Health systems and global preparedness are not only an investment in the future but “the foundation of our response” to today’s COVID-19 health crisis, the head of the UN’s health agency said on Monday.
“Public health is more than medicine and science and it is bigger than any individual and there is hope that if we invest in health systems…we can bring this virus under control and go forward together to tackle other challenges of our times”, UN World Health Organization chief Tedros Adhanom Ghebreyesus told journalists in a regular press briefing.
‘Seize the opportunity’
Speaking via video conference from self-quarantine, having himself been in recent contact with someone who tested positive for COVID-19, the symptom-free WHO chief noted that over the weekend cases spiked in some countries in Europe and North America.
“This is another critical moment for action…for leaders to step up…for people to come together for a common purpose”, he said. “Seize the opportunity, it’s not too late”.
He also flagged that where cases are going up exponentially and hospitals reaching capacity “patients and health workers alike” are at risk.
“We need countries to again invest in the basics so that measures can be lifted safely and Governments can hopefully avoid having to take these measures again”, the UN agency chief asserted.
As some countries are putting in place measures to ease the pressure of health systems, he attested that building “stronger systems ensuring quality testing, tracing and treatment measures are all key”.
“WHO will keep working to drive forward science, solutions and solidarity”, the WHO chief concluded.
To understand more about how hospitals can prepare and cope with COVID-19, three guests spoke about how their countries were coping with the pandemic.
The Republic of Korea went from the second highest caseload of coronavirus patients globally to one of the lowest – without having to lock down the country – by drawing on lessons it learned from the 2015 MERS COVID outbreak, according to Yae-Jean Kim, Professor in the Division of Infectious Diseases and Immunodeficiency Department of Pediatrics, Sungkyunkwan University School of Medicine.
In addition to rapid PCR swab testing and rapid isolation, she explained that physicians for the Republic of Korea, among other things, developed “drive-through testing facilities”; had a community treatment centre for milder cases; prepared public hospitals for high-risk communicable diseases; and had private hospitals pick up overload cases.
From South Africa, Mervyn Mer, Principal Specialist at Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, said they worked within their capacity to reach the greatest number of people.
Since the pandemic struck South Africa months after other countries, they used their time to draw up a protocol to maximize “everything we feasibly could”, including expanding the capacity of existing hospitals as opposed to putting up field hospitals, he said.
Meanwhile, new WHO staff member Marta Lado, an infectious disease specialist and chief medical officer of Partners In Health in Sierra Leone, underscored that the 2014-2016 Ebola outbreak had that country how to manage infectious diseases through contact tracing, surveillance, critical care and PPE use.
“One of the most important lessons learned is how we were able to develop a critical care training” that covered monitoring patients vital signs and for shock as well as ventilation and oxygen, she detailed.
Pharmaceutical Strategy for Europe: Affordable, accessible and safe medicines for all
The Commission has today adopted a Pharmaceutical Strategy for Europe to ensure patients have access to innovative and affordable medicines and to support the competitiveness, innovative capacity and sustainability of the EU’s pharmaceutical industry. The Strategy will allow Europe to cover its pharmaceutical needs, including in times of crisis, through robust supply chains. A key component of building a stronger European Health Union, as called for by President von der Leyen in her State of the Union Speech, the Strategy will help to establish a future-proof and crisis-resilient EU pharmaceutical system.
Europe’s Pharmaceutical Strategy has four main objectives:
- Ensuring access to affordable medicines for patients, and addressing unmet medical needs (e.g. in the areas of antimicrobial resistance, cancer, rare diseases);
- Supporting competitiveness, innovation and sustainability of the EU’s pharmaceutical industry and the development of high quality, safe, effective and greener medicines
- Enhancing crisis preparedness and response mechanisms, and addressing security of supply;
- Ensuring a strong EU voice in the world, by promoting a high level of quality, efficacy and safety standards.
Although the Strategy is much more than a crisis-response instrument, it draws lessons from the initial response to the COVID-19 pandemic, and makes Europe’s pharmaceutical sector better prepared and more resilient.
The Strategy presents concrete actions to ensure accessibility, availability and affordability of medicines. It supports diversified and secure supply chains, ensuring the EU’s open strategic autonomy in the world, and it promotes environmentally sustainable pharmaceuticals.
The Strategy will also ensure that the EU’s pharmaceutical policy continues to serve public health in an ever-changing environment of scientific and commercial transformations. It will support patient centred innovations and accommodate digital and technological change.
Members of the College said
President of the European Commission, Ursula von der Leyen, stated: “The coronavirus pandemic has highlighted the vital need to strengthen our health systems. This includes access to safe, effective and high-quality medicines at an affordable price. In the challenging economic and social times the EU is currently facing, the strategy adopted today will ensure that Europe and Europeans will continue to benefit from such medicines. I call on Member States and the Parliament to endorse this approach which will be rolled out in the next three years, and beyond.”
Vice-President for Promoting the European Way of Life, Margaritis Schinas, said: “Effective and safe medicines, vaccines and treatments have helped to tackle some of the leading causes of disease and life-threatening illnesses in the past. These products will be crucial to uphold the health and well-being of the European citizens in these challenging times. Today’s strategy supports the EU’s pharmaceutical industry to remain competitive and innovative, whilst addressing the needs of the patients and those of our health systems.”
Stella Kyriakides, Commissioner for Health and Food Safety, stressed: “Today we launch the work to ensure that safe and effective medicines are accessible and affordable at all times and to all patients across the EU. With our Pharmaceutical Strategy for Europe, we are delivering on our commitment to create a future-proof and patient-centred pharmaceutical environment in which the EU industry can innovate, flourish and continue to be a global leader. It is our long-term vision for open strategic autonomy, and our response to the challenges of today and the vulnerabilities exposed by COVID-19. Today we put in place another pillar of the European Health Union.”
