World Health Organization Director General, Dr Tedros Adhanom Ghebreyesus has welcomed the call by Costa Rica’s President, Carlos Alvarado Quesada, for WHO to launch an initiative that would “pool rights to technologies that are useful for the detection, prevention, control and treatment of the COVID-19 pandemic.”

“I welcome his initiative & call for pooled rights to COVID-19 diagnostics, drugs & vaccines, said the WHO Director General in a reply Thursday on his Twitter account to the presidential overture. “WHO is working closely with governments & agencies around the world to promote rapid R&D. These efforts are rooted in our commitment to equitable access for all.”

Alvarado’s letter, dated Monday 23 and co-signed by Costa Rica’s Health Minister, Daniel Salas, also called for the creation of a “repository of information on diagnostic tests, devices, medication or vaccines, with free access or licensing on reasonable and affordable terms, in all member countries of the Organization,” according to excerpts later posted on the presidential website and Twitter account.

Meanwhile, in another letter to the WHO Director General dated 25 March, the WHO hosted-partnership UNITAID,  offered to work with WHO and the Medicines Patent Pool, a public-private partnership that it founded, to identify “concrete steps to ensure that there will be equitable and timely access to critical health technologies and products for COVID-19 for people anywhere in the world.”

“We appreciate that several initiatives are underway or proposed that seek to address access barriers; this includes but is not limited to the proposal that has been sent to you by the President of Costa Rica about a voluntary pool of patents for COVID-19 related medicines and technology,” the UNITAID letter added.

In his letter, the Costa Rican president further urges the WHO to “develop a memorandum of understanding to share this technology, and to promote its implementation with financial support from the public and private sectors, as well as from international organizations.”

The president also asked WHO’s Global Observatory on Health Research and Development create a database on research and development activities related to COVID-19, including estimates of the costs of clinical trials and subsidies provided by governments and charities.

Extraordinary Virtual Summit of G-20 Leaders Pledges Massive Support for Global Health Response   

Meanwhile, in an Extraordinary G20 Leaders’ Summit on COVID-19, the Group of 20 most industrialized nations issued a far-reaching  set of commitments to fight the pandemic on health, economic and social fronts. Among their key health-related commitments, leaders pledged to protect the most vulnerable as well as safeguarding the global economy; expand manufacturing capacity to ensure medicines and supplies would be available widely at an affordable price; and support WHO and other global health institutions.

“We commit to take all necessary health measures and seek to ensure adequate financing to contain the pandemic and protect people, especially the most vulnerable,” the G-20 statement said at the close of a virtual one-day meeting on Thursday. “We will share timely and transparent information; exchange epidemiological and clinical data; share materials necessary for research and development; and strengthen health systems globally, including through supporting the full implementation of the WHO International Health Regulations (IHR 2005).

“We will expand manufacturing capacity to meet the increasing needs for medical supplies and ensure these are made widely available, at an affordable price, on an equitable basis, where they are most needed and as quickly as possible.”

As for support to WHO and other global health preparedness and R&D efforts, the G-20 statement said: “We will quickly work together and with stakeholders to close the financing gap in the WHO Strategic Preparedness and Response Plan. We further commit to provide immediate resources to the WHO’s COVID-19 Solidarity Response Fund, the Coalition for Epidemic Preparedness and Innovation (CEPI) and Gavi, the Vaccine Alliance, on a voluntary basis. We call upon all countries, international organizations, the private sector, philanthropies, and individuals to contribute to these efforts,”

While acknowledging the need for “urgent short-term actions” to protect front-line health workers, deliver medical supplies, diagnostics tools, medicines and vaccines, the statement also acknowledged that deeper structural changes are needed to bolster health systems, emergency preparedness strategies and spending, as well as related R&D.

“To safeguard the future, we commit to strengthen national, regional, and global capacities to respond to potential infectious disease outbreaks by substantially increasing our epidemic  preparedness spending. This will enhance the protection of everyone, especially vulnerable groups that are disproportionately affected by infectious diseases. We further commit to work together to increase research and development funding for vaccines and medicines, leverage digital technologies, and strengthen scientific international cooperation.

