On Monday, April 27, Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (WHO), called for a renewed focus on primary care services, such as vaccinations, in the midst of the pandemic. Noting that COVID-19 has threatened immunization campaigns and other essential health services, Dr. Tedros asserted that if such needs go unmet, “The tragic result is children will die.”How can the world respond to this call to protect primary care when attention is diverted to containing the spread of COVID-19 and saving lives in the immediate term? On Sunday, April 26, Bill Gates, Co-Founder of the Bill & Melinda Gates Foundation, noted in an interview with the Financial Times that the Foundation would give its “total attention” to the COVID-19 pandemic. Given this pivot, the Foundation’s work on clinical trials and vaccination campaigns will suffer: “We’ve taken an organization that was focused on HIV and malaria and polio eradication, and almost entirely shifted it to work on this [pandemic],” he said.

Clearly, there is a huge gap in meeting public health challenges. When donors move from supporting essential primary care services to responding to urgent needs, it is apparent that society has a long way to go in building resilient and sustainable health systems that can weather the storm of a pandemic.

The private sector can help fill this gap. Business has an indispensable role to play in safeguarding public health and numerous companies have stepped up to contribute to the pandemic response. COVID-19 is fueling more public-private partnerships, which are often effective models for long-term impact. Johnson & Johnson’s collaboration with the U.S. Department of Health & Human Services to produce one billion vaccines – if the candidate is successful – is one example of a cross-sector partnership in action.

This week’s issue of Rabin Martin’s COVID-19 Briefing spotlights the need for public-private partnerships and their potential to mitigate the effects of the pandemic and avert future public health crises. See more of Rabin Martin’s COVID-19 briefings here.

In-Depth Look: Public-Private Partnerships

On Friday, April 24, the World Health Organization announced a new initiative in partnership with several country governments, industry groups and civil society organizations focused on ensuring global access to new medicines and technologies to fight COVID-19. The Access to COVID-19 Tools Accelerator (ACT Accelerator) is a collaborative effort to develop and manufacture new diagnostics, therapeutics and vaccines for COVID-19 and ensure global access – based on “an unprecedented level of partnership.” In a demonstration of such collaboration, Sir Andrew Witty, President of UnitedHealth Group, and Dr. Ngozi Okonjo-Iweala, Chair of the Board, Gavi, the Vaccine Alliance, will serve as Special Envoys for the ACT Accelerator. A pledging campaign will begin on Monday, May 4, with the aim of securing $8 billion in financing.

Key partners include the Bill & Melinda Gates Foundation, Coalition for Epidemic Preparedness Innovations, Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, Wellcome Trust, World Bank and the International Federation of Pharmaceutical Manufacturers & Associations. G20 President Mohammed Bin Abdulla al-Jardan asserted that safeguarding public health against future pandemics “will be the smartest investment for us all to make today.” Notably, the U.S. and China have not signed on to the ACT Accelerator.

Similarly, the Rockefeller Foundation’s commitment of $15 million to a COVID-19 national testing action plan in the U.S. underscores the importance of collaboration across sectors. “Now more than ever, philanthropy needs to work together with business and government to offer a new vision of how the world can cooperate,” said Rajiv Shah, President of the Foundation. As part of its efforts, the Foundation is building a coalition called the Testing Solutions Group, which aims to “bring together expertise from industry and academia to develop strategy and policy recommendations” to support city governments as they rapidly expand testing.

In another example of a newly formed public-private partnership to combat COVID-19, on Wednesday, April 29, the U.S. National Institutes of Health (NIH)  announced a $1.5 billion initiative to speed development and delivery of diagnostics. The Rapid Acceleration of Diagnostics (RADx) initiative calls for scientists across the country to compete for a share of this funding to develop and scale up production of effective diagnostics, with the ultimate objective of deploying millions of tests per week. “RADx is an urgent call for science and engineering’s most inventive and visionary minds—from the basement to the board room—to develop rapid, easy-to-use testing technologies,” said Dr. Francis Collins, Director, NIH. This new effort builds on NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership, through which government, nonprofit and 16 biopharmaceutical partners are collaborating to speed research into the most promising treatment and vaccine candidates.

