Access to life-saving dexamethasone will be expanded to some 4.5 million COVID-19 patients in low- and middle-income countries through an advance bulk purchase of the drug in bulk, UNITAID has said. The move is the first concrete step by a global health agency under the umbrella of the WHO ACT accelerator partnership to boost access to critical COVID-19 treatments beyond national borders.  

“With this advanced purchase we aim to ensure equitable access for low- and middle-income countries for treatment of COVID-19 with the life-saving drug dexamethasone, and avoid shortages resulting from high-levels of demand from other parts of the world”, said Unitaid Executive Director Philippe Duneton in a statement about the initiative with the Wellcome Trust and others. “It will allow UNICEF, the Global Fund and other partners to procure quality dexamethasone.”

Advance Purchase of Dexamethasone – Precautionary Response to Recent US Moves

The advance purchase of dexamethasone – the first drug to significantly curb mortality in critically ill COVID-19 patients – may represent a precautionary response to hoarding by countries hungry for COVID-19 vaccines and treatments.

On Monday, US Health and Human Services (HHS) secured almost all of Gilead Sciences’ projected production of remdesivir for the next three months, sparking concern that there won’t be enough of the treatment for people elsewhere in the world – one of the other few with demonstrated efficacy against the SARS-COV-2 virus. 

And behind the scenes, various European countries have sealed deals with vaccine manufacturers, effectively bypassing the WHO’s mechanism to ensure ‘equitable access’ to COVID-19 technologies – the Act Accelerator.

While this purchase is “good news”, it’s more of a “defensive purchase” rather than an ‘advanced purchase’, Ellen ‘t Hoen, director of Medicines, Law & Policy, told Health Policy Watch:

“Donors want to ensure that supply for LMICs is assured and created a defence against hoarding by high-income countries that could buy up supply – including by offering higher prices,” she said, adding. “One would wish to live in a world where supply was based on solidarity automatically.”

While the UNITAID announcement was also welcomed by Health Action International, a spokesperson warned that “top-down stockpiling” cannot be the long-term answer to facilitate access toquality-assured medicine in LMICs:

“Essential medicines should be available to countries through regular supply chains, economically sustainable procurement mechanisms and fairly paid, skilled health workers.”

The WHO’s pre-qualification programme, for instance, is a concrete mechanism that can facilitate access to high-quality medicines in LMICs, said the spokesperson to Health Policy Watch.

COVID-19 Transmission From Humans to Animals 

Meanwhile on Friday, WHO said that humans were apparently transmitting coronavirus to animals such as dogs, minks or even tigers.  The WHO statement follows increased reports of animals becoming infected with COVID-19 in several countries, including a tiger in a New York Zoo.

The WHO statement about human-to-animal transmission came at the conclusion of a two-day virtual scientific summit involving some 1000 scientists around the world, which assessed progress on vaccine research, therapeutics, as well as pandemic trends.

“More evidence is emerging that transmission from humans to animals is occurring, namely to felines (including tigers), dogs and minks,” WHO said.  The WHO statement follows reports in June by the US Centers for Disease Control, observing that transmission from infected people to animals, particularly felines, had occurred.

While humans may be infecting new animal species with coronavirus, some of those animals may also in turn infect humans. WHO cited infections at a Dutch farm in mid-April as likely evidence of the vicious cycle, stating: “In a few instances, the minks that were infected by humans have transmitted the virus to other people.” WHO described the cases as “the first reported cases of animal-to-human transmission” – beyond the original presumed leap of the virus from an animal species to humans in China, where the pandemic first originated. 

As of 3 July, about 20 mink farms in Holland had been infected with COVID-19. In one of the Dutch farms where mink-to-human transmission was first documented, it is “most likely” that “at least one” of the three COVID-19 patients on the farm was infected by the minks, two Dutch ministers told Parliament in late May. 

The  United States Department of Agriculture (USDA) has also identified one lion, four cats and four dogs as infected with COVID-19. 

However, so far, there is still “no evidence” that other animals like ferrets, cats and tigers can transmit the disease to humans and thus spread COVID-19, according to WHO.  And even if some animals can feasibly catch and transmit the coronavirus, they do not drive the spread of COVID-19, says the World Organization for Animal Health (OIE):

“There is no evidence that companion animals are playing an epidemiological role in the spread of human infections with SARS-CoV-2”, the OIE states.

Even so, in light of current evidence, the OIE recommends that suspected or confirmed individuals with SARS-CoV-2 limit their contact with animals.

A better understanding of animal-human transmission will be important as the world tries to halt the rampant virus, as animals can become reservoirs of the virus and contribute to outbreaks.

However, it is “very difficult” to directly prove animal-to-human transmission, said virologist Linda Saif from Ohio State University in a Nature article.

Most International Research Favours High-Income Countries

The two-day WHO scientific meeting also reviewed the latest data from the WHO “Solidarity Trial” which has tested four potential COVID-19 therapeutics including: hydroxychloroquine, lopinavir/ritonavir, remdesivir and dexamethasone. Scientists agreed on the need for more trials to test antivirals, immunomodulatory drugs and anti-thrombotic agents, as well as combination therapies, at different stages of the disease.

The meeting analyzed 15 vaccine trial designs from different developers, and criteria for conducting robust trials to assess safety and efficacy of vaccine candidates. Participants discussed the use of a global, multi country, adaptive trial design, and clear criteria to advance drug candidates through the various stages of trials.

The scientists also concluded that most internationally-funded research projects have so far favoured high-income countries, with very few funded in low- and middle-income countries, highlighting the importance of the ACT-Accelerator Initiative to speed up the development and equitable deployment of COVID-19 tools.

Meanwhile, the Pan American Health Organization (PAHO) published a new 77-page report on Friday outlining the epidemiological situation and its response in the Americas, which have become the epicentre of the pandemic.

Image Credits: World Conservation Society, Twitter: @WHO, Cardiovascular and Interventional Radiological Society of Europe.