Gilead Stock – The Covid tool every nation still needs
This week we’re looking at the status of Covid-19 treatments while the world waits for more vaccines.
CAN I TAKE SOMETHING? — It’s going to take a good while to vaccinate the world against the coronavirus. In the meantime, drug development has lagged. We don’t have anything resembling an affordable treatment millions of people can take at home immediately after Covid exposure or when they start to experience mild symptoms.
So, for now, the world basically has one old-standby drug that helps very sick people; monoclonal antibodies that are expensive and complex to administer; and some unproven or questionable drugs that people are using to self-medicate, particularly in poor countries.
On the horizon – maybe? Global health experts are closely following clinical trials of molnupiravir to see whether the antiviral pill works in mild and moderate cases. Colchicine, an anti-inflammatory widely available in poor countries, is being studied against mild disease. If it does work, production could easily be scaled up, according to the World Health Organization. The British government this week launched a task force to find at least two drugs by the fall that people could take at home to prevent hospitalization.
The only treatment WHO currently backs is dexamethasone, an old anti-inflammatory drug given to Covid-19 patients sick enough to require oxygen. It’s not an expensive drug, but international organizations UNITAID and UNICEF put $8 million last year toward stockpiling millions of doses to help poor countries access it in case of a global shortage.
Afghanistan, the Central African Republic, Djibouti, El Salvador, Lebanon, Mali, Somalia, Tajikistan and Zimbabwe have received 750,000 doses from the stockpile as of late January, according to UNICEF data. But demand has been limited, as countries need to train health workers on how and when to use it.
“The reality is that the demand was not really there,” said Philippe Duneton, the executive director of UNITAID, a WHO-hosted agency that has helped develop and distribute Covid-19 therapies. It’s possible, however, other countries may have purchased the medicine directly from producers, rather than turn to the stockpile, he added.
More complicated treatments like monoclonal antibodies, which can prevent people from developing severe Covid-19 if given early after infection, also need health systems capable of using them, Duneton said. That means being able to deliver Covid test results within hours and quickly administering the hour-long infusions. Poor countries’ access to the few such therapies backed by the U.S. drug regulator – but not yet by WHO – hasn’t progressed much in the five months since we last checked in.
One thing that has changed: the emergence of variants. That’s already put one monoclonal antibody therapy out of action. Two combinations of such therapies remain available in the U.S, but it’s unclear if other countries use them.
Countries have also largely shrugged off WHO’s advice not to use Gilead’s remdesivir because it didn’t find sufficient evidence that it works, though the U.S. regulator said it does speed recovery of severely ill people. India produces it locally, but it’s experiencing shortages during its severe outbreak. India and Kenya both report scarcity of Tocilizumab, a rheumatoid arthritis drug that a UK. trial found reduces the risk of death in people hospitalized with severe Covid-19.
Self-medication: Lacking treatments, people are turning to unproven drugs. In India, for example, some people ending up in the hospital told doctors they used hydroxychloroquine, a much-hyped antimalarial that clinical trials found is ineffective against Covid. Others have also caught on, including ivermectin, a controversial anti-parasitic that WHO says should only be used in a clinical trial.
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PANDEMIC-FIGHTING CHATBOTS — Facebook-owned messaging platform WhatsApp has been a cornucopia of Covid misinformation, frustrating government efforts to tamp down harmful messaging. The popular service, with 2 billion global users, is now partnering with about 150 national, state and local governments, including India and Brazil, on chatbots sending official – and accurate – health information directly to people who ping the service. A WhatsApp chatbot is even the official channel for vaccine sign-ups in two of South America’s largest cities, Buenos Aires and São Paulo, writes POLITICO’s Mohana Ravindranath.
It represents a small part of the ongoing effort to spread trustworthy health information during the crisis – and it’s reasonable to wonder about its broader impact in places like Brazil and India, home to the world’s two worst Covid hotspots.
But WhatsApp does report high levels of interest in what’s essentially been a huge public health experiment. About 3 billion messages have been sent across these bots in the past year, including 300 million since January.
