Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa

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  • 1 Independent Consultant, Issaquah, Washington;
  • | 2 Department of Public Health and Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark;
  • | 3 The National Research Center of Working Environment, Copenhagen, Denmark

COVID-19 has had considerable global impact; however, in sub-Saharan Africa, it is one of several infectious disease priorities. Prioritization is normally guided by disease burden, but the highly age-dependent nature of COVID-19 and that of other infectious diseases make comparisons challenging unless considered through metrics that incorporate life-years lost and time lived with adverse health. Therefore, we compared the 2020 mortality and disability-adjusted life-years (DALYs) lost estimates for malaria, tuberculosis, and HIV/AIDS in sub-Saharan African populations with more than 12 months of COVID-19 burden (until the end of March 2021) by applying known age-related mortality to United Nations estimates of the age structure. We further compared exacerbations of disease burden predicted from the COVID-19 public health response. Data were derived from public sources and predicted exacerbations were derived from those published by international agencies. For sub-Saharan African populations north of South Africa, the estimated recorded COVID-19 DALYs lost in 2020 were 3.7%, 2.3%, and 2.4% for tuberculosis, HIV/AIDS, and malaria, respectively. Predicted exacerbations of these diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were < 12% of those for other compared diseases; furthermore, the mortality of compared diseases were dominated in all age groups younger than 65 years. This analysis suggests the relatively low impact of COVID-19. Although all four epidemics continue, tuberculosis, HIV/AIDS, and malaria remain far greater health priorities based on their disease burdens. Therefore, resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.

Author Notes

Address correspondence to David Bell, 25 Mt. Quay Drive NW, Issaquah, WA 98027. E-mail: bell00david@gmail.com

Authors’ addresses:David Bell, Independent Consultant, Issaquah, WA, E-mail: bell00david@gmail.com. Kristian Schultz Hansen, Department of Public Health and Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark, and The National Research Center of Working Environment, Copenhagen, Denmark, E-mail: krh@nfa.dk.

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