COVID-19 continues to strain health systems around the world. A recent report by the U.S. Department of Health and Human Services Inspector General confirms that hospitals across the country are confronting severe shortages of critical supplies, including tests, ventilators and protective equipment, as they work to combat the growing COVID-19 crisis. A coalition of more than 200 national and local patient advocacy organizations and health care providers sent a letter to the Trump administration demanding action on the “crisis-level shortage of medical equipment.”

At the same time, Japan, another wealthy country with an advanced health system, declared a state of emergency on April 7, with Prime Minister Shinzo Abe stating, “Clearly, we are approaching the limit in terms of hospital beds.”

Meanwhile, the public health countermeasures deployed in many countries, including handwashing, isolation and self-quarantine, stay-at-home orders and social distancing, are showing hopeful signs of preliminary success in some cases. But implementing these measures in certain locales, particularly in resource-limited settings, provides a challenge. As Yasmin Sooka, the chairperson of the Commission on Human Rights in South Sudan, said on April 8 in relation to the refugee crisis in South Sudan, “One cannot realistically talk about strict social distancing in a country where nearly one and a half million internally displaced persons are living in tents, often inches apart from one other, and subsisting on rapidly diminishing humanitarian aid.”

As the pandemic continues its inexorable global spread, the question is: how will low- and middle-income countries (LMICs) fare and what can be done to shore up their health systems to save lives?

“Poorer countries and fragile economies stand to face the biggest shock from this pandemic and leaving anyone unprotected will only prolong the health crisis and harm economies more,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

This issue of Rabin Martin’s COVID-19 industry briefing focuses on lower-income countries around the world and how a more equitable global response could work to alleviate, rather than exacerbate, disparities in health outcomes. Will LMICs be able to “flatten the curve” of COVID-19 infection, or will they face catastrophic consequences?

Private Sector Insights

A conversation with Don Darden, General Manager of Firestone, Liberia, Inc. 

As the largest private employer in Liberia, with nearly a 100-year history operating in the country, Firestone plays a significant role in the health and safety of the 120 communities where its 7,500+ employees live and work. Darden described the agility the company demonstrated in the face of government bureaucracy when “the health system came to its knees” during the Ebola outbreak six years ago. For example, Firestone’s engineering team put up buildings and septic systems to isolate and care for Ebola patients, turned a gymnasium into a makeshift warehouse facility, and used its voice and clout to educate community leaders about protecting themselves and to help fight the stigma surrounding the disease.

In making the comparison with COVID-19, Darden stated that the situation is completely different – including Liberians’ reactions. He noted that unlike Ebola, “if they can’t see it, they don’t believe it” and, as a result, Liberians are not taking as many precautions to prevent COVID-19 as they should. He commented on the resistance to restricting people’s mobility as part of a lockdown, given common practices of congregating in marketplaces and elsewhere; high rates of illiteracy also make communicating about health threats more challenging.

While there have been only 14 confirmed cases of COVID-19 in Liberia so far (likely under-reporting), Darden noted that Firestone’s preparedness mentality has enabled the company to mobilize quickly even though there is limited access to resources in high demand in COVID-19 hotspots.

COVID-19 & LMICs: A Question of When

A burgeoning crisis

According to official estimates, LMICs are currently shouldering less of the global COVID-19 burden. While cases to date have been relatively low compared with the rest of the world (potentially due to lack of testing), the World Economic Forum notes that Africa has a veritable “COVID-19 time bomb to defuse.”

Cases in Africa are growing at a faster rate than during comparable periods in Europe (African Union)

Although the United Nations has launched a $2 billion emergency response plan for LMICs, this is a fraction of what will be required, given that these countries have been described as “likely the next battlefield for the virus.” While certain countries, like South Africa, have implemented strict social distancing policies, it is not a realistic option for most, given large population segments required to leave their homes to sell goods, get water and food, etc. to meet basic needs. Also, with only two ICU beds per 100,000 people in India, Pakistan and Bangladesh (and even fewer in sub-Saharan Africa), COVID-19 could devastate already fragile health systems.

Ensuring LMICs are not left behind: Global actors respond

On Thursday, April 2, a group of over 70 global organizations, including the Bill & Melinda Gates Foundation, Wellcome Trust and several research institutes based in Asia, Africa and Latin America, launched the COVID-19 Clinical Research Coalition. The Coalition aims to accelerate COVID-19 research in resource-limited settings, bringing together individuals and institutions working to fast-track research that will provide evidence on COVID-19 prevention, diagnosis and case management.

