While we’re starting to see early signs of a flattening curve of new infections in some hotspots, the COVID-19 pandemic continues to overwhelm health systems and communities around the world, with COVID-19 related deaths rising every day. It’s been clear from the outset that mortality rates are highest among older populations, and that risk only increases with age. What’s growing ever clearer as more data become available is that the virus is also affecting people of color and lower-income groups disproportionately.

The pandemic is shining a spotlight on disparities in access to healthcare, highlighting gaps in global and domestic responses that are leaving people behind. COVID-19 is a “time bomb” for the most vulnerable populations, including those who are homeless or incarcerated. And as John Nkengasong, head of the Africa CDC has observed, “Even countries in sub-Saharan Africa that are better off, like Kenya and South Africa, have huge populations of vulnerable people. I cannot imagine what will happen if the coronavirus spreads to slum areas around Nairobi and Johannesburg.”

From an economic standpoint, while the $2.2 trillion CARES ACT relief package will alleviate some of the short-term economic burden in the U.S., it neglects the needs of many low-wage and undocumented people who work in industries, such as restaurant and  hospitality, that have been shuttered.

As the debate heats up about “reopening” for business, global, national and local decision makers must grapple with tough questions. When does predictable and avoidable loss of human life become “acceptable”? What are the opportunity costs of flattening the curve? How long can we afford to lock down the economy? Who gets a voice in the decisions of when and how to loosen public health countermeasures in the interest of returning people to work?

This week’s Rabin Martin COVID-19 briefing explores how the pandemic is magnifying longstanding health and economic disparities and the danger of maintaining the status quo. For more information, please see our previous briefings and further details on our broader response to COVID-19.

COVID-19 & Discrimination: Exacerbating Health Disparities

Racism During a Pandemic: Populations at Risk

It’s clear that COVID-19 knows no borders and does not discriminate. The highly infectious and widespread nature of the disease has forced people across the socioeconomic spectrum to self-isolate. Yet, a growing body of data makes clear that in the U.S., African Americans are being infected in greater numbers and dying at higher rates. In Chicago, African Americans account for almost half of all residents who have tested positive and 55 percent of deaths, although they represent only 30 percent of the population. In Milwaukee, nearly three-quarters of all COVID-19 related deaths are among African Americans, even though they represent less than 40 percent of the population.

Historically, people of color have faced significantly worse health outcomes than other groups. African Americans face higher rates of obesity, diabetes, asthma and heart disease; racial disparities in maternal mortality rates are particularly glaring, with black women three-four times more likely to die from complications of pregnancy or childbirth than white women.

While there has been denialism around disparities in the care and outcomes for patients with COVID-19, Morehouse School of Medicine fellow Camara Phyllis Jones argues, “COVID-19 and the statistics about black excess deaths are pulling away that deniability.” A variety of organizations including the American Hospital Association, American Medical Association, American Nurses Association and National Hispanic Medical Association sent letters (April 3 and April 14) to Dr. Alex Azar, U.S. Secretary of Health and Human Services, urging the Trump administration to develop approaches that specifically address the COVID-19 needs of minority populations. The Lawyers Committee for Civil Rights Under Law’s letter to Dr. Azar called similarly for the federal government to release data on the race and ethnicity of people being tested for, infected with and dying of COVID-19, noting, “This Administration’s alarming lack of transparency and data is preventing public health officials from understanding the full impact of this pandemic.”

A Global Lens

Globally, the efforts of low- and middle-income countries to address the pandemic are plagued by inequities in gender, race and socioeconomic and health status. In Latin America, governments continue to be undercut by wealthier countries as they bid for essential supplies. The New York Times reports, “Another troubling divide is also emerging, with poorer countries losing out to wealthier ones in the global scrum for masks and testing materials.” Widespread poverty in areas like Rio de Janeiro pushes many to continue working in the face of lockdowns, forcing on working parents the impossible choice of whether to put their families at risk from the virus or from hunger. On Wednesday, April 22, World Food Programme Executive Director David Beasley warned that this dilemma is provoking a “hunger pandemic.”

Meanwhile, Africa is facing severe disparities in access to critical equipment and technologies to combat COVID-19. The shortage of ventilators is dire: 10 African nations have no ventilators to treat virus patients who need respiratory support. According to the World Health Organization, fewer than 2,000 working ventilators, many of which are clustered in South Africa and other relatively economically-advanced countries, will have to serve hundreds of millions of people in public hospitals across the continent.

