COVID-19 continues to pose challenges to people’s health and well-being globally and is impeding progress in meeting Goal 3 targets. Before the pandemic, gains were evident in many areas of health, including reproductive, maternal and child health, immunization coverage and treatment of communicable diseases, though progress was marred by huge regional disparities. As of mid-2022, COVID-19 had infected more than 500 million people worldwide. The latest estimates show that global “excess deaths” directly and indirectly attributable to COVID-19 could have been as high as 15 million by the end of 2021. The pandemic has severely disrupted essential health services, triggered an increase in the prevalence of anxiety and depression, lowered global life expectancy, derailed progress towards ending HIV, tuberculosis (TB) and malaria, and halted two decades of work towards making health coverage universal. As a result, immunization coverage dropped for the first time in 10 years, and deaths from TB and malaria increased. Urgent and concerted action is needed to set the world back on a trajectory towards achieving Goal 3.
COVID-19 directly and indirectly led to the deaths of nearly 15 million people in the first two years of the pandemic
COVID-19 is now a leading cause of death. The latest estimates suggest that 14.9 million people died as a direct result of COVID-19 or from the pandemic’s impact on health systems and society in 2020 and 2021. This estimate is nearly triple as the 5.4 million officially reported COVID-19 deaths in the same period. About 84 per cent of these “excess deaths” are concentrated in South-East Asia, Europe and the Americas (as defined by WHO), and 68 per cent are in just 10 countries.
The pandemic has severely disrupted health systems and essential health services. Interruptions in essential health services were reported in 92 per cent of 129 countries surveyed at the end of 2021. These disruptions were found across all major areas of health, including maternal and child health, immunization, mental health programmes, and treatment of diseases such as HIV, hepatitis, TB and malaria. As a result, impressive strides in global life expectancy came to a sudden halt. In many parts of the world, life expectancy has fallen by one to two years.
To effectively curb the spread of COVID-19 and prevent tens of thousands of additional deaths, it is critical to ensure equitable access to safe and effective vaccines. WHO has called for 70 per cent of people in all countries to receive vaccinations by mid-2022. That said, global vaccine distribution is far from equitable. As of May 2022, only around 17 per cent of people in low-income countries had received at least one dose of a vaccine, compared with more than 80 per cent in high-income countries. For everyone’s health, it is imperative that all countries and relevant manufacturers suspend patents, prioritize vaccine supply to COVAX, and create the conditions necessary for the local production of tests, vaccines and treatments.
Available data do not indicate an increase in suicide rates during the first months of the COVID-19 crisis. However, the pandemic has had a severe impact on the mental health and well-being of people around the world. In 2020, the global prevalence of anxiety and depression increased by an estimated 25 per cent, with young people and women most affected. At the same time, countries reported that services for mental, neurological and substance use conditions were the most disrupted among all essential health services, which widened gaps in mental health care. By the end of 2021, the situation had improved somewhat, but many people remain unable to get the care and support they need for both pre-existing and new mental health conditions.
Even before the pandemic, depression, anxiety and other mental health challenges affected far too many children. It is estimated that, in 2019, more than 13 per cent of adolescents aged 10 to 19 had a diagnosed mental disorder as defined by the WHO; this translates into 86 million adolescents aged 15 to 19 and 80 million adolescents aged 10 to 14. The pandemic has added to the mental health issues facing children and young people, since many of them are still experiencing school closures, disruption of daily routines, stress over food insecurity and loss of family income, and uncertainty about the future. For the most vulnerable children, the impact of COVID-19 may also increase their exposure to multiple forms of violence and exploitation.
It is imperative that COVID-19 response plans include mental health and psychosocial support. Increased attention and investment are particularly needed to improve mental health care for children and young people and to protect the most vulnerable children.
Progress has been made in maternal and child health, but glaring regional disparities must be addressed
Competent skilled birth attendance is key to reducing maternal and newborn morbidity and mortality. Globally, in 2015–2021, an estimated 84 per cent of births were assisted by skilled health professionals, including medical doctors, nurses and midwives. This was an increase from 77 per cent in 2008–2014. Still, coverage in sub-Saharan Africa was 20 percentage points lower than the global average.
Progress was also made in under-5 and neonatal mortality, though too many children are still dying. The global mortality rate of children under age 5 fell by 14 per cent from 2015 to 2020 – from 43 to 37 deaths per 1,000 live births. Similarly, the mortality rate of children in their first 28 days of life, the neonatal period, fell by 12 per cent over that same period – from 19 to 17 deaths per 1,000 live births. Even with this progress, 5 million children died before reaching their fifth birthday in 2020 alone – down from 5.9 million in 2015. Almost half of those deaths, 2.4 million, occurred in the first month of life. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world at 74 deaths per 1,000 live births in 2020. This is 14 times higher than the risk for children in Europe and Northern America.
The adolescent birth rate also fell worldwide. From 2010 to 2020, the rate dropped from 47.9 births to 41.2 births per 1,000 adolescents aged 15 to 19. The largest declines occurred in Central and Southern Asia, from 43.6 births to 23.7 births over the same period.
