The importance of multidisciplinary approaches during public health crises

Published: 15 Dec 2021
Category: Unmet health needs & health inequalities


This article is part of a series of blogs exploring how pharmacology can help address unmet health needs and health inequalities. Read our editorial to find out more. 

The impact of the SARS-CoV-2/COVID-19 pandemic is unprecedented in its impact on lifestyle, mentality, and fear around the world. For most, never has an infection been so unknown and feared. However, for others, there is a precedent event – the HIV/AIDS epidemic.

This year marks the 40th anniversary since the first official reporting of HIV/AIDS in 1981, and both the HIV/AIDS epidemic and the current SARS-CoV-2/COVID-19 pandemic have had significant impacts on our lives requiring swift action by world leaders. Clear parallels can be drawn between government responses to the HIV/AIDS crisis and the beginning of the SARS-CoV-2/COVID-19 pandemic. In this article, we explore the lessons from the HIV/AIDS epidemic for the current SARS-CoV-2/COVID-19 pandemic and the takeaways for the next generation of policymakers and scientists.

There are many similarities between SARS-CoV-2 and HIV; they are both RNA viruses that have reached us from animals and for both viruses, behavioural changes have been employed to control their spread. For SARS-CoV-2, these measures include face coverings, social distancing, and self-isolation. For HIV, they include education on how to avoid mother to child transmission and practising safe-sex. Crucially, in both cases, minorities are disproportionately at risk.

Pharmaceutical interventions have also been central to progress in both cases – as we are currently experiencing with new vaccines and treatments for SARS-CoV-2. As of 2019, it is estimated that 105,200 people are living with HIV in the UK though an estimated 6,300 people remain undiagnosed. The tide, however, seems to be turning in this forty-year battle. Further, scientific learnings from HIV have meant we are better equipped for SARS-CoV-2/COVID-19. The same platform technology used in the development of mRNA-based SARS-CoV-2/COVID-19 vaccines has now been used to develop a novel mRNA-based HIV vaccine, which is currently being tested in mice and non-human primates. While SARS-CoV-2/COVID-19 vaccines carry mRNA instructions for the coronavirus spike protein, the HIV vaccine delivers coded instructions for making two key HIV proteins, Env (a glycoprotein required for binding and entry into host cells) and Gag (the major structural protein of HIV viruses). This novel vaccine has been shown to produce virus-like particles in vivo, trigger production of broadly neutralising antibodies, and other immune responses that were protective against HIV.

The development of the SARS-CoV-2/COVID-19 vaccine has been a major turning point in the pandemic, with many lessons coming from the tried and failed development of HIV vaccines. SARS-CoV-2/COVID-19 vaccines were authorised for emergency use less than 12 months after the genetic sequence of SARS-CoV-2 was published. In contrast, despite over 30 years of research, only six efficacy trials of candidate HIV vaccines have been completed with only one resulting in a partial reduction in of new HIV infection. However, the uptake of the SARS-CoV-2/COVID-19 vaccine is significantly lower in ethnic minority groups. A major challenge for both the SARS-CoV-2/COVID-19 pandemic and the HIV/AIDS epidemic is how research and healthcare systems can build trust with minority groups. Doing so will require a genuine willingness to listen to and act upon concerns and needs from all within the community.

This matters because both SARS-CoV-2/COVID-19 and HIV/AIDS exist in a socio-political context, not just a health one. A significant factor in the severity of the AIDS crisis was the widespread apathy by policymakers in its initial phase. During the HIV/AIDS crisis, Margaret Thatcher, the then Prime Minister, was ‘neurotic about getting too associated with AIDS’ and there appeared to be a widespread public perception of HIV/AIDS as a ‘gay plague’. Similar inaction claims have been raised at the UK Government’s SARS-CoV-2/COVID-19 response.

While HIV/AIDS disproportionally affects gay, bisexual and other men who have sex with men, SARS-CoV-2/COVID-19 disproportionally affects those from ethnic minority backgrounds, and those who are most vulnerable in our society. A 2020 Government report found that people from ethnic minority backgrounds are more likely to work in occupations with a higher risk of SARS-CoV-2/COVID-19 exposure. It also found that historic racism and poor experiences within healthcare settings can dissuade individuals from seeking care when needed. These negative experiences can have a similar impact upon members of LGBTQ+ communities. Worryingly, the risk of dying from SARS-CoV-2/COVID-19 is twice as likely in people of Bangladeshi ethnicity than White ethnic groups and people with Chinese, Indian, Pakistani, other Asian, Black Caribbean and other Black ethnicity had a 10 - 50% higher risk of death when compared to White British people. Inaction, inequalities, and systematic underrepresentation within governments leads to the health of society’s minorities suffering.

At Pharmacology 2020, when asked if pharmacology educators should be integrating policy into their curriculum, Sir Patrick Vallance, the Government’s Chief Scientific Adviser, responded with a resounding “yes”. The dynamic interplay of science and policy is pivotal when managing public health crises and moving forward, we would like to see scientists playing a bigger part in policymaking.

As we continue to navigate the current crisis, and with vaccines bringing hope that the SARS-CoV-2/COVID-19 pandemic may end, it is important to remember that the HIV/AIDS epidemic continues. Continued advancements in HIV treatments have meant that for many the virus is no longer a death sentence (Undetectable means Untransmissible (U=U)) and with the right care patients can lead full and long lives.

Even with the ongoing vaccination programmes for SARS-CoV-2/COVID-19, alongside novel HIV therapies being trialled (such as Excision Bio’s new CRISPR-based therapy, EBT-101), and the recent UK government commitment to achieving no new HIV infections or HIV/AIDS related deaths by 2030, it is likely that both viruses will continue to be with us for a long time. Therefore, it is imperative that we ensure risk groups have equal access to vaccines, treatments, and support – nationally and internationally.

This will require building trust between community leaders, policymakers and scientists. By engaging in these discussions now, and by preparing the next generation, pharmacologists can contribute to ensuring everyone can benefit from life-changing research. In learning the lessons of these crises, we can choose research and public health solutions that recognise and address inequalities.

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Aidan Seeley

Aidan was the inaugural recipient of the Society's Equality, Diversity & Inclusion prize, sponsored by AstraZeneca, and is a member of the Inclusive Pharmacology Education Steering Group. He is a Senior Lecturer in Medical Pharmacology at Swansea University Medical School. Aidan is also the current Chair of the Early Career Pharmacologists Advisory Group and a proud member of the LGBTQ+ community.

Adam L. Dicks

Adam is a final year LLB (Hons) Law student within the Hillary Rodham Clinton School of Law, Swansea University. As a member of the LGBTQ+ community, he is passionate about the current legal and political landscape especially with regards to inequalities faced by minority groups.