On the Frontlines of the COVID-19 Response

Q: What are your greatest concerns for health providers at this time?
A: I am most concerned about the health workers on both ends of the spectrum – from those at the frontlines facing high-risk situations and burnout, to those who are furloughed due to the cancellation of elective procedures. We hear a lot about our health care heroes – the ones risking their own health in the busiest COVID-19 hospital units in the country. My daughter is a nurse at a busy Boston hospital, so of course I am concerned about the health and wellbeing of our frontline warriors. However, we are hearing less about the health workers who now find themselves out of work. In my home state of Kentucky, the largest care provider in Southeastern Kentucky has announced that it will have to furlough 500 employees.

How do we maintain an effective, high-quality, pandemic-ready health system when we do not have processes to ensure that health workers are deployed where they are needed most and adequately compensated and supported for their work?

Q: How could the site where you’re working have prepared better?
A: We are in uncharted waters with a new virus and we are learning every day. Preparedness is not sexy. It doesn’t get the funding it deserves and the lack of resources is evident at every level. The good news is that I am seeing some creative solutions that may even endure post COVID-19. For instance, our hazmat team figured out that they could use an agricultural sprayer to sanitize large areas like the drive-through testing center. These kinds of innovations emerging from necessity are ingenious, effective and often cost-saving.

Q: What’s your sense of the equity issues at play?
A: Women outnumber men 3 to 1 in health care fields. And of course, women are often the primary caregivers at home. This means that women are bearing the weight of this crisis. Not surprisingly, all of the volunteers I have met are women.

I’m concerned that the altruism that drove many health workers, mostly women, to choose these careers is being exploited. Health workers deserve crisis pay and there should be more compensated short-term positions to support the health system. I am fortunate that Johnson & Johnson has expanded its global volunteer program to allow health workers up to 14 weeks of paid leave to volunteer during the pandemic; unfortunately, many people are volunteering without pay or additional support at home.

Q: What are you bringing back to your colleagues at J&J from this experience? What’s important for them to know about what’s happening on the frontlines?
A: This experience has given me a deeper understanding of the challenges of large-scale public health programs. I am being transported from theory to practice. I cared for patients for many years prior to joining Johnson & Johnson, but I have never been on-the-ground in a public health emergency. I see how important it is to think big about addressing public health challenges – and that we have to build infrastructure for our big ideas!

Q: What advice would you like to share?
A: As difficult as it is, we must continue to follow current guidelines for safety. This is important on both a personal level and for society broadly to ensure our health workers can provide the best care for everyone. We are learning more every day about how to keep our communities safe, and we need to course-correct based on those learnings. This is not the new normal. This is only the normal for right now.

Private Sector Insights

On Thursday, April 23, we hosted our 9^th virtual briefing of the Private Sector Roundtable (PSRT) for global health security. We were joined by Rear Admiral Nancy Knight, MD, Deputy Incident Manager, Global, CDC COVID-19 Response, to learn more about how the CDC is supporting Africa in responding to COVID-19.

Dr. Knight discussed Africa’s growing pandemic, which is in the “acceleration phase.” While most new COVID-19 cases are coming from Europe and the Americas (each of these regions account for 44 percent of new cases in the last 24 hours), the number of cases in Africa is expected to increase rapidly. At present, official estimates are reporting about 16,000 cases and 720 deaths, likely low compared to actual figures. She noted Imperial College’s modeling shows that Africa could see more than one billion infections and two million deaths due to COVID-19 – which may be an underestimate given assumptions of health system capacity and ability to implement social distancing measures.

The CDC is examining key gaps within African countries’ health systems that are specific to COVID-19, including those related to lab systems, emergency response and pandemic preparedness planning, infection prevention and control, surveillance and vaccine capabilities. Some of the major gaps are related to hygiene due to lack of access to clean water, soap and alcohol-based hand sanitizer. In response, the CDC is providing recommendations to communities about keeping water as clean as possible and alternatives to handwashing. Similarly, the CDC is providing operational guidance to reduce strain on health care settings, such as triaging patients, performing safe and dignified burials and ensuring continuity of health care services for those with chronic disease – applying lessons learned from PEPFAR and its approach to multi-month dispensing of HIV medicines.

Dr. Knight also described how the CDC’s incident management team is supporting countries’ health leaders on preparedness and response as well as serving as technical advisors to the Africa CDC to help develop strategy and guidance documents, event-based surveillance systems and modeling. She noted how Uganda is building on the extensive work that has been supported through the Global Health Security Agenda, with the support of the PSRT, including establishing the first-ever border health program and helping staff trained at Entebbe Hospital for Ebola to pivot and now respond to COVID-19.