Childbearing among girls aged 10 to 14 is much more common in countries in sub-Saharan Africa and Latin America and the Caribbean than in other parts of the world. Most countries with measurable levels of early childbearing have recorded a reduction since 2000.
Although data to assess the total impact of COVID-19 on maternal and child health and adolescent fertility are not yet available, concern is mounting that the pandemic has inadvertently undermined achievement in those areas.
Universal health coverage (UHC) is achieved when all people can receive the good-quality health services they need without facing financial hardship from having to pay for them. Even before COVID-19, alarming trends in universal coverage were evident. The UHC service coverage index improved from a global average of 45 out of 100 in 2000 to 64 in 2015 and 67 in 2019. However, almost 1 billion people spent more than 10 per cent of their household budget on out-of-pocket health expenses in 2017, and more than half a billion were pushed into extreme poverty due to these out-of-pocket payments.
Data are not yet available to provide a detailed and comprehensive look at the impact of COVID-19 on progress towards UHC. However, since the pandemic has led to significant disruptions in essential health services, the continuous progress made over the last two decades has likely come to a halt. With the combined health and economic impacts of COVID-19, people may be facing greater financial constraints in accessing care. Among those paying out of pocket for health services, financial hardship is likely to worsen further, particularly for those already disadvantaged.
In 2020, an estimated 1.5 million people were newly diagnosed with HIV and 680,000 people died of AIDS-related causes. The incidence of HIV infections globally declined by 39 per cent between 2010 and 2020, far less than the 75 per cent target agreed to by the General Assembly in 2016. Measures to slow the spread of COVID-19, along with the added pressures on health systems, have disrupted HIV services.
In 2020, an estimated 10 million people worldwide fell ill with TB. That year, the notification rate of new and relapse cases in TB incidence fell to 59 per cent, down from 72 per cent in 2019. Disruptions associated with the pandemic globally caused a noticeable rise in the number of TB deaths, from 1.2 million in 2019 to 1.3 million in 2020 (excluding TB deaths in people with HIV). This is the first year-on-year increase in TB deaths since 2005, and it took the world back to the 2017 level. Progress in reducing TB incidence also slowed in 2020 to less than 2 per cent per year. This is much lower than the 4 to 5 per cent annual decline required to achieve the End TB Strategy (i.e., an 80 per cent drop in new cases by 2030). Between 2018 and 2020, TB treatment reached 20 million people, only half of the global target. Due to the pandemic, TB incidence and mortality are expected to worsen, especially in 2021 and 2022.
An estimated 241 million malaria cases and 627,000 deaths from malaria were reported worldwide in 2020. This means that 14 million more people contracted malaria and 69,000 more people died from it than in 2019. About two thirds of the additional deaths were linked to disruptions in the provision of malaria services during the pandemic. Even before COVID-19, global gains against the disease were levelling off, and the world was not on track to reach the targets set in WHO’s Global Technical Strategy for Malaria 2016–2030. By 2020, the global malaria incidence rate was 59 cases per 1,000 people at risk against a target of 35. In other words, progress against malaria was off track by 40 per cent.
Progress towards preventing, controlling and eradicating neglected tropical diseases (NTDs) continued in 2020, despite significant disruptions to health services. The number of people globally requiring NTD treatment and care declined from 2.19 billion in 2010 to 1.73 billion in 2020. Notably, in LDCs, 48 per cent of the total population required treatment and care for NTDs in 2020, down from 79 per cent in 2010. This progress was largely due to the elimination of a number of NTDs. By the end of 2020, at least one NTD had been eliminated in 42 countries. Important declines were observed in the number of reported cases of diseases targeted for elimination and eradication, including African trypanosomiasis (sleeping sickness) in humans and dracunculiasis (Guinea-worm disease).
COVID-19 and associated disruptions have caused more children to miss out on essential vaccines. From 2019 to 2020, coverage of infant immunization slipped from 86 to 83 per cent. This means that 22.7 million children missed out on vaccinations in 2020, 3.7 million more than in 2019 and the highest number since 2005. In addition, 17.1 million older children did not receive vaccines through the routine immunization programme in 2020, an increase from 13.6 million in 2019.
The consequences could be devastasting. Measles, for example, is a highly contagious disease, and the current coverage levels of 70 per cent with two doses are insufficient to prevent illness, disability and death from measles outbreaks or complications associated with the disease. What’s more, COVID-19 responses and vaccinations have diverted health system resources away from other essential services. It is therefore likely that in 2021 and beyond, too many children will continue to miss out on immunization as well as other health-care services. Recovering these to pre-pandemic levels must be an urgent global priority.
Health and care workers remain on the front lines of the COVID-19 response. Between January 2020 and May 2021, the pandemic may have claimed the lives of 115,500 health and care workers worldwide. Greater efforts are needed for equitable distribution of COVID-19 vaccines to ensure that they have access to vaccination and personal protective equipment personnel in Northern America remains the highest in the world, at over 152 per 10,000 people. This is almost 4 times the global average, 8 times that of Northern Africa and Southern Asia, and over 15 times that of sub-Saharan Africa. Despite a steady increase in the density of medical doctors per 10,000 people globally, the disparities among regions remain high – from an estimated 40 medical doctors per 10,000 people in Europe to only 2 in sub-Saharan Africa.
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