COVID-19: Meeting the access challenges, Part 5
By Yvette Madrid, Evan Lee and Jon Bastow
A 5-part series which delves into the challenges and solutions of getting diagnostics, drugs, and vaccines for Covid-19 to all who need them. Previously published:
Part 5. Bringing it all together
In the previous series of blogs, we have attempted to separately address the specifics of access for vaccines, drugs, and diagnostics for COVID-19. Further R&D is needed for all of these to ensure that effective products that meet the needs of resource-limited settings where health care infrastructure and highly trained healthcare workers are not always available. For diagnostics and therapeutics, in particular, the need is for safe and reliable products that are available and affordable close to the communities where people live. Supply chain challenges must be considered, including cold chain requirements; preventing fakes; and assuring quality all the way down to the user, although these vary across the categories and within them as well.
Ultimately, it is insufficient to address access for each product category on its own. The access interventions must work together in a coordinated fashion to enable countries to be able to adequately meet the challenge of COVID-19. For example, the ability to make a diagnosis has to be linked to treatment. At a front-line clinic in a rural area, having a diagnostic test that can provide an immediate result and that is suitable and available for use by a nurse or medical assistant will be needed to target appropriate treatment — if it becomes available — in these settings.
Diagnostics may also be relevant for vaccine use. There may exist reasons to avoid vaccinating individuals who have recently been infected (limited supply, safety), but this can only be done if reliable point-of-care diagnostics are very widely available. Similarly, should an effective vaccine also have rare adverse events stemming from immune system dysregulation, it may still be desirable to use this vaccine, but it will be vital to ensure that treatment for any eventual side-effects is also available.
Antibody-based products may be useful in both preventing and treating Covid-19. Currently, they require a cold chain and are administered by infusion or injection. In purpose (prevention) and in delivery and supply chain requirements these products could overlap with those of immunization systems in countries. Considerations for optimizing access to these products, at global and national levels, must take into account their possible dual roles and their supply chain requirements.
In summary, the world will need to have simultaneous availability of diagnostic, drugs, and vaccines — whether at a highly sophisticated referral hospital located in a big urban center that is staffed by highly trained specialist doctors, or at a community clinic located hundreds of kilometers from the nearest city that is staffed by a nurse. Although lab networks are often established separately from hospitals and clinics, it will be critical to link these elements through tools such as DHISII ( District Health Information System II) This enormous disparity in health settings has to be considered in the design of effective access solutions, along with the specific uses of each product. The first step of aligning objectives across global access mechanisms is needed, but global access will require further planning and significant investment. Currently, diagnostics, drugs, and vaccines can be procured and supplied through different channels, yet defeating COVID-19 will require strengthened coordination and near real-time visibility of the movement of products. The technology exists to achieve this, and indeed some initial steps towards this have been made, but much more coordination, investment, and urgent effort is still required.
Covid-19 access solutions are being developed from a base of past initiatives. There have been many successes in getting needed products — both innovative ones and existing ones — to populations who otherwise would not have had access. Yet, siloed approaches will be insufficient to meet the global urgency and scale of this outbreak. This will have to be done through both the tighter linking of development that’s already underway along with investments in innovative approaches to access that go beyond affordability. Work already underway to harmonize and streamline regulatory processes should be accelerated, and the rapid pace of innovations will mean that developing and updating guidelines in real-time will be needed.
Certainly, new and bold platforms like ACT-Accelerator, and a range of new partnerships that have been created demonstrate the willingness of a broad range of stakeholders to rapidly address these issues. In fact, we have never before seen this scale of commitment to equitable access to existing and still-to-be developed health goods. No one can undo this pandemic, but these extraordinary collective efforts give countries a fighting chance to change its course — and to be ready for future pandemics.
…………………………………………………………………………………….
Yvette Madrid is a Swiss-based, global health consultant with expertise in immunization and health product access. She has worked for the International AIDS Vaccine Initiative (IAVI), PATH, UNITAID, and the World Health Organization (WHO), and has also served as an advisor to the latter. With a background in biomedical engineering, she holds a doctorate from the Massachusetts Institute of Technology.
Evan Lee is a Geneva-based consultant and an expert in global health policy. He has previously worked for pharmaceutical company Eli Lilly, the Foundation for Innovative New Diagnostics (FIND), Management Sciences for Health and Medicines Sans Frontieres. A medically qualified doctor by training, he has a BA in chemistry and physics from Harvard University, a medical degree from New York University School of Medicine and an MBA from Massachusetts Institute of Technology.
Jon Bastow helps organisations accelerate innovation across R & D and Access in healthcare. He brings over 30 years of experience, having led R&D and access projects across multiple diseases. He has held senior roles in pharmaceutical companies and international organisations such as FIND and The Global Fund, building partnerships between private sector healthcare and tech companies, NGO’s and governments addressing major problems of poverty. Jon is a member of the Chartered Institute of Marketing, holds degrees in Biochemistry and Philosophy and has given lectures at IMD, London Business School, INSEAD and the Graduate Institute in Geneva.