In terms of opportunities for private sector engagement, Dr. Knight highlighted the following areas: build and scale testing capacity, especially outside of urban areas; secure personal protective equipment and other commodities; innovate quickly to ramp up intensive care capabilities; and develop risk communications.

Finally, Dr. Knight underscored the “secondary implications” of COVID-19 and the importance of making sure that people living with chronic disease stay healthy and remain home. She emphasized the need for health systems to continue to address vaccine preventable diseases and ensure ongoing access to immunizations.

Pandemic Spread

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

Some countries, which previously appeared to have their epidemics under control (such as Singapore), are seeing a spike in cases. In many more countries, infections continue to grow along an exponential curve, despite social distancing.

In the U.S., the global epicenter of the pandemic, some states are discussing lifting distancing restrictions and reopening their economies, even as cumulative deaths rose to 46,851 this week. Experts note that U.S. testing capacity needs to increase at least three-fold.

(Models showing wide variety in the weekly testing targets the U.S. must reach to safely relax social distancing measures, Kaiser Family Foundation)

Worldwide, as of Thursday, April 23 at 10:30am ET, the Center for Systems Science and Engineering at Johns Hopkins University reported 2,658,387 confirmed cases and 185,434 deaths attributed to COVID-19. With 843,937 reported cases of COVID-19, the U.S. accounts for nearly a third of the global burden.

Industry Developments

On Friday, April 17, the National Institutes of Health announced a coalition, Accelerating COVID-19 Therapeutic Interventions and Vaccines, to develop an international strategy for a coordinated research response. Members include the European Medicines Agency, the U.S. Department of Health and Human Services, U.S. Centers for Disease Control and Prevention, U.S. Food and Drug Administration and more than a dozen biopharmaceutical companies, including AbbVie, Johnson & Johnson, MSD, Novartis and Pfizer.

Notable progress – and setbacks – are being made across efforts to combat COVID-19:

• In an effort to produce high-quality data on hydroxychloroquine’s efficacy in treating COVID-19, on Monday, April 20, Novartis announced it would begin a large scale, double-blind, randomly controlled trial. Recruitment for the Phase III trial will begin in the next few weeks. This trial would add to the limited body of data that currently suggests mixed results. A retrospective study of 368 patients treated by the U.S. Veterans Health Administration saw an overall increase in mortality among patients treated with hydroxychloroquine alone. Those patients who received hydroxychloroquine plus azithromycin fared better, but the combination showed no positive impact on the need for ventilation.

• On Tuesday, April 21, the FDA issued an emergency use authorization for LabCorp’s at-home COVID-19 testing kit. The kit – the first of its kind to be approved in the U.S. – will be available first to health care workers and then the general public in the coming weeks.

• Implementing widespread testing remains a challenge in the U.S. as the highly anticipated Abbott Labs rapid test has produced inconsistent results. Researchers at the Cleveland Clinic revealed the test produced an almost 15 percent false-negative result in a sample of 239 specimens.

• Researchers at the Jenner Institute and Oxford Vaccine Group initiated trials of their recombinant viral vector vaccine candidate this week in 1,112 healthy young adults. Anticipating that the vaccine will prove effective, the U.K. government is preparing large-scale production capacity, aiming to produce a million doses by September.

• Germany’s first vaccine trial will begin in the next few weeks following BioNTech’s announcement on Wednesday, April 22 that the company has received approval to start Phase I/II clinical trials of four vaccine candidates. BioNTech and Pfizer are collaborating to develop the mRNA vaccine candidates and expect to receive approval to begin trials in the U.S. shortly.

In light of such rapidly progressing developments, on-going calls to “facilitate the equitable and affordable access” to innovative diagnostics, medicines and vaccines take on new urgency. Some companies are answering this call: In announcing the Phase III trial of hydroxychloroquine, Novartis promised to make the drug’s intellectual property available broadly if the medicine is approved to treat COVID-19.

Comings and Goings

Effective Monday, April 20, Sir Andrew Witty, President of UnitedHealth Group and former CEO of GlaxoSmithKline, will co-lead the WHO’s efforts to accelerate development of a COVID-19 vaccine. He will take a leave of absence from his current position.

On Tuesday, April 21, the U.S. Department of Health and Human Services announced it has replaced Rick Bright as director of the Biomedical Advanced Research and Development Authority (BARDA), the agency overseeing COVID-19 vaccine and treatment development. The sudden removal is seen by some as a sign that the Trump administration grew frustrated with Bright’s refusal to promote blanket use of  hydroxychloroquine. Bright has been reassigned to the National Institutes of Health. Gary Disbrow, Bright’s former deputy, will serve as acting director of BARDA.

