Opportunity To Reduce The Risk Of A Catastrophic COVID Pandemic By Urgent Scale-up Of Prevention And Control Of NCDs, Using An All-of-society Approach
Dr. the Hon. Timothy Harris
Prime Minister of St. Kitts and Nevis
Chairman, CARICOM’s Council for Health and Social Development (COHSOD)
Chair, High Level Council, The Defeat-NCD Partnership
On 11 March, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic, one of at least 30 emerging infectious diseases that have made their way across the globe in the past 30 or so years.
The most disruptive event in our modern history, the COVID-19 pandemic, has exacerbated already unsustainable levels of global and racial economic inequality and health disparity, revealing the underlying pandemic of non-communicable diseases (NCDs), particularly in vulnerable populations like the poor and the elderly, and also in low-resource countries, which have disproportionately higher rates of NCDs such as cardiovascular diseases, cancer, diabetes and hypertension.
Some estimates are that as many as 90 per cent of people dying from COVID-19 have a pre-existing or underlying NCD. The Lancet Global Health published an illuminating modelling study, suggesting that 20 per cent of the world’s population would be at an increased risk of severe COVID-19 should they become infected – mostly because of underlying NCDs. We in the Caribbean have long realized that NCDs are our major health threat, with significant negative economic impact.
Against this backdrop, it is quite clear that the world’s small island developing countries such as St. Kitts and Nevis have a lot at stake in the fight against COVID-19, where some 83% of all deaths are due to NCDs. Fortunately, all 19 persons to date with confirmed COVID-19 cases have fully recovered. While this is excellent news, we are not yet out of the woods.
Indeed, it seems the world could benefit if its leaders and societies took a step back to consider the bigger picture that COVID-19 presents to us. Providing an X-ray of the global health order, COVID-19 reveals the fractures in a system whose frailty is compounded by the increasing prevalence of NCDs – a metastasis, so to speak, which has spread to its bones, further immunocompromising its ailing structure.
Taking a further step back shows that the dangerous duo of COVID-19 and NCDs are connected to a much bigger issue of climate change and environmental degradation – the overarching challenge for our small island and low-lying developing states (SIDS). This situation of interacting epidemics is what The Lancet calls a ‘syndemic’, which is a valuable perspective in considering how to balance measures to reduce contagion with measures to fortify the world’s population to face COVID-19.
Countries in the Caribbean face two challenges with respect to COVID-19: the high levels of NCDs, which increase the risk of severe COVID-19 and death on the one hand, and high levels of economic dependence on tourism on the other hand. COVID-19’s impact on economies, especially some very tourism-dependent SIDS, has been little short of devastating, which undermines the resources required to respond to the pandemic and to climate change.
Across the Caribbean, the spreading COVID-19 pandemic is revealing health vulnerabilities – in particular, the prevalence of NCDs, although the virus has only reached a very small percentage of the population to date. According to OurWorldinData, Barbados and Guyana have COVID-19 case fatality rates at or above the global average of 3 per cent. According to WHO, in 2016, Barbados and Guyana had some of the highest premature NCD death rates globally, at 522 and 831 deaths, per 100,000 population, respectively. Here in St. Kitts and Nevis, we are thankful that we have been able to flatten the COVID-19 curve. As we reopened our borders on October 31st, 2020, our focus is on the overall strengthening of the health system with a multi-sectoral approach to countering NCD risks, including investing $10 million to boost production in Agriculture, with free seeds and seedlings, as part of the Federal Government’s $120 Million COVID-19 stimulus package.
Among other islands, Singapore, with a COVID-19 case fatality rate of 0.2 per cent, stands out, as it is significantly less than the global average of 3 per cent and partly reflective of high levels of testing. Singapore has invested over time in robust health care systems, which have reduced NCD death rates to a near global best of 247 per 100,000. Another island city, Mumbai, in India, has demonstrated that a joint approach to COVID-19 and NCD leads to reduced COVID-19 deaths. Mumbai, the country’s commercial capital, resorted to extensive testing for COVID-19, reaching test rates of 75 per 1,000 people, more than twice that of the city’s larger neighbours. What is less known is that Mumbai also undertook an innovative survey of over 9 million slum dwellers for diabetes and hypertension along with COVID-19 screening during the first two months of the pandemic. This enabled better targeting of those affected by NCDs and elderly people, bringing down the monthly COVID-19 case fatality rate from above 4 per cent to 2.6 per cent.
