Welcome back to Contain This.
This is Episode 2, Season 2, brought to you by the Indo-Pacific Centre for Health Security.
Today we bring you an Indo-Pacific Health Leaders interview hosted by Australian Ambassador for Regional Health Security, Dr Stephanie Williams, that looks at the global effort to fight Covid-19 whilst not losing any of the progress gained reducing the epidemics of HIV/AIDS, Malaria and Tuberculosis.
We were delighted to speak with Lady Roslyn Morauta. Lady Roslyn is a permanent resident of Papua New Guinea.
She has extensive experience in both the private and public sectors in PNG. Her voluntary work mostly based on health and HIV issues began when she was the First Lady of PNG and has intensified in the years since.
She was formerly the Chair of the PNG Country Coordinating Mechanism for the Global Fund to fights AIDS, Tuberculosis and Malaria, and in 2019, Lady Roslyn was appointed as the Vice Chair of the Global Fund's Board.
For more information about the Indo-Pacific Centre for Health Security, visit our website: https://indopacifichealthsecurity.dfat.gov.au
Connect with us on Twitter via @CentreHealthSec and @AusAmbRHS.
Welcome to Contain This. I’m Stephanie Williams, Australia’s Ambassador for Regional Health Security. Today we bring you an Indo-Pacific Health Leaders interview that looks at the global effort to fight COVID-19, whilst not losing any progress gained in reducing the epidemics of HIV/AIDS, malaria and tuberculosis.
I’m pleased to invite Lady Roslyn Morauta to join us. Roslyn Morauta is a permanent resident of Papua New Guinea and lived in the country for thirty-seven years. Roslyn has extensive experience in both the private and public sectors in Papua New Guinea. Her voluntary work, mostly focussed on Health and HIV issues, began when she was First Lady of PNG, and has intensified in the years since. She was formerly the chair of the PNG Country Coordinating Committee for the Global Fund to Fight AIDS, Tuberculosis and Malaria and in 2019 Roslyn was appointed as Vice Chair of Global Fund’s Board.
Ros, welcome to Contain This.
Can you describe progress in the fight against malaria, TB and HIV from the Global Fund's experience?
At the turn of the millennium, just 20 years ago, the world was staring into an abyss. You know, societies and economies and many countries were on their way to being decimated by HIV. Entire families were being wiped out. Communities emptying, villages emptying, orphanages filling up. Education and health capabilities weakened. It was a catastrophe of unprecedented proportions. The birth of the Global Fund reflected the international community's political will to mobilize whatever it takes. The means, the voice, the science to confront this, and the results of the work of the Global Fund and partner organizations in tandem with countries and affected communities - they're really spectacular in the last 20 years. Since 2002, in fact, the Global Fund partnership has saved 38 million lives. Millions of people around the world are now on antiretroviral therapy, and they've been spared the death sentence that used to come with HIV. AIDS related deaths have dropped by 61% since 2002. The results with malaria are also spectacular. The number of people dying from malaria, most of them young children that have been cut in half. And TB deaths dropped by 25% in that period, thanks to new diagnostic systems, which is speeding up the testing treatment of people with TB. So these achievements show what's possible when the world unites to fight infectious disease.
So it's really important to reflect now on the progress of the last 20 years and I know even pre-COVID there was some urgency around the SDG [Sustainable Development Goals] 2030 goals for the three diseases. And I've heard it being said the Global Fund was created to stop the pandemics of HIV, TB and malaria. I wonder if you could tell us a bit about how the Global Fund, in addition to its core mandate for the three diseases, has supported the COVID-19 response around the world including through the ACT-Accelerator?
As you said the Global Fund was set up to fight pandemics. And COVID has very much impacted the services for HIV, TB and malaria in low and middle income countries. So we're now leveraging our strengths in pandemic response to mitigate the impact of COVID on HIV, TB and malaria programs, but also to contribute to the fight against COVID directly in more than 100 countries. So using our extensive health and community networks, our well-established health, procurement and distribution systems to distribute COVID-19 tools, medical supplies and training. And also leveraging the strengths and effectiveness of our partnership model at the country level. We've already deployed over 1 billion US dollars, and just in the last couple of months raised a further $3.7 billion. This is just for COVID, separate from the $14.1 billion that we raised for in the last replenishment in 2019.
