The pandemic’s next equity fight

The people and politics driving global health.

Feb 10, 2022 View in browser   By Daniel Payne THE BIG IDEA Paxlovid, Pfizer's antiviral drug, could become a larger part of the global strategy to control the pandemic in low- and middle-income countries. | Pfizer via AP CHANGING CALCULUS ON COVID THERAPEUTICS — The promise of Covid-19 antiviral drugs is already prompting questions about their fair distribution worldwide, which could affect Washington's pandemic response abroad. The antivirals, which are difficult to make and in already short supply, could significantly aid countries hit hardest by the coronavirus. But they're also seen as a tool to prevent future variants like Omicron and control their spread in at-risk countries. An issue of fairness: "There will be very significant equity issues," Steve Morrison, senior vice president at the Center for Strategic and International Studies, said of the therapeutics at a Johns Hopkins conference. Though he said vaccines remain the dominant issue, he told Global Pulse the changing pandemic has changed the outlook on aid. "We're shifting our mindset away from emergency response, away from trying to exterminate or eliminate this, to something that's more evened out," he said. "It's not either/or. It's: We need to defang this and bring it down into a more manageable and more normalized seasonal continuous viral presence — and therapies are part of that." Strategy ahead: The broader strategy can be seen in Democrats in Congress who asked the Biden administration for an additional $17 billion in funding for international pandemic response. Two members of the group told Global Pulse they want to see antivirals — among other resources — in the package, even as the White House proposed a smaller, $10 billion investment. "The antiviral pill, I think, is an important addition to our arsenal of tools, but we do need to focus on global vaccine equity, and I think if we can get that right, that becomes a model for anything else that we might want to be able to provide to the rest of the world," Rep. Pramila Jayapal (D-Wash.) said. Though she hasn't yet been in conversations about how much of the drugs to donate abroad, Jayapal said it should be part of the broader U.S. strategy to invest in health infrastructure in low- and middle-income countries. "In the short term, let's produce and send as many vaccines as possible," she said. "In the medium term, let's get the TRIPS waiver passed so that we can license technologies and establish distributing centers for whatever it is — whether it's our current set of pharmaceuticals or antivirals or testing equipment." 'Half-measures': Rep. Raja Krishnamoorthi (D-Ill.), who also signed the letter, said the next round of global funding should support several containment tools, from vaccines to antivirals and PPE to health care infrastructure more generally. "This is not the time for half-measures or second-guessing; we must fund this crucial work in full and end this pandemic," he said in a statement to POLITICO. Pfizer and Merck have agreed to license agreements to make their Covid antivirals more accessible in developing nations as they work to create a sustainable supply. The U.S. expects about 20 million doses of Pfizer's Paxlovid by the end of the year — but that could just be the beginning of the global supply, depending on other countries' future production. "The ability to reduce hospitalizations by about 90 percent and deaths with a pill … it's really remarkable, but it should be globally available — not just in rich countries," Eric Topol, professor and executive vice president at Scripps Research Translational Institute, said. WELCOME TO GLOBAL PULSE WELCOME BACK TO GLOBAL PULSE, where your hosts are wondering whether a possible increase in antibodies is a good enough reason to go to the gym more. Global Pulse is a team effort. Thanks to editors Eli Reyes and Barbara Van Tine. Follow us on Twitter:@ErinBanco and @_daniel_payne. WASHINGTON WATCH NSC SENIOR DIRECTOR LEAVING POST — Beth Cameron, the National Security Council senior director for global health security and biodefense, is leaving her post this month after a year working in the Biden administration, Erin Banco reports. Role plays: Cameron helped formulate President Joe Biden's international strategy for fighting Covid-19 and worked intensively on the administration's vaccine distribution across the world. She also helped author a pandemic playbook for then-President Barack Obama. The Trump White House eliminated Cameron's office, moving staffers onto other NSC teams. Raj Panjabi, the global health malaria coordinator at the U.S. Agency for International Development, will replace Cameron this month. Before joining USAID, Panjabi was the CEO of Last Mile Health, a nonprofit he founded to help develop community health care systems. Why this matters: Panjabi's move to the NSC is taking place at a time when the Biden administration is reenvisioning its global Covid-19 strategy. In 2021, the administration focused on securing and shipping hundreds of millions of doses overseas. In 2022, the Biden team is looking to help put the more than 1 billion shots it has promised the world into arms, particularly in low- and middle-income countries, according to two senior administration officials working on the effort. The NSC leadership switch comes amid rising tensions among the White House, the NSC and other agencies such as USAID over the direction of the administration's global pandemic response. POLITICO reported that officials working on the effort have said the White House's decisions on vaccine donation allocations lack transparency, and that it has cut officials from other agencies out of the process. GLOBAL PULSE NUMBER $16.8 Billion The amount of grant money the WHO is requesting for tools to fight Covid around the world. Only $814 million has been raised so far. AROUND THE WORLD SHORTER COVID INCUBATION PERIOD — British researchers found that exposing people to small amounts of the coronavirus caused infections in less than two days on average compared with previous estimates of five to six days, POLITICO Europe's Helen Collis reports. The study, which used a strain of the virus circulating early in the pandemic and not the Omicron or Delta variants, analyzed 36 healthy, unvaccinated people between ages 18 and 30 who volunteered to be infected by having a small dose of the virus inserted in their nostrils. Half of the participants became infected, meaning they had two positive PCR tests. Viral load was at its highest at about five days after being infected, with the virus spreading from the throat to the nose, which had the highest levels of virus. Research has shown that the now-dominant Omicron variant has an even shorter incubation period than the wild-type coronavirus as well as the Delta variant. Next on the list for the researchers from Imperial College London, the Royal Free London NHS Foundation Trust and others: a study with the Delta strain in vaccinated volunteers. mRNA PIONEERS PIVOT TO CANCER— The success of mRNA vaccines in the pandemic has scientists and investors excited about the diseases that could be treated or prevented — including cancer, POLITICO's Ashleigh Furlong reports. In 2021, BioNTech and Moderna made progress studying mRNA vaccines in cancer patients, and other companies — like CureVac — are engaged in similar research. And investors are piling on, with $9 billion in funding for mRNA therapies. Though the pandemic has brought new opportunities, researchers caution that many questions about efficacy and future access to treatments remain unanswered. WHAT WE'RE CLICKING The New York Times: New York deer infected with Omicron, study finds. StatNews: 'Good, not great': Some long Covid patients see their symptoms improve, but full recovery is elusive. Nature: The urine revolution: how recycling pee could help save the world.   Follow us

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