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Economic inequities threaten COVID-19 response

The growing pandemic funding gap The gap between donor commitments and the funding needed to respond to [ ... ]

An article by the WHO Director General and President of Costa Rica remind us that COVID-19 will remain a global threat everywhere as long as it is present anywhere, demanding a collective and collaborative global response. At the World Health Assembly last month, Costa Rica took leadership in proposing a new COVID-19 Technology Access Pool (C-TAP) that would allow all participating countries, research partnerships and companies to share data, knowledge and intellectual property relating to diagnostics, treatments and vaccines for COVID-19. The mechanism was launched in the first week of June and has attracted at least 30 countries after resolutions by the WHA and UN General Assembly were adopted in support of “universal, timely, and equitable access to health technologies.”

At the Global Vaccine Summit on June 4, countries, philanthropic foundations and private companies pledged US$8.8 billion towards the WHO Access to COVID-19 Tools Accelerator, which places special emphasis on access.

While the IMF reports that countries have committed over $10 trillion USD in global fiscal response to the pandemic (of which 90% is in OECD countries), the monthly funding update by UNOCHA shows that only about $2 billion has been pledged thus far for the COVID-19 Global Humanitarian Response Plan ( that requests 6.7 B USD). This represents less than 18% of requested emergency funding for UN and aid agencies needed for supplies and logistical support to reach those in urgent need of assistance.

WHO to create a COVID-19 Intellectual Property Pool

The WHO embraced a proposal by Costa Rica to develop a voluntary mechanism that would pool patents and regulatory testing data to develop drugs, vaccines and diagnostics for COVID-19. Modelled after the Medicines Patent Pool by UNITAID for HIV/AIDS medical products, the COVID IP Pool would serve as a repository that target governments, industry, universities and non-profit organizations in order to ensure equitable access to resulting medical products, something that the Access to COVID-19 Tools (ACT) Accelerator announced last month does not sufficiently address.

The WHO has until May 29 to finalize the framework for the voluntary pool. The US has expressed reservations, while it has been accused of “pandemic chauvinism” because it refused to attend the launch of the WHO ACT Accelerator and is alleged to have offered to buy a German vaccine developer, while the CEO of Sanofi said that the U.S. may get priority access to COVID-19 vaccine, even though the company is headquartered in France.

Covid-19 has exposed the limits of the pharmaceutical market model

As the global search for Coronavirus treatments and vaccines intensify, two articles this week highlight the limitations of the existing drug development models. Health Policy Watch featured an interview with the Director General of a trade association representing the leading pharmaceutical companies. Among the “old-new tensions between profit and public needs” that were discussed was the “concern” by the pharmaceutical industry that the newly adopted World Health Assembly resolution referenced WTO flexibilities that allow countries to override patents to ensure access to vaccines, therapeutics and diagnostics.

The STAT article, meanwhile, points to failures of the existing market model that do not sufficiently incentivize investment into new treatments and vaccines for neglected diseases and pandemic preparedness despite warnings. Building on an extensive body of research, the author advocates for a new economic model of drug development that does not rely on market mechanisms. That would include more open and transparent research and development practices that address the “rapid global expansion of intellectual property” as well as more expansive government initiatives to address collective challenges (particularly given the significant role of government-funded research).

The 15 drugs being tested to treat COVID-19 and how they work

Even under the most optimistic projections, developing new treatments and vaccines for COVID-19 will require far greater time and resources than would be required for repurposed existing therapeutic compounds. An article in Nature this week provides an overview of the 15 leading candidates of existing drugs that are being studied as treatments for COVID-19. These can be divided into two categories: those that target the viral replication cycle, and those that aim to control the symptoms of the disease. They include:

Chloroquine/hydroxychloroquine (primarily used to treat malaria)
Lpinavir and ritonavir (HIV/AIDS)
Nafamostat and camostat (pancreatitis)
Famotidine (heartburn)
Umifenovir (influenza virus A and B)
Nitazoxanide (anti-infective)
Ivermectin (anti-parasitic)
Corticosteroids (cytokine storm, acute respiratory distress syndrome)
Tocilizumab and sarilumab (cytokine storm, ARDS)
Bevacizumab (oncology)
Fluvoxamine (antidepressant)

Contact tracing apps: balancing privacy and public health

Traditional public health contact tracing systems require significant time and resources, as one projection by Johns Hopkins University estimates a workforce of 100,000-300,000 would be needed to contain COVID-19 in the U.S. alone at a cost of $12 billion. As a result, health systems are increasingly turning to mobile contact tracing apps that are pitched as a way to reduce these costs by automating the process of logging people’s contacts should they became infected in the future. Despite their promise, there are outstanding challenges, including marginalizing vulnerable populations that may not have smartphones.