Supporting the Response

At Rabin Martin, in addition to supporting our clients with their response efforts, our employees are volunteering their time. If you are looking for ways you too can get involved in local New York City efforts, the New York Academy of Medicine is maintaining an ongoing list of opportunities.

From the Experts

“There’s a pandemic every three years. That’s not the black swan. The black swan is the lack of coordination between governments to deal with it.”

Paul Polman, former CEO, Unilever
Friday, April 17

“We have to give credit to Africa for getting ahead, I think it is very important to value the work that African countries have done so far.”

Dr. Silvia Lutucuta, Minister of Health, Angola
Friday, April 17

“It’s important that organizations involved in [data analysis] commit to doing it in a way that protects people’s information and that any data collected is used solely for responding to public health emergencies and for other crisis response efforts. Fighting the pandemic has required taking unprecedented measures across society, but it shouldn’t mean sacrificing our privacy.”

Mark Zuckerberg, Founder and CEO, Facebook
Monday, April 20

“This pandemic, and now the attack on WHO, is going to set countries back decades.”

Richard Horton, Editor, The Lancet
Monday, April 20

“We must not, especially now, let down our guard on immunizations. Access to vaccines for all has transformed our societies, but it is a public good that must be maintained to be effective, even in difficult times. Our overstretched health systems cannot bear any outbreaks of vaccine-preventable diseases.”

Dr. Hans Henri P. Kluge, WHO Regional Director for Europe
Monday, April 20

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through.”

Robert Redfield, Director, CDC
Tuesday, April 21

Additional Resources

Reports from International Governments and Bodies

• WHO COVID-19 Information and Guidance
• WHO Situation Reports, April 20, April 21, April 22
• White House Coronavirus Task Force Press Briefings, April 20, April 21, April 22
• CDC Coronavirus Resource Page
• COVID-19 Health Systems Response Monitor
• NCD Alliance COVID resources relevant to NCDs

Funding and Policy Trackers

• International Monetary Fund Policy Tracker
• Kaiser Family Foundation Coronavirus Policy Tracker
• U.S. Chamber of Commerce Foundation Corporate Aid Tracker
• Devex Interactive Funding Tracker

Resource Pages and Market Research Literature

• JAMA Resource Center
• The Lancet COVID-19 Resource Centre
• PharmaIntelligence: Coronavirus – What will the Impact Be?
• Health Affairs Resource Center
• STAT Preparedness Tool
• International Association of National Public Health Institutes COVID-19 Resources
• U.S. Global Leadership Coalition COVID-19 Issue Briefs

Communications Toolkits

• Page Society COVID-19 Toolkit
• USAID Social Media Materials

What We’re Reading

• Meet the Top American Fighting COVID-19 at WHO, Reid Wilson, TheHill
• The Health 202: Twelve Takeaways from the 1918 Flu Epidemic that Help us think about the novel coronavirus, Paige Winfield Cunningham, Washington Post
• The Pandemic’s Hidden Victims: Sick or Dying, but Not From the Virus, Denise Grady, The New York Times
• The Secret to Germany’s COVID-19 Success: Angela Merkel Is a Scientist, Saskia Miller, The Atlantic
• The Remaking of Big Pharma in a Post-Pandemic World, Ethan Guillén and Melissa Chan, Foreign Policy
• British Scientist to Head UN Task Force Distributing COVID-19 Vaccine as US Blocks G20 Agreement, Sarah Newey and Paul Nuki, The Telegraph
• Politics May Kill Us, Not the Coronavirus, Eduardo J. Gómez and Sandro Galea, Think Global Health

For more information or should you have any questions, please contact us.

About Rabin Martin

Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise  include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.

About Omnicom Public Relations Group

Omnicom Public Relations Group is a global collective of three of the top global public relations agencies worldwide and eight specialist agencies in public affairs, marketing to women, fashion, global health strategy and corporate social responsibility. It encompasses more than 6,000 public relations professionals in more than 330 offices worldwide who provide their expertise to companies, government agencies, NGOs and nonprofits across a wide range of industries. Omnicom Public Relations Group delivers for clients through a relentless focus on talent, continuous pursuit of innovation and a culture steeped in collaboration. Omnicom Public Relations Group is part of the DAS Group of Companies, a division of Omnicom Group Inc. that includes more than 200 companies in a wide range of marketing disciplines including advertising, public relations, healthcare, customer relationship management, events, promotional marketing, branding and research.