Perhaps the most important lesson for the world from the COVID-19 pandemic is that we need healthier populations. This we can begin to achieve now via a serious focus on NCDs and associated major risk factors, taking an all-of-society approach, where governments, people and business play their appropriate roles. We need to leverage digital health technologies and partners, with people-centred governance, to create more supportive environments so people can take greater responsibility for their health. In that way, we can secure healthier populations and societies by reducing NCDs through education, prevention, screening, and self-management, and with more supportive environments, we can mitigate a catastrophic COVID pandemic, and other such events in the future.
However, a WHO survey of 155 countries showed that the COVID-19 pandemic has dramatically curtailed the provision of health services for NCDs. Health systems have reassigned resources in hospitals to COVID-19 treatment and care, put on hold elective treatments, surgeries, and other essential treatments, including chemotherapy. This is in addition to reassigning health personnel working in primary and secondary care to COVID-19 related responses. Health staff, who have been at the front line of the COVID response globally, have lost over 7,000 of their members, and many are working under extremely stressful conditions, heroes, and heroines in the response. Social distancing and quarantine restrictions, including the absence of transportation, affected the ability of patients with NCDs to access their urgently needed health care and treatment, leading to increased complications and deaths of people with NCDs.
Albert Einstein once said, “in the midst of every crisis, lies great opportunity”. The World Bank, has committed US$160 billion, the IADB has committed US$2.8 billion to Central America, and the Caribbean Development Bank has pledged US$67 million for the COVID-19 response. The huge investments channelled for the pandemic can be spread across COVID-19 and NCDs. Improving and increasing the capacity of medical laboratories to test and screen for COVID-19 should include the same for NCDs. Health and disease surveillance, and health information systems, being strengthened to track and report COVID-19, must also be used for NCDs.
The increased global concern for health and additional resource flows should be applied to achieve the global commitment to reach Sustainable Development Goal 3.4 –a one-third reduction in premature deaths from NCDs by 2030. This can be done by developing a clear plan, training community health workers in NCD screening protocols, along with screening for COVID-19; providing additional diagnostic tools needed for NCD detection to primary care providers at the community level, and connecting private testing and diagnostic facilities with primary health facilities to undertake NCD screening and testing with or alongside COVID-19 testing. Partnering with communications service providers can help develop a matching digital health approach, which facilitates maintenance of protocols of COVID-19 risk reduction. While preventing COVID-19 is still an uncertain science, and even though treatment protocols are at an experimental stage, the only certain way to reduce COVID-19 mortality is to prevent, reduce and treat NCDs. These protocols are well established and can result in predictable reduction in NCD morbidity and therefore in a reduction in COVID-19 mortality as well.
While COVID-19 has claimed many lives, the vast majority of people have yet to meet the virus. Thus, until we have a safe and effective vaccine, there is a window of opportunity and a duty to mitigate the catastrophic COVID-19 pandemic by enhanced prevention and control of NCDs, building on our public health care approach, and by leveraging digital health technology.
Collaboration is critical to the success of this approach. The Defeat-NCD Partnership, a public-private-people partnership, is anchored in the United Nations. Launched at the UN General Assembly on September 24th, 2018, the Partnership is a practical response to the global challenge of preventing premature deaths from NCDs, with focus on low-resource countries.
A session on October 26th, 2020 at the World Health Summit, in which I participated as Chairman of CARICOM’s Council for Health and Social Development (COHSOD) and Chair of the High Level Council of The Defeat-NCD Partnership, was an opportunity to renew multisectoral commitments to reducing NCDs, in light of COVID-19 and climate change, the greatest health hazards of our time. Climate-smart actions, like eating locally grown produce and embracing green transportation, also make economic sense as they help reduce the upward spiral of NCD costs. All this in turn makes the goal of universal health coverage more attainable. A healthy world with reduced NCDs is a world safer from future pandemics like COVID-19.