There are also privacy concerns that has led civil liberties advocates to raise warnings about potential abuses, including by authoritarian countries during and after the pandemic. The CSIS also urges policy makers that digital tools such as contact tracing apps are not “silver bullet” substitutes for investment in fundamental pandemic response capabilities. That message was echoed by health authorities in Iceland, where Rakning-19 yielded very little benefit compared to traditional public health systems, despite its high uptake of 40% of the population.

Machine learning applications

In Nature Machine Intelligence, authors report on machine learning tools applying pattern classification to identify three biomarkers associated with COVID-19 mortalities.

Another paper in Nature examine real-time tracking of self-reported symptoms to predict potential cases of COVID-19. The smartphone app allowed the authors to develop a model that was 80% accurate and showed that loss of smell and taste were additional symptoms indicative of COVID-19. While this study used simple statistical regression analysis, another paper in pre-print used machine learning algorithms on a smaller Brazilian dataset that achieved better performance of 92% specificity and 95% sensitivity.

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The growing pandemic funding gap

The gap between donor commitments and the funding needed to respond to the pandemic continues to grow. As the UN Office for the Coordination of Humanitarian Affairs tripled its appeal last week to US$6.7 billion, they admit to only receiving US$1 billion towards its initial request for US$2 billion. That includes a mere $65 million contribution from the U.S. that a senator described as “unconscionable,” while the Washington Post reports the US$3 trillion COVID-19 bill introduced by Democrats this past week contains no funding for international assistance. Germany and France likewise agreed to support a 500 billion Euro aid package to support E.U. countries with recovery from the pandemic.

NGOs such as the International Rescue Committee argue that much of the aid is stuck within multilateral channels, as humanitarian funding to front-line NGOs accounts for only 2% of commitments under the UN Global Humanitarian Response Plan.

The global economy is shrinking, and 130 million people may be pushed into extreme poverty

Global economic output is expected to drop by 3.5% in 2020, and by US$8.5 trillion over the next two years as a result of the pandemic. The UN World Economic Situation and Prospects report warns that an additional 34 million people could fall below the extreme poverty line by the end of this year. The UN Department of Economic and Social Affairs did “not anticipate (the global economy) would dive as quickly as it did” amidst the sharpest economic contraction since the Great Depression. The report projects that by 2030, an estimated 130 million will be pushed into extreme poverty. Africa is expected to absorb 56% of the rise in poverty, in part due to limited economic and social protection measures as well as debt burdens.

In the World Economic Forum’s weforum.org, the Dean of the Wharton Business School projects that COVID-19 would also reverse trends in globalization and urbanization. The resulting compression of the global economy, he predicts, will be further impacted by reduction in international cooperation and increased likelihood of international conflict.

250 million Africans could be infected, with up to 190,000 dead by years’ end

Modelling by the WHO predicts that nearly a quarter of a billion people across 47 African countries will be infected with the Coronavirus, with as many as 190,000 projected mortalities by year’s end, according to a study to be published in BMJ Global Health. While African countries may experience fewer severe cases and deaths per capita due to younger populations and lower obesity rates, health system capacity gaps and disruptions in maternal and child health could result in additional deaths.=

ODI calls for increased solidarity to support developing countries

The Overseas Development Institute estimates that the economic impacts of the pandemic to sub-Saharan Africa remain uncertain but will likely exceed $100 billion. While many countries have imposed stringent measures to contain the spread of the virus, there are immediate and long-term concerns about the lag in economic and social protection measures as governments face major liquidity and fiscal constraints. Since much of the global economic dislocation stems from decisions to protect citizens in wealthier countries, the ODI calls for increased international solidarity to support developing countries. That can include special drawing rights to address capital outflows, moratoria on debt service repayments, development finance to provide liquidity to protect employment, as well as non-concessional lending and economic resource packages as aid.