So Global Fund is now the primary channel for providing ground support to low and middle income countries for COVID-19 tests, treatments, including medical oxygen, PPE and critical elements of health system strengthening. We're also a leading partner in the Access to COVID Tools Accelerator, ACT-Accelerator or ACT-A. This is the global collaboration that includes WHO, GAVI the Vaccine Alliance, World Bank and others, to ensure the accelerated development and equitable deployment of tools to fight COVID-19. So with the other partners, we're advocating a comprehensive approach that brings together testing treatments, vaccines and health systems and medical supplies to make tests, treatments and vaccines happen. It's really important to stress: vaccines alone will not be enough.
Good progress is being made. The ACT Accelerator has raised $14 billion of the 33 it needs to respond to the acute phase of the pandemic this year. It's been able to speed up the availability of antigen rapid diagnostic tests as well as reduced prices of these tests by half to three quarters. The accelerator has already procured more than 63 million tests, distributed life saving tax, dexamethasone treatment and oxygen and delivered more than 100 million PPE kits to protect frontline health workers so Global Fund is leading two of the four pillars of the accelerator. We're co-leading the diagnostics pillar and the health systems connector. We're also supporting the procurement and distribution for the therapeutics pillar. But much more needs to be done to ensure equitable access to these tools and public health responses. Just this year, the funding gap for what's required is $19 billion. And the estimate of what's required next year is $35 to 45 billion. So the funding gap is huge.
And to defeat COVID, the choice facing wealthier countries like Australia is whether to invest billions now to fund equitable access to the tools necessary to defeat COVID or risk paying trillions later to respond to uncontained COVID. New mutations of the virus underscore the urgent need to contain COVID in all countries, because even if wealthier countries succeed in rapidly rolling up vaccine and containment campaigns, if we don't do the same in low and middle income countries, at the same time, the virus will continue to mutate. And pose a new threat to everybody, even countries that managed to control the original COVID strain. This could see a continuation of the current humanitarian crisis that by some estimates has already cost 10 million lives around the world, and the continuation of an economic crisis that the IMF has estimated will cost 11 trillion this by this year to the global economy and $28 trillion by 2025. So fighting COVID really does require rich countries to step up not only because they have the resources to do so but it's also in their interests. So obviously, in my view, I think Australia needs to do more on the international stage in this respect too.
And it's so important to have the voices of the Global Fund playing that role in the global response to be able to articulate some of those real challenges about the urgency of now and the potential even worse situation of the future. But I also want to acknowledge earlier in your answer about recognising and how the Global Fund's strength is their procurement distribution and the practice of being able to channel funds to countries, but also on the connection to people and communities and, you know, halfway through 2021 we're now talking about people. But I think for 2020 we were talking about a pathogen before we were talking about people and having the Global Fund as a key part of the global response has just brought the strength that it has had over decades in the fight against the three diseases to what still I think we need to improve, putting people at the center of the COVID response. And I know it's the subject of much discussion at the Global Fund currently.
Exactly I couldn't agree more.
And moving to our region, I wonder if you could give us some insight into the important work the Global Fund does in PNG?
Yes, well, that's a topic that I'm very familiar with. Global Fund doesn't have country offices, the only offices are in Geneva. So at the country level, there's an organization that replicates the public private partnership at the Global Fund that governs the work of the Global Fund in each country. From grant application to grant implementation and grant monitoring. In countries it's called the Country Coordinating Mechanism. So in PNG, we have the PNG country coordinating mechanism and I was chair of the CCM for a number of years there. It's made up of members of from government, from the National Health Department, from Treasury, four provincial government representatives, reps from the private sector, faith based organizations, other NGOs, multilateral and bilateral donors. DFAT is on the CCM and most importantly, people directly affected by the three diseases. So in each country, the grants are implemented by a combination of the health agencies and other local experts.