Dr. Bourdeaux highlighted the often-overlooked indirect contributors to death and morbidity following a disaster, noting that humanitarian crises, health emergencies and earthquakes tend to kill more people indirectly. Knock-on impacts – including economic fallout, people driven into poverty, collapse of health systems – are ultimately more destructive than the immediate health toll. She added that the Ebola outbreak in West Africa in 2014-2015 infected 26,000 people and 11,000 of them died, however the crisis led to a $53 billion downturn in the regional economy.

The challenge is communicating these dangers – even though they are obvious in the moment – in a way that prompts timely preventive action in the public health sphere, even as attention shifts to economic recovery. This is true currently with the COVID-19 response: “The temptation in the U.S. is to bring a bazooka to the economic crisis, but a water pistol to the health crisis.”

Dr. Bourdeaux added that in many countries, there has been a “hollowing out” of health systems – including the primary care system in the U.S. Where health systems are weak, they struggle more with epidemics. Dr. Kerry added that the most fragile systems will be the hardest hit and least able to care for their populations.

And while many think of health systems as just labs, testing agents and infrastructure, Dr. Bourdeaux commented that the relationship between individuals and their health providers to solve routine problems is the underpinning of a robust health system. Likewise, she emphasized that an epidemic is worse when people don’t trust their health system: “Trust is the biggest intervention in promoting health security.”

Dr. Kerry added that health security is national security and that a failure to invest in health meaningfully will leave us all vulnerable: “We are only as strong as our weakest neighbor.”

She urged a shift in thinking about health – moving away from health as a charitable or scientific enterprise to viewing health as a prerequisite for security. “We need to get more serious about building health systems around the world to detect and contain emerging threats because we are all depending on other countries to keep us safe.”

In terms of the private sector’s role, both urged that companies speak up about the need to invest in primary health care and health governance – and also invest in policy conversations and forums to bring security, financial and health policymakers to the same table.

Likewise, Dr. Kerry noted that the willingness of businesses to invest in the health of their own workforce and communities will go a long way toward protecting populations, improving community wellness and reducing vulnerabilities. If a company’s workforce gets sick, it’s harder to do business: “We need to think more holistically about a well-being agenda which would help businesses become more sustainable and lead to a steadier state of growth and prosperity.”

Pandemic Spread

COVID-19 Global Cases (Center for Systems Science and Engineering at Johns Hopkins University) 

This week, the global community passed the tragic milestone of reporting 3 million cases of COVID-19 worldwide. Confirmed cases in the U.S. now total more than 1 million, but experts warn that the true number is undoubtedly significantly higher. The U.S.’s poor testing strategy has hamstrung the country from the beginning of its response, and limited access to tests continue to produce unreliable estimates for total cases. The focus on measuring deaths by positive tests alone underestimates the number of individuals dying of usually treatable conditions, like heart attacks, because they are unable to access care in an overburdened health system.

Worldwide, as of Thursday, April 30 at 1:30 pm ET, the Center for Systems Science and Engineering at Johns Hopkins University reported 3,231,701 confirmed cases and 230,615 deaths attributed to COVID-19.

There is no longer any question that the U.S. is confronting the worst COVID-19 epidemic across the globe. The question now is how the U.S. will move forward in its response. On Monday, April 27, the Trump administration unveiled a “Blueprint” for testing and rapid response programs to reopen the country. Key among the Blueprint’s promises is a dramatic expansion of U.S. testing capabilities to run 2 million tests per week. Experts warn that the need for testing varies by state and, even with expansion, many states are significantly below these testing targets. Some experts caution these targets are too low to provide the kind of surveillance data needed to monitor the epidemic and prevent a resurgence of infections. Government officials have expressed further concern that these targets are not attainable given current shortages and under resourcing.

The Blueprint also relies heavily on antibody testing to identify those who have already had the virus and are presumably safe to return to work. This recommendation puts the onus on states independently to verify the validity of antibody tests not yet authorized by the FDA, a valid concern given that a review of 14 available antibody tests showed that only three produced reliable results. Furthermore the WHO warned against such reliance on antibody testing saying, “At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediate.

 Industry Developments