10th December 2020

The 12th of December is International Universal Health Coverage Day, marked by the United Nations each year as a moment to raise awareness of the need for strong, sustainable and resilient health systems that ensure all people, everywhere, can get the quality health services they need without financial hardship.

The critical importance of Universal Health Coverage (UHC) is certainly more recognised than ever before, as the world grapples with the fall-out of COVID-19 and works towards a world better prepared for future pandemics. However, the unfortunate irony is that the way out of COVID-19 and towards strengthened pandemic preparedness follows a road that those working in infectious disease control and antimicrobial resistance (AMR) are all too familiar with.

Take the global tuberculosis (TB) crisis. TB was first classed a global health emergency by WHO in 1993, but continues to be a top 10 global cause of death. In 2019, 1.4 million people died from TB despite it being a curable disease. A major contributor to this staggering number of fatalities is that one third of the 10 million people with TB are never formally diagnosed and reported to national health authorities.  Treatment relies on multiple months of antibiotics. Any misdiagnoses, interruptions to or sub-standard provision of treatment contribute to the development of drug-resistance, which is even more difficult to diagnose and treat. Today, drug-resistant TB is the single-biggest cause of AMR-associated deaths around the world, killing an estimated 240,000 people every year.

The COVID-19 pandemic has caused substantial disruption to TB services globally. Staffed by respiratory and infectious disease specialists, national TB programmes acted as a springboard for many national COVID-19 responses, with diagnostic capacity, hospital beds and staff redeployed to manage COVID-19. TB services that relied on frequent interaction between patients and clinicians were suspended or had to be completely re-designed to function in in lockdown and socially distanced settings. TB case notifications plummeted and have yet to recover, even in the highest-burden countries like India, South Africa, and Indonesia and Nigeria. In their recent Global TB Report, the World Health Organization predicts that a 50% drop in TB case detection over 3 months could result in 400 000 additional deaths this year alone. It is as yet unclear how this period of limited access to healthcare and prolonged time spent indoors will affect rates of drug-resistant TB.

It perhaps comes as no surprise then that the Global Fund to End AIDS, TB and Malaria has said that the secondary impacts of COVID-19 on essential health services may well cause greater morbidity and mortality than the pandemic itself. Crucially, investing in health systems strengthening, including diagnostic capacity, contact tracing, healthcare workforces, and decentralised, person-centred care, are critical not only to ending TB, but also tackling AMR, responding to the growing impact of non-communicable diseases, and building the resilient and responsive health systems that have been the most successful at responding to the pandemic.

This International UHC Day, it is therefore particularly important that we consider the role of UHC in tackling to COVID-19, mitigating its secondary impacts, and strengthening global pandemic preparedness. In 2021, the UK will host the G7. By investing additional resources in mechanisms like the Global Fund’s COVID-19 Mitigation Plan and the Access to COVID-19 Tools Accelerator, the UK can build on its historical leadership and unite allies in a collective effort to tackle COVID-19 and supercharge the delivery of the Sustainable Development Goals despite the setbacks of the last year.

Janika Hauser, Senior Parliamentary Advocacy Officer at RESULTS UK. 


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