infectious disease. The TB pathogen has been known since the late 1800s. According to the latest available statistics, 10 million people fell ill with TB and 1.5 million died of it in 2018.

The occurrence of TB has been falling gradually, but drug resistance remains a challenge to pushing numbers down further. Nearly half a million cases were drug-resistant, requiring long and expensive treatment.

Among the most affected are those suffering with undernutrition, children, and those with HIV/AIDS, especially in South-East Asia, Africa and the Western Pacific region.

The goal set out by the United Nations Sustainable Development Goals (SDGs) is to end the TB epidemic by 2030. On World Tuberculosis Day in March this year, the WHO highlighted the need for more effective diagnostics, medication, vaccinations and other ways to break the hold TB has on many parts of our world. It highlighted a $12 billion annual cost for diagnosis, treatment, care and research.

Tackling malaria

Malaria was endemic in temperate parts of the world well into the 20th century – even as far up as the Arctic Circle. It appears in the works of Chaucer, Shakespeare and Defoe. It took until 1975 for Europe to be declared free of the disease.

Today, more than 9 out of 10 cases – and deaths – occur in sub-Saharan Africa, according to the WHO. In 2018, worldwide cases totalled an estimated 228 million worldwide, with 405,000 deaths. Young children under five are most vulnerable to infection and make up two-thirds of all malaria deaths.

Malaria is also on the UN’s 2030 target list for eradication. But despite a funding focus – with $2.7 million committed in 2018 alone – the occurrence of malaria has only been falling slowly.

Recently, a vaccine has been successful during advanced clinical trials, and has been given to children and infants in a number of pilot countries in Africa since 2019 as part of a trial set to finish in 2023. A new study also suggests that a symbiotic microbe could protect mosquitoes, which spread the disease to humans, against being infected with malaria.

In the shadow of the new coronavirus

Talking about cholera may seem like the proverbial “blast from the past”. But while the water-borne disease reached its peak in the mid-1800s, it remains a serious threat. We are currently experiencing the seventh cholera pandemic, which has now persisted for over 50 years, with recurrent outbreaks.

But numbers are hard to pin down. Last year, a WHO study surveying 34 countries noted a 60% decline in cholera between 2017 and 2018. This was still equivalent to nearly 500,000 cases and close to 3,000 deaths in 2018. But with many cases not being reported, the real numbers globally could be significantly higher.

The highest number of cases occurred in the WHO’s Asia region, which includes the Middle East and a large outbreak in Yemen in 2018, with close to 375,000 people falling ill. But the most deaths – over 5,000 – occurred in sub-Saharan Africa.

Access to clean water and sanitation, along with medication and vaccination, will be critical to reaching the UN target of reducing cholera by 90% by 2030.

Vaccinations are critical

Proactive vaccinations have driven down the occurrence of measles, another highly infectious disease transmitted through coughs, sneezes and close contact, similar to COVID-19.

According to the WHO, before measles vaccinations, epidemics occurred every two to three years, killing an estimated 2.6 million each year. Since 2000, immunization has brought the death rate down by nearly three-quarters, preventing some 23 million deaths.

It is still common in many developing countries, especially in Africa and Asia and where the public health infrastructure is weak. But in the past couple of years, measles experienced a resurgence beyond these regions.

In 2018, around 353,000 confirmed cases were reported to the WHO, and 140,000 people died – in the majority children under the age of five. And in the first half of 2019, more than 500,000 measles cases were recorded, with large outbreaks around the world, including Europe and the US.

The case of measles underlines the importance of vaccinations, and raises the question of whether public health’s current focus on COVID-19 will affect routine immunization programmes.

Measles requires two sets of injections, and even a small drop-off in take-up can have a serious impact.

UNICEF has warned that a backlog in deliveries of vaccines against diseases including measles could lead to children missing key vaccinations. With few flights available, and costs very high as a result, the organization has urged governments and airlines to free up freight space to get vaccine supplies to where they are needed.