In PNG, the principal recipient for the TB/HIV grant is World Vision with the Health Department as an implementing partner, and a number of sub-recipients. WHO also receives a little bit of funding for some key technical positions. For malaria, the principal recipient is Rotarians Against Malaria with the Institute of Medical Research, a sub recipient and the Health Department, an implementing partner. So our first grant in PNG was 2004. And since then Global Fund has invested a billion kina, about 287 million US dollars in PNG. The current funding cycle, the allocation is US$78 million dollars, but 270 million kina. That's for 2021 to 23. US$40 million is for TB, HIV, and nearly US$38 million for malaria. We've also been able to attract additional funding in the past. DFAT has contributed to the CCM Secretariat, which has been extremely helpful assistance. But we've also had direct assistance to the grants. In the last round, we managed to get 6 million US dollars to procure mosquito nets from Against Malaria Foundation in the UK, and also assistance in the malaria grant from Comic Relief. But the challenge is fighting to fight these diseases in PNG are huge. There's a very high disease burden, especially for TB and malaria. PNG is one of 30 high multi-drug resistant TB and TB/HIV burden countries in the world. The estimated incidence of TB was 432 per 100,000 people in 2018, which is among the highest globally and TB mortalities are around just under 5000 deaths a year.
PNG has the highest malaria burden in the world outside of Africa and a very large percentage of the population is at risk. An estimated 94% of population is at risk of malaria. With an estimated 900,000 cases, that's more than three quarters of the malaria burden in the Western Pacific region. But Rotarians Against Malaria I've done a fabulous job. And in some areas since 2007, the incidence of malaria has dropped by 70%. They've distributed over 10 million nets to provinces and one and a half million nets to pregnant women through the antenatal clinics.
For HIV while the national prevalence is less than 1% - it's 0.85% - there's much greater prevalence in eight provinces, which we call the high burden HIV provinces. Morabe, National Capital District, Eastern Highlands, Simbu, Western Highlands, Enga, Jiwaka and Madang. And these eight provinces account for two thirds of the known people with HIV in PNG. The prevalence is also much higher among a set of key populations. It's just over 7% in men who have sex with men and transgender populations, and just under 20% in female sex workers. Reaching these affected and vulnerable populations is difficult because of the geographical dispersion of diseases, but also key populations for HIV, female sex workers, men who have sex with men, transgender people, are socially marginalized. They are criminalized and they face a range of human rights abuses that increase their vulnerability to HIV and make their access to services very difficult.
And then of course, there are challenges with the health system itself. Stock outs and shortages in commodities like medicines, test kits, reagents, condoms, chronic staff shortages, right throughout the country in the health centres. Many positions are vacant due to lack of funds, weak laboratory infrastructure and capacity and insufficient access to timely data. However, you know the results are there to be seen as well. For example, in the fight against AIDS, over 30,000 Papua New Guineans received anti-retroviral therapy last year and HIV prevention programs are reaching over 17,000 sex workers, 7000 men have sex with men and 400 transgender people. The grant is very much focused on the key populations, as well as help helping support the national treatment program.
Ros, can you expand a bit on why it is so important that people affected by the three diseases are on the decision making bodies in countries, the CCMs?
This is really important. And it's one of the features of the Global Fund. I think it's the only global health organization that actually has people who are affected by these diseases in every stage of the process of decision making right to the Global Fund board. But in PNG, we did a lot of work in the last few years to strengthen the voice of the communities. A lot of training about the diseases involving people living with disease, in actually rolling out prevention programs, particularly, also involvement in treatment programs. The community aspect of support for TB treatment is really important, as it is for HIV too. And hearing the voice of the people who are affected by the disease and how they want services to be delivered to them is really important. So the PNG CCM probably has the highest number of community representatives on it, of any in the world and that it's one of the things that I am really proud of, because it's also helped change people's thinking. And it's improved the way we deliver services without question.
In amidst all those challenges and again, acknowledging the positive results that have been possible in PNG, how is the Global Fund adapted to the COVID situation in PNG in particular? And you know, we've just been through a large rise in cases over the last couple of months. Can you tell us a bit more about the Global Fund's work on COVID there?