The Pharmaceutical Strategy for Europe marks the beginning of a process: its implementation includes an ambitious agenda of legislative and non-legislative actions which will be launched over the coming years.
Actions will cover the whole ecosystem of pharmaceuticals, but also some aspects of medical devices. It creates synergies with the Green Deal and our actions under the EU Strategic approach of pharmaceuticals in the environment to reduce their environmental risk, address pollution from pharmaceutical residues and promote greener manufacturing, use and disposal (a progress report is available). It is also linked to the action plan on Intellectual Property presented today.
The flagship actions of the Strategy include:
- A revision of the basic pharmaceutical legislation* (target date for a proposal: 2022) with a view to making this framework future-proof and innovation friendly;
- A proposal for a EU Health Emergency Response Authority (proposal: 2nd semester 2021);
- A revision of the regulations on medicines for children and rare diseases
- Initiating a structured dialogue with and between all actors in the pharmaceutical manufacturing and public authorities to identify vulnerabilities in the global supply chain of critical medicines and shape policy options to strengthen the continuity and security of supply in the EU;
- Cooperation between national authorities on pricing, payment and procurement policies, to improve the affordability, cost-effectiveness of medicines and health system’s sustainability;
- The creation of a robust digital infrastructure, including a proposal for a European Health Data Space (target date for a proposal: 2021);
- Support to research and innovation, notably via Horizon 2020 and EU4Health;
- Actions to promote innovative approaches to EU R&D and public procurement for antimicrobials and their alternatives and measures to restrict and optimise their use.
‘Real hope’ surrounding COVID vaccines ‘cannot be overstated’: WHO
Along with other tried and tested public health measures, the head of the World Health Organization (WHO) told journalists on Monday that “there is now real hope” that vaccines will play an essential part in helping end the COVID pandemic.
“With the latest positive news from vaccine trials, the light at the end of this long, dark tunnel is growing brighter”, said Director-General Tedros Adhanom Ghebreyesus. “The significance of this scientific achievement cannot be overstated”.
Setting new standards
Noting that no vaccine in history has been developed as rapidly, the WHO chief remarked that the scientific community had set “a new standard for vaccine development” and now the international community must set “a new standard for access”.
“The urgency with which vaccines have been developed must be matched by the same urgency to distribute them fairly”, he spelled out, warning of a real risk that the poorest, and most vulnerable will be “trampled in the stampede” to get innoculated.
“The ACT Accelerator has supported the fastest, most coordinated and successful global effort in history to develop vaccines, diagnostics and therapeutics”, he attested.
He said that currently 50 diagnostics are under evaluation; rapid antigen diagnostics are now available for low and middle income countries; while life-saving treatments are being rolled out and new medicines tested.
Moreover, 187 countries are taking part in the COVAX facility, to collaborate on the procurement and rollout of vaccines, “ensuring the best possible prices, volumes and timing for all countries”, he said.
Despite the excellent progress, Tedros said that “only a fundamental change in funding and approach will realize the full promise of the ACT Accelerator”.
He revealed that $4.3 billion is still needed to support mass procurement and delivery, tests and treatments this year and another $23.8 billion would will be required in 2021.
“This isn’t charity, it’s the fastest and smartest way to end the pandemic and drive the global economic recovery”, he stressed.
According to the International Monetary Fund (IMF), if medical solutions can be made available faster and more widely, they could lead to a cumulative increase in global income of almost $9 trillion by the end of 2025.
“The real question is not whether the world can afford to share vaccines and other tools; it’s whether it can afford not to”, stated the WHO chief.
Remdesivir no COVID-19 silver bullet
An advisory body of the UN health agency is not recommending the use of the high-profile antiviral drug Remdesivir for hospitalized COVID-19 patients, saying on Thursday there is insufficient evidence that it improves survival outcomes or cuts down on the need for patients to be put onto ventilators.
A World Health Organization (WHO) Guideline Development Group (GDG) panel of international experts made the recommendation in the BMJ – the weekly peer-reviewed medical journal, published by the British Medical Association – as part of so-called “living guidelines” to manage the coronavirus and help doctors make better decisions in consultation with patients.
“Living guidelines are useful in fast moving research areas like COVID-19 because they allow researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available”, said WHO, in a press release on the findings.
Remdesivir has received global attention in treating severe coronavirus cases and is increasingly being used for hospitalized patients. But its role in clinical practice has remained uncertain.
WHO’s recommendation is based on new evidence comparing the effects of several drugs on treating the virus and includes data from four international randomized trials involving more than 7,000 COVID-19 inpatients.
After reviewing the evidence, the WHO GDG expert panel, which includes four patients who have had the coronavirus, concluded that the intravenously administered Remdesivir “has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement”.
Arguing its use
The panel acknowledged that the certainty of the evidence is low and did not prove that Remdesivir has no benefit; but rather, “there is no evidence based on currently available data that it does improve important patient outcomes”, according to the WHO release.
However, the GDG supported the continued enrolment of patients into Remdesivir evaluation trials to determine whether more substantial evidence can be obtained, especially with regards to specific groups of patients.
The WHO press release also cites a feature article linked in the panel’s BMJ report, which says that the full story of Remdesivir will not be understood until its manufacturer, Gilead, releases full clinical study reports.
In the meantime, reports the journalist who wrote the feature, Jeremy Hsu, alternative treatments such as widely available corticosteroid, dexamethasone, that has been proved to reduce mortality among some severely-ill COVID-19 sufferers, are “now impacting discussions about Remdesivir’s cost-effectiveness”, in the words of the WHO press release.
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