A critical concern is ensuring that all research is conducted ethically, respecting the dignity of participants. On Tuesday, April 7, global actors, including the WHO, condemned racist comments from French scientists about using Africa as a potential testing ground for potential COVID-19 treatments, citing the region’s general lack of infrastructure.

On Friday, April 3, the Medicines Patent Pool announced the temporary expansion of its mandate to include “any health technology that could contribute to the global response to COVID-19 and where licensing could facilitate innovation and access.” Generic licensing of novel technologies to fight COVID-19 would support the response efforts of LMICs, ensuring their populations have access to affordable medicines and vaccines. This commitment builds on Unitaid’s announcement to commit an initial US$30 million for innovative treatment, diagnostics and respiratory triage tools as part of the global response to the pandemic.

On Monday, April 6, Dr. Tedros endorsed Costa Rica’s proposal for a pool to ensure full access to medicines and vaccines that are being developed to combat COVID-19, noting: “I call on all countries, companies and research institutions to support open data, open science and open collaboration so that all people can enjoy the benefits of science and research.”

Aid Effectiveness in the Age of COVID-19

The United Nations Conference on Trade and Development (UNCTAD) recently published an analysis of the potential economic shocks of COVID-19 on the economies of LMICs. The report calls for a “whatever it takes” approach to mitigate the pandemic’s effects on the “two-thirds of the world’s population being left behind.” UNCTAD brings attention to the potentially catastrophic economic impacts of COVID-19 for vulnerable economies, noting that it is “a matter of immediate urgency for the international community to co-ordinate appropriate economic rescue packages… to address the looming financing gap which many developing countries are now imminently facing.”

On Monday, April 6, the Modernizing Foreign Assistance Network hosted a virtual roundtable discussion on the COVID-19 response, global health security and implications for aid effectiveness. Rabin Martin CEO Jeff Sturchio offered some reflections on the need for an integrated approach to this issue – health and development are inextricably linked, as the COVID-19 pandemic demonstrates. Jeff recommended viewing the COVID-19 crisis from a global health security perspective and urged donors to ensure aid is allocated effectively to vulnerable countries to support the response. “The cost of baseline preparedness for prevention, detection, and response to emerging health crises is estimated at only about $1 per person per year, while the cost of inaction is measured in trillions,” Jeff said. “It is a global imperative for the international community to build resiliency in regions with fragile health systems so they can withstand the current pandemic and be ready for future health emergencies.”

Pandemic Spread

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

As the virus continues to spread around the world, the U.S. remains the global epicenter. There are now 432,438 reported cases of COVID-19 – more than any other nation and more than twice the number in Spain, the second-hardest hit country with 152,446 cases. Worldwide, as of Thursday, April 9 at 9:00am ET, the Center for Systems Science and Engineering at Johns Hopkins University reported 1,498,833 confirmed cases and 89,733 deaths attributed to COVID-19, including 14,808 deaths in the U.S.

Updated models by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington suggest current diagnoses represent just a fraction of eventual U.S. cases. IHME predicts the epidemic will peak nationwide in just three days, on Sunday, April 12, but state-level epidemics will follow slightly different trajectories. The country could see nearly 60,415 COVID-19 related deaths in the epidemic’s first wave.

Projected Deaths Attributed to COVID-19 in the United Sates (Institute for Health Metrics and Evaluation)

Industry Developments

The clinical trials required to prove the safety and efficacy of vaccine and treatment candidates are extensive, and the time to bring these products to market is long. Beyond investments in research and development, pharmaceutical companies are committing extensive resources, both monetary and in-kind, to support the United Nations’ call for an “immediate, coordinated health response.” A comprehensive list may be foundhere.Select commitments from the past week include:

• Following the European Medicines Agency’s (EMA) recommendation that Gilead make remdesivir accessible for compassionate use “in a fair and transparent way,” the company announced it is attempting to scale up production to meet demand for clinical trials and compassionate use. Gilead set a goal to produce more than 500,000 treatment courses by October and more than a million by the end of this year.

• Pfizer announced a commitment of $40 million in medical and charitable cash grants to help respond to the COVID-19 pandemic. Emergency relief funds will be provided to public health agencies and international nonprofit organizations including Direct Relief, International Medical Corps and Project Hope.

