With COVID-19’s relentless global spread and mounting number of deaths, consensus is growing that the response has largely been an international failure. The pandemic has forced global, national, and local decisionmakers to take action: some, like New Zealand, South Korea, and Taiwan, have been quick to contain the virus; many others have been criticized for doing “too little, too late.” Global inaction and lack of coordination have led to upwards of half a million deaths, devastating economic losses, and backsliding on progress in other areas of infectious disease, such as HIV/AIDS, as well as essential health services like childhood immunizations. The situation will persist – and potentially worsen – until we change our strategy.
Early lessons have emerged from China, Italy, and elsewhere around the importance of rapid and widespread testing, contact tracing, isolation, and strict restrictions on mobility, among others. And yet, government officials seeing similar epidemiological trends in their cities, states, and countries have not heeded these lessons. In the U.S., public health experts have argued that had the Trump administration engaged decisively just a week sooner, the country wouldn’t be facing a crisis of the current magnitude – with 29 consecutive days of record-highaverage infections as of Wednesday, July 8. Several nations have now barred U.S. travelers from crossing their borders, underscoring the negative consequences of the U.S.’ poor handling of the response.
Globally, decisionmakers are struggling to keep up and to understand how to best respond over the coming months until one or more safe and effective vaccines can be deployed. Governing bodies, ranging from the World Health Organization (WHO) to federal agencies, have been working to develop and adapt their strategies in real-time. Against a whirlwind of new data and evidence, it will be critical to stay nimble and responsive to the facts – no easy feat when the news about the novel coronavirus is constantly shifting.
This week’s issue of Rabin Martin’s COVID-19 Briefing explores how countries are reacting and changing their strategies to meet the evolving challenges. Are decisionmakers implementing data-driven policies to contain the virus? Will such actions prepare the international community for the next global health crisis? Please find our earlier COVID-19 Briefings here.
Responses Under A Microscope
There have been 3,084,690 confirmed cases and 132,803 deaths in the U.S., more than twice as many as any other nation.
A Global Imperative: Multilateral Efforts
WHO has been the leading authority on the pandemic, offering guidance, resources, and technical assistance to countries around the world. It has routinely reviewed and adapted its strategy based on the evolving understanding of the novel coronavirus. In addition, WHO continues to focus on generating global evidence. On Monday, June 29, Dr. Tedros Adhanom Ghebreyesus, Director General, WHO, announced that the organization will send a team of experts to China to investigate the origins of COVID-19. “We can fight the virus better when we know everything about the virus, including how it started,” he said.
Even as WHO invests in providing the most up-to-date scientific information, it has been criticized for being slow to acknowledge some scientific shifts. On Monday, July 6, a group of over 200 scientists published an open letter to WHO, urging the organization to update its scientific position on airborne transmission, in light of mounting evidence that infectious droplets linger in the air longer than assumed. (Om Thursday, July 9, WHO updated its position acknowledging the role aerosols play in transmission.)The implications of such evidence are critical for policymakers as economies continue to reopen around the world.
Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO
National Responses: Conflicting Priorities
Countries around the world have enacted pandemic response policies with varying degrees of success. While much of the European Union has returned to a semblance of normal as schools and shopping districts reopen, Sweden’s epidemic continues to swell. In March, Sweden decided against government mandates of social distancing, hoping that responsible behavior and the robust health of young people would allow the country to reach herd immunity without substantial casualties. That method proved tragically flawed, as the country now reports 40 percent more deaths per capita than the U.S. and no economic gains.
The U.S. is another example of a country with a “catastrophic” response. In the past week and a half, the number of U.S. cases almost doubled, and on Tuesday, July 7, cases topped 3 million. Now, as the entire nation has reopened to some degree, the buffer created by the near nationwide shutdown in March and April has been eroded. Hospitals in Texas are buckling under a crushing influx of COVID-19 cases. Similarly, Florida is seeing spikes in infections, particularly among young people, after the state was among the first to reopen. The New York Times reported that “the Sun Belt has become the global virus capital,” with cases growing faster in Arizona, Florida, and South Carolina than any country in the world. In response, some counties are closing again, and more governors are ordering mandatory mask usage. But without strong federal support, policies and their enforcement remain inconsistent.
Brazilian leadership has been criticized for undermining the nation’s ability to respond effectively to the pandemic. The country, which bears the second highest caseload globally, continues to see high mortality rates and exponential growth and has been disparaged for gross mismanagement. With emerging news of President Jair Bolsonaro’s positive COVID-19 diagnosis, the world waits to see if this will influence his administration’s policy towards a more aggressive containment strategy.
