Relative burdens of the COVID-19, malaria, tuberculosis and HIV/AIDS epidemics in sub-Saharan Africa in 2020

BELL, D.; Schultz Hansen, K.

Objectives: While the COVID-19 pandemic has had considerable global impact, recorded mortality in sub-Saharan Africa has been relatively low. Ensuring the public health response creates overall benefit is therefore critical. However, the highly age-dependent nature of COVID-19 mortality makes comparisons of disease burden challenging unless considered in terms of metrics that incorporate life years lost and time lived in adverse health. We therefore assessed the relative disease burdens of COVID-19 and the three major epidemic-causing pathogens; malaria, tuberculosis and HIV/AIDS, in sub-Saharan Africa. Design: We compared estimates of 2020 disease burdens in sub-Saharan African populations in terms of mortality and Disability-Adjusted Life Years lost (DALYs) for COVID-19, malaria, tuberculosis and HIV/AIDS, applying known age-related mortality to UN estimates of sub-Saharan population age structure. We further compared exacerbations of these diseases predicted to occur through the COVID-19 public health response. Data was derived from public sources, predicted disease exacerbations from those published by international agencies. Main outcome measures: Mortality and DALYs lost Results: For sub-Saharan African populations north of South Africa, recorded COVID-19 DALYs lost in 2020 was 2.0%, 1.2% and 1.3% of those estimated for tuberculosis, HIV/AIDS and malaria respectively. The predicted exacerbations alone of each of these comparator diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were [≤]6% of each of these predicted disease burdens and dominated by them in all age groups below 70 years. Conclusions: The analysis here suggests a relatively low impact from COVID-19. While all four epidemics continue, concentration on COVID-19 runs a high risk of increasing the overall health burden, further increasing global inequities in health and life expectancy, and needs to be guided by clear economic evaluation.