COVID-19 Therapeutics Must be Shared to Avoid Replicating Vaccine Inequality, Warns DNDi
Innovation in COVID-19 treatments needs to be shared equitably.

Much more global attention needs to be paid to developing early therapeutics to protect patients with COVID-19 from “hospitalisation, intensive care, or worse”, according to a report from Drugs for Neglected Diseases initiative (DNDi) released on Thursday.

In addition, the few innovative treatments that exist are mostly available in high-income countries, and DNDi warns that the world risks “replicating the vaccine inequality that has become a defining characteristic of this global pandemic” if these are not shared with low and middle-income countries (LMIC).

To arrest the progress of COVID-19, there is a “clear rationale emerging” that strong antivirals combined with host-directed therapies (anti-inflammatories and immunomodulators) need to be given to patients during the first few days of infection, according to the report.

“Efforts are today rightly focused on identifying novel antivirals, additional repurposed therapeutics, and more affordable and adapted new approaches, such as second-generation monoclonal antibodies and other biologics,” it adds. 

But, says Rachel Cohen, DNDi’s North America Executive Director, “with more interest now in second-generation monoclonal antibodies and antivirals, the investment going into these areas needs to be directed to the right area, and it must ensure access.”

Change the governance of ACT-Accelerator

Describing the development vaccines as a success for science, but their rollout as a failure for access, the report proposes three main solutions to ensure that the COVID-19 “vaccine apartheid” is not replicated with therapeutics. 

The first is support for open drug discovery and development of “novel antivirals, host-targeted interventions, and repurposed compounds, as well as for robust testing of these options in comparable adaptive platform trials”.

Second, DNDi recommends that the governance structure of the Access to COVID-19 Tools Accelerator (ACT-A) be changed to provide for equal representation from LMICs. 

ACT-A houses the global vaccine platform, COVAX, which has recently faced criticism from African leaders for having a “charity” mindset rather than seeing LMIC as partners. ACT-A was set up by the World Health Organization (WHO) and others to ensure global access to vaccines, but it has been undermined by pharmaceutical companies selling their vaccines to wealthy countries first.

The report also urges ACT-A to address all intellectual property (IP) barriers and “improve transparency with respect to development, production, and supply of COVID-19 medicines, diagnostics, and vaccines”.

The third solution proposed by the DNDi report rests on securing “specific contractual commitments and enabling policies, such as a temporary waiver on IP”, to ensure equitable access to new and existing COVID-19 therapeutics. 

COVID could become endemic to Africa

“Great strides have been made in the development of new tools for COVID-19, especially vaccines, but the past year has made it painfully clear that access is the unfinished business of global health,” said Dr Bernard Pécoul, Executive Director of DNDi, the International non-profit organisation dedicated to developing safe, effective, and affordable treatments for the most neglected patients.

“We now have the opportunity to course correct with treatments and make the response to COVID-19 a model for equity, collaboration, and knowledge- sharing.”

Dr John Nkengasong, Executive Director of Africa Centre for Disease Control (CDC), recently warned that COVID-19 may become endemic to Africa unless the continent’s lack of vaccines was addressed.

“If we have a predictable supply of vaccines, we can break the backbone of this pandemic by the end of next year,” Nkengasong told a recent media briefing. “But if vaccines are not available to enable us to vaccinate at speed and at scale then, past next year we’ll be moving towards the endemicity of this virus on our continent and the consequences will be catastrophic.

“Our economy will continue to be damaged, the death rate will continue to increase. We will see the fourth, fifth, sixth waves, and it will be extremely difficult for us to survive as a people.”

Image Credits: DNDi.

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