How To BEST Prevent and Treat Covid-19 In Resource Limited Settings

WE are all watching with horror as COVID-19 overwhelms the world’s most advanced health systems in Asia, Europe, and North America, leading to tremendous suffering and death. Clinicians, scientists, and communities in low- and middle-income countries in Africa, Asia, Latin America, and the Middle East are bracing themselves. Health systems in some of the most resource-constrained areas are fragile and already under strain – and in crowded slums and townships, social distancing and enhanced hygiene measures to slow the spread will be difficult to implement.

There is a very narrow window for action to help mitigate this disaster, and it is rapidly closing.  

We have few tools to combat this new virus: personal protective equipment and ventilators are in short supply; no therapeutics are yet proven to effectively prevent or treat the disease; and no vaccine is likely for another year or two. Diagnostics are mostly still time-consuming, complex, costly, and lab-based, although our colleagues at the Foundation for Innovative New Diagnostics (FIND) are doing a remarkable job in accelerating the emerging pipeline of rapid tests.

For drugs, the response from the medical and scientific community has also been fast-moving, with new trials and results announced daily. DNDis closely monitoring the many clinical trials now underway. Particularly encouraging are the WHO-led SOLIDARITY trial for treatment of COVID-19 and the COPCOV trial for prevention, led by the Mahidol Oxford Tropical Medicine Research Unit.

But the overwhelming majority of the 600+ studies taking place worldwide are being conducted in high-income settings, where critical research questions specific to the needs of resource-limited settings are unlikely to be answered.  

While approaches to prevention of new cases – for example pre-exposure prophylaxis for health care workers – may be similar, the tools and approaches to treatment that will work in Berlin or Bangkok may be hard to replicate in Lubumbashi or Lilongwe, especially for severe cases.

What interventions will work best in fragile and overburdened health systems with little to no intensive care capacity?  Will the treatments being investigated today, such as remdesivir – an intravenous drug needing refrigeration – be implementable in settings where hospital capacity is limited, and electricity unreliable?  How can we focus research efforts on treatments that could be effective at an earlier stage, delaying disease progression and the need for intensive care for severe complications?  And what are the implications of widespread underlying co-morbidities, such as malnutrition, HIV, TB, and neglected tropical diseases, on transmission and clinical outcomes?

Only a coordinated response with global cooperation and solidarity, led by experts in low- and middle-income countries, can ensure the rapid action required to generate the needed evidence for new tools.

That is why DNDi has helped launch a new international coalition – the COVID-19 Clinical Research Coalition. Together with the more than 70 other partners that have joined us to accelerate COVID-19 research in resource-limited settings and promote the greatest possible sharing of research knowledge and data.

The Coalition will also push for equitable access to the fruits of scientific progress on COVID-19 – for there are looming questions in this regard.  Will new tools be affordable and available in low- and middle-income countries?  Will intellectual property barriers stymie research collaboration, access, and production? Will stockpiling or export bans leave little to no supply for low and middle-income countries?

At DNDi, it is our view that all new health tools for life-threatening diseases, including COVID-19, must be developed as global public goods, available to all who need them. Never has this imperative been clearer than it is today.

The pandemic we have feared and anticipated for years is now here. The success of the global response will depend upon our collective action to support health research and development that is in the public interest, prioritizes the most vulnerable, and makes sure that the best science serves even the most neglected.

Dr Bernard Pécoul, Executive Director, DNDi

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