As a 134-year old healthcare company, one of Johnson & Johnson’s strengths is the ability to learn from the past to prepare for the future.
For many of us in the global health space, this moment is beginning to feel eerily familiar. In particular, the congruence of world events in the 1980s including a global recession and the emergence of the HIV/AIDS pandemic offer some parallels to the crisis we are facing with COVID-19. We are at a similar crossroads with a rapidly spreading infectious disease and an economic downturn forecasted to be the worst since the Great Depression. A historical perspective could be helpful in guiding our COVID-19 response and rebuilding efforts in the months and years ahead.
In the decades following Alma-Ata Declaration of 1978, a focus on primary health care (PHC) was largely set aside for a more vertical, disease-specific approach. While a laser-sharp focus on diagnosing HIV and distributing antiretrovirals (ART) brought major progress, many other parts of the health system were left behind, especially in sub-Saharan Africa. Since then, many in the field have concluded that the continuum of HIV prevention and care including access to ART can only be sustainable by integrating HIV care within PHC.
By 2008, the pendulum was swinging back in the direction of PHC as a means to put health development back on track. Stalled progress on the health-related Millennium Development Goals especially in countries affected by high levels of HIV/AIDS, economic hardship or conflict forced a hard look at failures in fundamental health infrastructure, services and staff. In October 2018, on the fortieth anniversary of Alma-Ata, world leaders and health experts came together at the Global Conference on Primary Health Care to reaffirm that PHC is the most effective way to sustainably solve today’s health system challenges and foundational to achieving the Sustainable Development Goals (SDGs) for health, including Universal Health Coverage (UHC) by 2030.
As we face a pandemic that is wreaking havoc around the globe and is making its way across Africa, where the WHO warns it could infect 10 million people and cause 300,000 deaths, we cannot afford to lose sight of our UHC aspirations and end up having to return to the starting blocks, or even further back.
The impact of the virus—overwhelmingly represented by images of crowded intensive care units and intubated patients in tertiary health facilities—has begun to demand our undivided attention, but we will undo years of progress if we become too single-minded in our COVID-19 response, diverting all scarce resources into hospital-based care to the detriment of already fragile primary health systems.
We know, for example, that during the Ebola outbreak in 2014-2015, mortality from other preventable and treatable conditions such as malaria, measles, tuberculosis and HIV exceeded deaths caused by Ebola. And health system failures that prevented women from accessing routine maternal health services resulted in an increase in maternal and infant mortality rates. Recent WHO guidelines stress the importance of maintaining high-quality essential health services to limit indirect mortality – but already we are seeing disruptions to immunization services, and midwifery deaths because primary care cadres are not sufficiently factored into PPE calculations to allow them to continue operating safely.
In the US, reports that African American and other minority communities are being disproportionately affected by COVID-19 re-emphasize the role of the social determinants of health and serve as a reminder that every disease must be viewed within its broader societal and community context.
A Response Rooted in Community Health
The Johnson & Johnson Foundation has committed $50 million towards supporting health workers on the front lines battling COVID-19. This is in addition to the 10-year $250 million commitment announced in January through the Johnson & Johnson Center for Health Worker Innovation to support one million nurses, midwives and community health workers to address the projected shortage of health workers to achieve the SDGs and other global health priorities, including UHC, by 2030.
Our company’s response, guided by the Center, will focus on supporting health workers at the front line of fighting the COVID-19 pandemic with the necessary safety equipment, training, tools and protocols for delivery of care as well as providing relief and psychosocial solutions to support their resilience and well-being. We will also actively engage with partners and governments on plans for long-term health systems strengthening.
Now, more than ever, we see the value of remaining rooted in primary and community health. Community health workers (CHWs) have an essential role to play in fighting this pandemic by educating communities and conducting surveillance and contact tracing. We must continue to support routine health services to prevent increases in maternal and child mortality and other preventable deaths.
When a COVID-19 vaccine and prophylactic treatment becomes available, it will be strong community health systems that allow rapid, equitable distribution across the world. Strong and resilient health systems that reach all people—especially the most vulnerable—with effective services will be the best defense against major disease outbreaks in the future and put countries on the road to good health and economic prosperity.
With this in mind, CHWI is working with national governments and partners—like AMREF and Aga Khan University in Kenya and CCBRT in Tanzania—to safely engage CHWs in prevention, detection and response efforts and to ensure delivery of primary health services in their communities. Rather than deploying one-off solutions, we are supporting organizations such as the World Continuing Education Alliance, Praekelt.org and Dimagi and leveraging existing digital platforms to educate health workers and communities and support disease surveillance, while also strengthening community health systems for the long-term.
As a global leader in healthcare, we are making the case for frontline health workers and health for all especially during this time of crisis. Let’s seize this opportunity to join forces and fight this disease while ensuring that every person has access to quality, essential healthcare.