• Medtronic announced it is sharing design specifications for its ventilator to accelerate efforts to increase global production. The current shortage of ventilators, a critical tool in the management of patients with severe cases of COVID-19, is driving innovation in retrofitting and repurposing other medical devices as breathing machines.

• Johnson & Johnson asserted its potential vaccine against COVID-19 could cost as little as 10 euro per dose. “We are counting on hundreds of millions of people worldwide to have access to this vaccine,” said Paul Stoffels, Vice Chairman of the Executive Committee and Chief Scientific Officer.

• Recognizing that on-going primary health care needs persist during a pandemic, Merck announced it is donating $3 million through its signature maternal health initiative Merck for Mothers to address maternal health needs during COVID-19. As stated by Julie Gerberding, Chief Patient Officer, “childbirth will not wait for the pandemic to ease.”

• While President Trump continues to champion hydroxychloroquine, despite lack of clinical evidence, as a potential treatment against COVID-19, the EMA announced it will not clear the medicine for use without trial data. In response to increased demand, Sanofi announced it is prepared to manufacture and provide millions of doses.

From the Experts

“But Covid-19 won’t simply disappear if the wealthy world is left to its own devices, manufacturing costly vaccines that are only affordable to fully insured residents of the 30 richest nations on Earth.”

Laurie Garrett, American science journalist
Thursday, April 2

“Today’s epidemic is a powerful reminder that infectious agents do not respect borders and that global cooperation is essential for dealing with them. Classic public health tools are a must: We cannot control what we cannot understand. And we need to maintain the collaborative and generous spirit that has emerged in response to Covid-19. It may feel like a once in a lifetime experience, but that, alas, is unlikely to be the case.”

Susan Desmond-Hellmann, Former CEO, Bill & Melinda Gates Foundation
Friday, April 3

“This is going to be the hardest and the saddest week of most Americans’ lives. This is going to be our Pearl Harbor moment, our 9/11 moment, only it’s not going to be localized; it’s going to be happening all over the country.”

Vice Admiral Jerome Adams, U.S. Surgeon General
Sunday, April 5

“Africa cannot and will not be a testing ground for any vaccine. We will follow all the rules to test any vaccine or therapeutics all over the world, using exactly the same rule […] to treat human beings the same way, equally.”

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General
Monday, April 6

“Unless the United States exerts leadership to prevent Covid-19 from raging out of control abroad, the crisis will not end at home.”

Samantha Power, former US Ambassador to the United Nations
Tuesday, April 7

“What’s really important is that people don’t turn these early signs of hope into releasing from the 30 days to stop the spread – it’s really critical. If people start going out again and socially interacting, we could see a really acute second wave.”

Dr. Deborah Birx, Coordinator of the White House Coronavirus Task Force
Wednesday, April 8

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.

Additional Resources

Reports from International Governments and Bodies

• Shared Responsibility, Global Solidarity United Nations Report on Responding to the Socio-economic Impacts of COVID-19

• WHO COVID-19 Information and Guidance

• WHO Situation Reports, April 6, April 7, April 8

• White House Coronavirus Task Force Press Briefings, April 6, April 7, April 8

• CDC Coronavirus Resource Page

• COVID-10 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

Academic and Market Research Literature

• JAMA Resource Center

• The Lancet COVID-19 Resource Centre

• PharmaIntelligence Coronavirus What will the Impact Be?

• Health Affairs Resource Center

Communications Toolkit 

• Page Society COVID-19 Toolkit

What We’re Reading

• Some say there is a trade-off: save lives or save jobs – this is a false dilemma, Kristalina Georgieva and Tedros Adhanom Ghebreyesus, The Guardian

• Virus exposes glaring inequalities between rich and poor, Winnie Byanyima, Business Day

• Early Data Shows African Americans Have Contracted and Died of Coronavirus at an Alarming Rate, Akilah Johnson and Talia Buford, ProPublica

• Redefining vulnerability in the era of COVID-19, Editorial team, The Lancet

• COVID-19 will not leave behind refugees and migrants, Editorial team, The Lancet

• Preparing for the Next Pandemic, Susan Desmond-Hellman, The Wall Street Journal

• More herd immunity, less herd mentality, Ariel Pablos-Méndez, The Hill

• Managing the march of COVID-19: lessons from the HIV and AIDS epidemic, Alan Whiteside, Warren Parker & Mike Schramm, African Journal of AIDS Research

• This Won’t End for Anyone Until It Ends for Everyone, Samantha Power, The New York Times

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.