What people ask tends to vary by season, said Aakrit Vaish of Haptik, the company that built the chatbot for the Indian government. He said questions include: Why is this happening? Will I get Covid if I get vaccinated? Are lockdowns real? Earlier in the pandemic, Vaish said, questions were more focused on Covid-19 symptoms.
Haptik and India’s digital government ministry, MyGov, said the country’s chatbot has processed more than 45 million conversations in a year. But not everyone can use it. Though WhatsApp can operate on simple mobile phones, large swaths of the Indian population don’t have those, Vaish said. It also only takes in messages in Hindi and English.
Before the pandemic, WhatsApp chatbots were mostly built by companies looking to automate customer service. Building a public health chatbot is more complicated, especially when people might be seeking medical advice. The bots only direct people to more official sources of information, according to WhatsApp.
“When it comes to the government, and when it comes to the worldwide pandemic, the engine needs to be very scripted,” Vaish said. “You can’t let the AI determine what’s right and what’s wrong.”
So far, the White House has said only that it’s considering a range of options to help globally. But top diplomats – including U.S. Secretary of State Antony Blinken – have been in touch, and one optimistic Indian government official did tell Reuters his country expects the U.S. to lift the ban. The head of the Serum Institute of India, the world’s largest vaccine manufacturer, chimed in on Twitter, asking Biden to lift the embargo.
But White House officials have danced around questions about exports. White House Press Secretary Jen Psaki this week only offered that the U.S. is looking at ways to help other countries fight the pandemic. State Department spokesperson Ned price said that the world also has a stake in Americans getting vaccinated. “I don’t have to tell you that this country has suffered tremendously,” he said, noting the U.S. now has well over a half a million Covid-19 deaths and tens of millions of cases.
India is now second to the U.S. in total cases, with more than 15 million. Its reported death toll, around 180,000, places it third after the U.S. and Brazil.
HOW TO MAKE THE EARTH HEALTHIER — On Earth Day, it feels worth noting health care’s role in shaping another global crisis: climate change.
If it were a country, the global health care sector would be the fifth-largest polluter in the world, responsible for 4.4 percent of global carbon dioxide emissions, mostly in rich countries. The sector emitted the equivalent of 2 gigatons of carbon dioxide in 2014 – an amount set to likely triple by 2050 if nothing is done to change the trajectory, according to a recent report by Health Care Without Harm, an international NGO.
The organization and engineering consultancy Arup laid out what the health sector must do to achieve net-zero emissions by 2050, the deadline that many countries have set for that goal. The bottom line, according to the report: The sector has a long way to go toward sharply reducing the use of fossil fuels powering hospitals and the manufacturing and distribution of medical products.
THE OTHER BIG KILLER — Before Covid-19, tuberculosis was the world’s deadliest infectious disease, killing almost 4,000 people per day in 2019. Once the pandemic recedes, global health experts expect that tuberculosis will reclaim its top killer status.
Their hope, though, is that the partnerships forged between governments and drugmakers during the pandemic, as well as global efforts like the COVAX program for distributing vaccines, would become a model for a tuberculosis vaccine for adults that is so desperately needed. The only available TB vaccine, the century-old Bacille Calmette-Guérin (BCG), is used to protect babies from severe disease but doesn’t stop transmission of pulmonary TB in adults due to a combination of the protection wearing off after 15 years and different circulating strains of TB bacteria. Though governments committed to invest in accelerated vaccine research in 2018, the pandemic set back TB control programs while resources for vaccine research stayed flat, WHO said.
Together with the European & Developing Countries Clinical Trials Partnership and the Amsterdam Institute for Global Health & Development, WHO laid out a research and development plan for TB vaccines this week, calling for a diversified pipeline of vaccine candidates, accelerated development and a better assessment of countries’ demand for TB vaccines.
“One hundred years after BCG, there is real hope that disadvantaged populations around the world can finally gain the benefits of TB prevention and cure through the use of vaccination,” the organizations wrote.
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