U.K. Prime Minister Boris Johnson, who was hospitalized with COVID-19 complications in April, has received mixed feedback on the nation’s response. Though slow to act in February, choosing to pursue a herd immunity strategy similar to Sweden, Johnson did institute a nationwide lockdown on March 23. New cases have fallen steadily since early May, allowing the U.K. to reopen much of its economy and reintroducing localized restrictions when hotspots emerge.
WHO expects interim results from the multinational SOLIDARITY trial in the next two weeks. The trial recruited participants from around the globe in simultaneous studies of Gilead’s anti-viral remdesivir, the anti-malarial hydroxychloroquine, HIV drugs lopinavir and ritonavir, and the combination of lopinavir/ritonavir plus the multiple sclerosis treatment Interferon beta-1a as treatments for COVID-19. WHO has already stopped the hydroxychloroquine and lopinavir/ritonavir arms of the trial after they failed to demonstrate positive impact, instead presenting high risk of side effects, in the case of hydroxychloroquine.
Dr. Stephen Hahn, Commissioner, U.S. Food and Drug Administration
The SOLIDARITY trial marked a first in global cooperation to scale and advance scientific investigation rapidly. Still, a recent review of myriad COVID-19 trials launched since January suggests that many suffer from fundamental flaws in design and management that compromise their ability to produce statistically sound data.
As multiple treatment and prevention trials progress to Phase 3 studies, questions of access and equity are returning to the fore. Recently, the European Commission and the U.K. and U.S.governments have signed substantial deals with pharmaceutical companies, securing supply for their population should treatments and vaccines prove efficacious. With the Trump administration’s decision to buy-out Gilead’s existing remdesivir supply, advocates in other countries are beginning to wonder, “What’s left for us?”
From the Experts
Vice Admiral Jerome Adams, U.S. Surgeon General
Thursday, July 2
“The right to health means that no one disease should be fought at the expense of the other. Any reduction in resources for HIV prevention in the face of COVID-19 will only make the current HIV prevention crisis worse.”
Winne Byanyima, Executive Director, UNAIDS
Monday, July 6
“We are still knee-deep in the first wave of this. This would not be considered a wave, it is a surge or resurgence of infections superimposed over a baseline.”
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Disease
Monday, July 6
“We have the control to change the course of this virus today, and it will take individual action, wearing masks in public everywhere in the United States, wearing masks around the vulnerable inside, wearing masks in the workplace, really curtailing our activities.“
Dr. Deborah Birx, White House Coronavirus Task Force Coordinator
Tuesday, July 7
“The COVID-19 pandemic, while primarily a health crisis, also quickly became the worst human and economic crisis in decades. It has exacerbated the already difficult situation for millions of people living in poverty.”
Mona Juul, President, United Nations Economic and Social Council
Tuesday, July 7
“The past six months have shaken our world. The next six months will not be easier, and we cannot let our guard down. To endure, we must rely on our growing knowledge of this virus, our ability to apply these learnings in solidarity and our unwavering resolve.”
Dr. Carissa Etienne, Director, Pan American Health Organization.
Tuesday, July 7
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Situation Reports, July 6, July 7, July 8
- 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
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT News COVID-19 Tracker
- International Association of National Public Health Institutes COVID-19 Resources
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
What We’re Reading
- How a COVID-19 Vaccine Could Cost Americans Dearly – Elisabeth Rosenthal, The New York Times
- How America Lost the War on COVID-19 – Paul Krugman, The New York Times
- The Fullest Look Yet at the Racial Inequity of Coronavirus – Richard Oppel, Robert Gebeloff, K.K. Rebecca Lai, Will Wright, and Mitch Smith, The New York Times
- Elegant But Unproven, RNA Experiments Leap To The Front In Coronavirus Vaccine Race. Will They Work? – William Booth and Carolyn Johnson, The Washington Post
- COVID-19 Coronavirus Won’t Be Last or Worst Pandemic: How To Stop Panic-Neglect Cycle – Bruce Lee, Forbes
- All Bets Are Off for Measuring Pandemic Preparedness: Three standard measures don’t predict how countries fare in COVID-19—so how do we better prepare for the next pandemic? – Sawyer Crosby, Joseph Dieleman, Samantha Kiernan, and Thomas Bollyky, Think Global Health
- WHO: Access To HIV Medicines Severely Impacted By COVID-19 As AIDS Response Stalls – Fadela Chaib and Andy Seale, World Health Organization
- How to Deal With the Anxiety of Going From Hospital to Home – Joel Zive, The Body
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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.
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