“We will bolster our coordination, including with the private sector, towards rapid development, manufacturing and distribution of diagnostics, antiviral medicines, and vaccines, adhering to the objectives of efficacy, safety, equity, accessibility, and affordability,” the statement added. “We ask the WHO, in cooperation with relevant organizations, to assess gaps in pandemic preparedness and report to a joint meeting of Finance and Health Ministers in the coming months, with a view to establish a global initiative on pandemic preparedness and response. This initiative will capitalize on existing programs to align priorities in global preparedness and act as a universal, efficient, sustained funding and coordination platform to accelerate the development and delivery of vaccines, diagnostics and treatments.”

In his speech at the G20 Extraordinary Leaders’ Summit on COVID-19, Dr. Tedros welcomed G20 leaders promise to “do whatever it takes to overcome the pandemic”.

“This is a global crisis that requires a global response”, he said, adding that leaders need to. “Fight, unite, ignite… with no excuses and no regrets.”

“”No country can solve this crisis alone,” he said, calling upon countries to build upon the solidarity that has so far been expressed, and exhorting them to “ignite a global movement to ensure this never happens again. “

Britain Announces £210 Million to COVID-19 Vaccine Effort 

Also today, the United Kingdom announced that it would provide some $US 254 million (£210 million) in new funding to the Oslo-based Coalition for Epidemic Preparedness Initiative (CEPI) to support the quest for rapid development of a vaccine for COVID-19, in what represents the single largest commitment so far to vaccine research.

CEPI CEO, Richard Hatchett, said the financial support “comes at a pivotal moment for a world that is in crisis. The UK has a long history of global health leadership and, today, the UK is once again stepping up as a global leader in its support CEPI and our crucial work to accelerate the development of a vaccine against COVID-19.”

The UK contribution complements pledges that have already been made by Germany, Norway, Denmark, and Finland, Hatchett said, noting it brings CEPI “closer to the $2 billion we urgently need develop a COVID-19 vaccine and we call on other world leaders to join us in our fight.”

Jeremy Farrar, Director of Wellcome Trust, welcomed the UK government pledge in a statement saying: “Support from enlightened Governments, with commitment to the global research effort is vital if we are to end this pandemic and prevent future tragedies. The pace and impact of the spread of this virus is unprecedented, our global response must be too. The research effort to rapidly advance the vaccines, treatments and diagnostics needed to save lives has been nothing short of staggering. Global support is still, however, falling seriously short – by at least $8 billion in the short-term.

US Appears Set To Overtake Italy as New Epicentre of COVID-19 Emergency 

The announcement of new investments in emergency response came as the United States appeared set to overtake Italy as the new centre of the COVID-19 pandemic.

There were now 521 086 reported cases of the virus worldwide, nearly 61 000 new cases since yesterday. Of all WHO regions, the European Region continued to experience the largest increase in new cases, with more than 25,000 fresh reports over the past 24 hours, ccording to WHO’s  daily Situation Report, followed by the Americas, with 11,390 new cases, and the Eastern Mediterranean region, with 2,416 new cases. In Europe, Spain is currently experiencing the highest growth in cases, having risen by approximately 10 000 cases since yesterday. In the Eastern Mediterranean region, Iran saw over 2,234 new cases. 

India Converting Railway Coaches to Hospitals 

In South-East Asia, where there were now 2344 cases, and Africa, which now had 1664 confirmed reports, government leaders were moving evermore aggressively on pre-emptive measures – while facing large, looming gaps in available hospital beds, medical supplies and services.

On Wednesday, India began a 21-day, nationwide lockdown along with announcing a massive aid bill to support its citizens during the closure. The bill aims to provide rice/lentils for ~60% of the country’s 1.3 billion people.  “No doubt this lockdown will entail an economic cost for the country, but saving the life of each and every Indian is the first priority for me,” said the Indian Prime Minister Narendra Modi, “If we are not able to manage the next 21 days, then many families will be destroyed forever. 