Since February there's been a 10% increase in cases. And the last estimate I saw toward the end of last week was 13,700 cases. But that number, of course, is an under representation. The Burnet Institute recently estimated that at least 80,000 people are currently infected. And adding that without effective interventions, we could expect the number of infections to double weekly, and even reach a median before too long. So COVID is in a critical stage in PNG at the moment, much more assistance is needed, including to ensure that PNG can access sufficient vaccines for a high proportion of the population, and that the health systems themselves can deliver the rollout of the vaccines. Global Fund is not directly involved in vaccines, but we're playing a leading role in global collaboration and assistance on diagnostics and treatments. So for PNG, we've provided an additional $4.3 million dollars about 15 million kina for HIV, not HIV, for COVID commodities and programming. Through these funds, we've seen masks, thousands of masks, respirator filters, surgical gowns, gloves, GeneXpert cartridges for COVID testing and antigen rapid tests being delivered. And with the recent announcement that the US will provide $3.5 billion to the Global Fund's COVID response and Canada and Germany. Also the Global Fund will be able to continue to support COVID in PNG this year. PNG was allocated a further $12 million, about 42 million kina in April. So the Country Coordinating Mechanism and Health Department and other partners are currently working on the funding request for this further support.
Perhaps the biggest challenge that the PNG faces, if constraints to COVID tools are overcome, is using them efficiently and effectively, getting life saving services to the frontline. The health system was struggling before COVID now it's teetering on the brink with large numbers of health workers becoming infected with COVID. But this is the same health system that that we need to roll out vaccines, testing and treatment for covered as well as for all other health conditions. Not just HIV, TB and malaria, but Maternal and Child Health, health promotion, disease prevention, diagnosis and treatment generally. It's a huge ask for PNG's health system, but it's one that must be met. It's encouraging to hear from WHO that PNG has distributed over 130,000 vaccine doses, some of those Australian ones but also the COVAX ones have arrived now. And they've started the national rollout and reached more than 10,000 people. But that's small we need to do far more. But I want to take this opportunity to acknowledge the extraordinary determination and commitment to those who work tirelessly to overcome weaknesses in health systems and PNG and ultimately save lives. We owe a huge amount to the frontline health workers, doctors, nurses, community health workers, lab technicians, all of whom have put their own health and lives on the line in the last year to save the lives of others. But much more is required. We need to support them with the resources they need. We need to support them with the recognition that they deserve. And we must mobilize whatever it takes to defeat COVID.
It's a nice segue to my last question after your acknowledgement of the frontline health workers in PNG, which is timely, and they will be on the front line for many years to come. All of us involved in global health are working hard during the pandemic, especially you and I know that you're all hours on the Global Fund board means that it's not daytime but nighttime also. How are you keeping personally healthy and motivated in 2021?
Stephanie, the actual work keeps me motivated. You know what one has a sense of doing something that's not just necessary, but it's also constructive and interesting. And that in itself, I think is huge motivation. In my downtime, which isn't too much, I'm brushing up on my French, I listen to lots of classical music. I read. I belong to two black book clubs, one in Brisbane, and one in Port Moresby, which of course is which is held virtually at the moment I also get together with friends when I can I cook for them, or we go to movies, or, or whatever.
Most days of the week, I'm interacting with colleagues and friends overseas. So I'm continuously reminded how fortunate we are in Australia, able to go to restaurants, the cinema and concerts, we're the envy of the world. But we also need to play our part to help the rest of the world achieve a relatively COVID free state, such as we have. And so we can open our borders safely, and visit the region in the world, and others can visit us.
Thanks, Lady Ros, it's been terrific to talk with you for your perspectives, your deep, deep knowledge and connection to PNG, as well as the really important work that the Global Fund has done to date and continues to do now with COVID in its portfolio, and for reminding us to that the sense of purpose is often what keeps us focused in global health during COVID-19 as we're in 2021, thanks again.
You’ve been listening to Lady Roslyn Morauta. This interview is the latest in our Indo-Pacific Health Leaders series. You can visit Contain This dot Buzzsprout dot com for discussions on combating COVID-19 with leaders from the Cook Islands, Cambodia, Kiribati, Australia and the World Health Organization.
Join us in another fortnight for the next episode in Season Two of Contain This.