Much of the current COVID-19 discussion across the US focuses on choreographing a transition from what has been called the “hammer” of lockdowns to the “dance” of a carefully staged easing of certain restrictions.
Faced with such an all-consuming tango, it’s understandable if few Americans are monitoring the steady rise of infections in sub-Saharan Africa and elsewhere in the developing world. Yet we must—and not just because wealthy countries have a responsibility to assist low- and middle-income countries.
As we contemplate our exit strategy from COVID-19, we need to keep one thing top of mind: The only victory against COVID-19 is a global victory. And winning that war will require a much bigger role for a star player from previous global health fights, the United States Agency for International Development. So far, the US Congress has overlooked the agency’s importance in innovation, something that can be remedied as lawmakers prepare a new round of COVID-19 appropriations.
We’ve all seen how quickly the SARS-CoV-2 virus that causes COVID-19 circled the planet. In the future, a pocket of infections in one part of the world could act like a smoldering ember that could be easily stirred to ignite another scorching wildfire of disease. Also, in today’s highly connected global economy, the revival of American jobs and businesses will be heavily dependent on a return to normal for markets and supply chains around the world.
There are also enormous implications for efforts now underway to develop and deploy new drugs, vaccines, diagnostic tests and medical devices. The technologies that work here may not be effective or affordable for impoverished regions that lack strong health systems and basic infrastructure. For example, optimism over the antiviral remdesivir is tempered by the fact that it must be administered intravenously for 10 days—a significant barrier for many poor countries.
The good news is that there is a history of developing and adapting innovations for global health—such as vaccines that don’t require refrigeration and simple, rapid diagnostic tests—that offer a roadmap for pursuing COVID-19 interventions that can be accessible and affordable in some of the poorest places in the world.
International public-private partnerships fueled many of these advances—with significant support from the US government. USAID, in particular, has been very effective at using its health research funding to bring together investments from industry players and nonprofit and philanthropic partners to support underserved populations.
Recently, Congress has moved with understandable urgency to provide significant funding for COVID-19 research and development at the National Institutes of Health and Biomedical Advanced Research and Development Authority. The USAID Bureau for Global Health has not received commensurate resources, even though it has a long history of leading US government efforts to develop health innovations targeting the needs of LMICs.
With appropriate resources, USAID, working independently and in partnership with other US agencies, could be instrumental in spurring the development of COVID-19 tools such as:
- Heat-stable vaccines that don’t require constant refrigeration. One reason a meningitis vaccine supported by USAID, known as MenAfriVac, has dramatically reduced deaths in sub-Saharan Africa is that it is formulated to remain stable for 4 days at temperatures approaching 100 degrees.
- Inexpensive, simple-to-operate medical devices. USAID is part of a new global effort to use $25 pulse oximeters to rapidly detect low blood-oxygen levels to help prevent pneumonia deaths in sub-Saharan Africa and South Asia. The devices may also help COVID-19 patients avoid the need for ventilators.
- Treatments that can be easily administered across large populations. Until very recently, treating sleeping sickness required a complicated infusion regimen similar to remdesivir. A major funding push led to the development of a pill that can be taken at home.
- Rapid point-of-care diagnostic tests that don’t require a separate laboratory. One COVID-19 test approved for emergency use can be run on an automated machine called GeneXpert. USAID already has been working with other donors to make this device more widely available in developing countries to increase access to tuberculosis testing.
USAID involvement in these and other global health innovations showcases a talent for tapping American science and ingenuity to deliver technologies that are as effective in poor communities as they are in wealthy ones. The agency’s work has saved lives and slowed epidemics—from chronic challenges such as HIV/AIDS to acute emergencies such as Ebola and Zika—and will be critical for resolving current and future threats.
The dance to defeat COVID-19 ultimately must be a global production. USAID, with its steady commitment to achieving health equity through biomedical innovation, is clearly primed to play a leading role.
Jamie Bay Nishi is director of the Global Health Technologies Coalition (GHTC), a coalition of 30 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people.
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