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When the HIV pandemic terrorized the world 40 years ago, it took a decade to make antiretrovirals accessible to the poorest. When the HN1N1 virus also became a pandemic problem, vaccines were invented fairly quickly, but when they reached less developed countries, they were no longer needed. And when covid-19 broke in a year ago, the picture looked similar. In order not to repeat mistakes of the past, nine international health agencies decided to form a philanthropic alliance. They called her Access To Covid-19 Tools Accelerator (ACT-Accelerator), which in Spanish means Accelerator of Access to Tools against covid-19, and its objective was twofold. The first is to rush to find good diagnoses, drugs, and an effective vaccine. The second, once those tools are found, achieve fair access for the rich and poor. This is now its first year of life and it is time to take stock.
Today we know that the new coronavirus has killed more than three million people, that it has infected almost 150 million, that it has pushed another 100 million into poverty and that the global economy has lost nine trillion (with be) of dollars. Has this super coalition served any purpose? For Françoise Vanni, director of external relations of the Global Fund One of the organizations involved in the ACT-Accelerator in the fight against HIV, tuberculosis and malaria, it could have been much worse. “There are to remember where we started from. Last year we did not know anything about the virus, there were no mechanisms to act collectively, there were no rapid diagnoses, it was not known what kind of treatments could work, there was not a single vaccine … ”he recalls. “Enough has been done, although not enough: the response is still a bit scattered, with political and commercial interests that have prevented working more closely” he values.
ACT-Accelerator is organized into three pillars: diagnostic, treatment, and immunization. Each of them is led by various international agencies such as the World Health Organization (WHO), UNICEF, the Gates Foundation, the Foundation for Innovative New Diagnostics (FIND), the Alliance for Vaccines (GAVI) and the Global Fund itself, among others. In the impact report just published it reveals all the good that has been achieved, and also all that has not been able to be.
“The markets for the acquisition of diagnostics were totally bankrupt. It was like a war between countries that had enough money to buy diagnostics and those that had almost nothing. Without a collaborative framework, it would have been much worse ”. This is how Sergio Carmona, acting CEO of FIND, recalls the first weeks of the pandemic. Now the situation is different. In the diagnostic field, 120 million rapid antigen tests have been reserved for low- and middle-income countries, of which 32 million have been sent, along with another 32 of PCR tests. Specific training on covid-19 has been provided to more than 23,000 health workers in 200 countries.
The goal for 2021 is to provide a total of 900 million rapid tests for less developed nations. “A year ago we only had PCRs, which are more expensive and require a laboratory and a trained technician behind it. In eight months we managed to launch the rapid antigen tests, it took five years to achieve that in the fight against HIV! ”, Celebrates the spokesperson for the Global Fund, who is part of the coordination of this first pillar.
In 2020, fewer than one in five health centers in Africa had access to diagnostic tests for covid-19
However, a serious problem remains: that low- and middle-income countries continue to have very little access to these tests to diagnose COVID-19, the first step in controlling the disease. In 2020, in fact, less than one in five health centers in Africa had access to them. In the end, for every test carried out in a poor country, more than 80 are made in a rich one. “In these countries they work as if they had their eyes covered because they cannot know how the pandemic is going, if they are variants or not … This is a problem for the safety of people, but also for global health security: not knowing what what is happening in a country is the same as not knowing what is happening in the world ”, warns Vanni.
In the therapeutic field, 2.9 million doses of dexamethasone were obtained, the only treatment against COVID-19 approved by the WHO; 15 clinical trials have been supported, and 21 therapies have been investigated in 47 countries with 85,000 patients involved. By December 2021, it is expected to have been able to give 245 million treatments. The challenge now is to find the definitive drug. “At this point we are still a bit awakening; we have dexamethasone and more successful clinical protocols, we know how to use oxygen much better … But we do not have a remedy as such ”, sums up the representative of the Global Fund.
The coveted vaccines
Regarding immunization, ACT-A and its diplomatic work contributed to 190 countries joining the Covax mechanism, the initiative led by WHO, United Nations and GAVI to guarantee access to the vaccine in developing countries. To date, it has led to the shipment of 40 million doses to more than 100 economies, and the goal by the end of the year is to have delivered 2.5 billion. However, it is still far from being fulfilled, as warned by the director general of the WHO, Tedros Adhanom Ghebreyesus.
Although the goal was to start immunization against the coronavirus in 220 countries in the first 100 days of 2021, by mid-April the promised 200 million doses had not been achieved or distributed: while 87% of those vaccinated They are from rich countries, in the least developed they have barely reached 0.2% of the population. “There is a serious equity problem, but there is also a problem of stocks”Vanni warns. “There are countries where vaccines are not being used, or they are not being used as quickly as required, and they could share the doses. The President of the Government of Spain has already committed to this, ”he recalls, and other countries such as France and the United States have as well.
Decentralization may be one of the solutions. Carmona explains that in the field of diagnostics, work is already underway to support initiatives like this. “We have investments in Senegal and South Africa, and possibly in other countries that we are still evaluating, it could be Kenya,” he advances.
Meanwhile, many voices have been raised, especially from the global south, calling for the liberalization of patents to facilitate more equitable access to immunizations. In recent days, in fact, important steps have been taken. India and South Africa announced this week that they will submit a new proposal to the World Trade Organization (WTO) which has been joined by more than 60 countries. Among them, the United States, which decided on Wednesday to support the initiative while the pandemic lasts. Hours later, Spain has seconded the proposal, while the European Union has stated that it is willing to negotiate.
From ACT Accelerator, the contribution has been to launch the Covid-19 Technology Access Pool, that is, a free access platform where to share, always on a voluntary basis, information, data and knowledge generated around the new coronavirus in order to accelerate the development of new products.
The crisis in India reminds us that we are still in a crisis and we need to scale up efforts, coordination, innovation and funding
In addition, there is a fourth arm in this strategy that is transversal to the previous three: the one that has to do with health systems. Providing tools to any country is useless if there is no system that can receive and deploy them in an equitable and efficient manner. The systems are the people: health workers, community workers … Above all, the front line. Thinking about them, what the ACT-Accelerator did in 2020 was to acquire and distribute personal protective equipment (PPE) worth 500 million dollars, or to carry out surveys in 129 countries to assess the obstacles that health personnel were encountering, among other initiatives.
But there is a long way to go, according to Vanni. “During the first months, perhaps not enough importance was given, and neither were laboratory systems, supply chains, data systems to monitor the epidemic … It is very important to support local workers and provide the tools quickly, but much remains to be done and we are seeing it now in the dramatic case of India, which reminds us that we are still in a crisis and we need to scale up the efforts, coordination, innovation and funding that we need ” .
Speaking of financing, when the platform was born an initial investment plan was made and it received funds for the different pillars and tools for a total of 14,000 million dollars. A year later, and after re-evaluating the needs, ACT-A now has a funding gap of 19,000 million more by 2021. countries to request support and they are doing a great job, ”says Vanni. On the horizon is the World Health Summit on May 21, from which more countries are expected to support and more funds to arrive.
The final balance in this year of war against covid-19 is summarized in a priority: to achieve equity, a totally uneven equity, as evidenced by the data collected, which is seen in examples such as the one reported by Carmona. While he, in Geneva, can go to a pharmacy and take five rapid tests for free, in other countries only 11% of the population has had access to these tests. “The only way out of this crisis is to respond on all fronts by optimizing the use of the tools we have, distributing them fairly and putting people and communities at the center,” insists Vanni.
Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.