Mathematical modelling suggests that 300 million Indians could become infected by COVID-19, of which about four to five million could be severe, said Dr Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, in an interview with the BBC. 

India’s dense population, which is one of the main drivers for India’s high predictions,  has not made it easy – Last wednesday, the first case of COVID-19 was reported in a slum of Mumbai inhabiting over 23,000 people in less than a square kilometre of land. Contact tracing has proved particularly difficult. 

In an attempt to alleviate an overwhelming shortage of beds in India and to prepare for a growth in COVID-19 cases, India was looking to convert its trains into hospitals.

Given that railway services in India have been suspended and the ready availability of 12 617 trains, with 24-30 coaches in each train, 10 million beds can be created “within no time”, said Sunil Kumar V, Managing Director of Asset Homes to to the Prime Minister and the authorities of the National Disaster Management Authority.

As of last Sunday, Indian National Railways had begun moving coaches to their home zones so as to prepare them for disinfection and quarantine facilities.  Meanwhile, the Indian government has said that all scheduled international commercial passenger flight services would remain closed till April 14th. 

Four fifths of countries in Africa are not Adequately Prepared for COVID-19

WHO Regional Director for Africa, Matshidiso Moeti, meanwhile said that local virus transmission still was not widespread on the continent, but time was running out to prepare.

“We still have a window of time that is narrowing. In about half of countries, we still only have imported cases. We have not yet identified that local spread is occuring,” she said, speaking at a World Economic Forum webinar on Thursday. 

She said that the draconian border closures that have been undertaken now in many African nations need to be accompanied by stronger public health interventions, including more systematic identification of cases, follow-up of contacts, and isolation of cases and contacts, as needed.

While some countries like Spain have already recommended the anti-malarial chloroquine to treat COVID-19 as part of their national outbreak response, Africa is “waiting to get robust data [from the WHO’s multi-country clinical trials] to make recommendations [about using chloroquine], said Michel Yao, Emergency Operations Programme Manager at the WHO’s Regional Office in Africa. 

“If clinical trials show the potential of the drug, we should use it. We will not recommend it formally before its impact and side effects are properly measured”, he said in the webinar. 

Only about a fifth of African countries (8/47) are adequately prepared to response, according to a WHO African Region Readiness Response Sheet. These include Algeria, Ghana, Cameroon, Kenya, Tanzania, Madagascar and Ethiopia. Another 33 countries are moderately prepared, while 7/47 countries have limited readiness status, including Benin, Namibia, Guinea Bissau and Gambia.

Among the issues identified, the assessment found that:

• Only a quarter of African countries have full access to PCR test materials for the SARS-Cov-2 virus;  while 39/48 countries have the capacity to detect viral pathogens using an open-PCR platform, only 12/48 have access to primers (probes) specifically designed to detect SARS-Cov-2 using PCR assays.
• Only 7/48 African countries have benefited from health worker training on Covid-19 (Angola, Botswana, Eswatini, Ethiopia, Ghana, Lesotho, Seychelles), and only 4/44 countries have districts with health facilities that benefited from training on detection and reporting on Covid-19. These include Seychelles (100), Lesotho (70), Zanzibar (36), Liberia (4);
• There are only 9 countries in the whole African continent that have more than 50 facilities with nCoV case definition and surveillance tools, including: Algeria (100), Capo Verde (100), Cote D’ivoire (100), Mauritius (100), Seychelles (100), Togo (100), Rwanda (100) Senegal (54), Gambia(51);

However, African countries seemed better prepared in terms of biosafety, the assessment found. Some 45 countries out of 48 had stocks of personal protective equipment (PPE), although only about 30 countries have sufficient PPE for medical staff for case management and screening procedures. Some 44/48 countries reported that air and transport distribution systems are available in the country to restock supplies. 

-Svet Lustig, Tsering Llhamo and Zixuan Yang contributed to this story.