Rising Inequity Gap

The IMF warns that COVID-19 could widen the inequality gap between rich and poor across and within countries, urging policymakers to put in place risk-sharing and social assistance mechanisms to protect the most vulnerable from economic impacts. Using past pandemics as a guide, the analysis shows net increases in Gini coefficient (a measure of inequity within a country) after five years as well as long-term impacts due to job loss and other shocks to income (e.g. lower remittances). To minimize long-term damage (or “scarring”) to the livelihoods of vulnerable communities – and improve resilience to future shocks (including the effects of climate change), the IMF urges countries to consider a range of measures including:

Access to sick leave, unemployment benefits, and health benefits;
A “New Deal,” particularly in countries where the employment sector is largely informal and where social protection systems are limited; and
Expanding social assistance systems, introducing new transfers, boosting public work programs, and progressive tax measures.

“Nothing lays bare inequality and discrimination like a disaster”

In a forceful address on the human rights dimensions of the COVID-19 pandemic, the UN Special Representative for Disaster Risk Reduction highlighted the disproportionate impact on marginalized and vulnerable populations, amplifying social inequities, forced displacement as well as gender- based violence. The central message was that the international community “must do more.” This includes treating persons at risk as people with human rights and not just as beneficiaries of humanitarian actions, who are consulted in decision-making relevant to their lives, and to foster greater resilience by focusing on the drivers of disaster risk, including poverty, lack of international solidarity and pandemic preparedness, and increasing frequency and magnitude of extreme weather events.

‘Donor states can and must do more’

According to a Devex survey of development professionals, two thirds say donors are not doing enough to respond to the Coronavirus. The UN estimates that US$500 billion will be needed to address the pandemic in developing countries, as Oxfam urged 30 donors of the OECD Development Assistance Committee to contribute $300 billion. In addition to more funding, development experts point to three other steps donors should take:

Simplified funding mechanisms for a faster response;
Clarity and transparency on decisions; and
Looking beyond the immediate needs, including longer-term impacts of COVID-19 and what preparation is needed now to respond to those.

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“Impartial, independent, and comprehensive evaluation”

For the first time in the WHO’s history, its annual World Health Assembly (WHA) was entirely virtual. With a focus almost entirely on the Coronavirus pandemic, the condensed two-day meeting was preceded by three weeks of intense negotiations.

The most significant outcome this year was the adoption of a COVID-19 resolution that was proposed by the European Union and supported by 120 countries that contained three major elements (A73/CONF/1), including an “impartial, independent, and comprehensive evaluation (of the) international health response to COVID-19.” In the closing remarks, the WHO Director General affirmed that the review would take place “as soon as possible.”

Rising geopolitical tensions shape emergent Global Health institutions and practices

The WHA opened with a failed motion to grant Taiwan Observer status, underscoring growing tensions in part arising from accusations by the U.S. (and shared by other Western and Pacific Asian countries) that China was not transparent in the early days of the pandemic.

In a letter, the U.S. President threatened to permanently eliminate the funding that was temporarily withdrawn from the WHO, suggesting the U.S. would pursue bilateral aid channels including US$500 million to 40 ‘at risk’ countries. The President of China addressed the Assembly directly pledging US$2 billion over the next two years to support COVID-19 response efforts in developing countries, and an ambition to establish China as a “global humanitarian response capital and hub.” Focusing on African countries in particular, President Xi referenced debt suspension initiatives, building “green corridors” to accelerate delivery of essential goods as well as partnering with 30 major hospitals in Africa to build a China Centres for Disease Control headquarters on the continent.

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

The negotiations on access to treatments and future vaccines were far more divisive. Led by Costa Rica, developing countries and civil society organizations expressed particular concern about ensuring equitable access, including to COVID-related knowledge, lessons learned, experience, and best practices. The WHO Secretariat will have until May 29 to develop a framework for a voluntary COIVD-19 Intellectual Property Pool for patents and clinical trial data, while the EU-led resolution also references WTO TRIPS flexibilities allowing countries to override patents to ensure access.

COVID is a ‘wake-up call to our global fragility’

In his address to the World Health Assembly, the UN Secretary General called for greater unity and solidarity along three dimensions: a coordinated and comprehensive health response guided by the WHO and focusing on developing countries; policies to address the social and economic dimensions of the COVID crisis; and a response and recovery plan based on equity, inclusion and sustainability centred on human rights. Given the unprecedented nature of the pandemic, some civil society organizations such as South Centre expressed disappointment in the lack of ambition of the COVID-19 resolution. Knowledge Ecology International (KEI) likewise referred to the “typical watered down, lawyered ambiguity” of the final draft that fails to limit legal monopolies that could affect access (they noted that other proposals like Canada’s would have called for “universal and non-exclusive and open-licensing” that referenced data sharing and more expansive mandate beyond existing mechanisms).

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