Why Researchers Are Exploring Antibodies From Recovered Patients For Possible Treatment And Prevention Of COVID-19

This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. Is there a Covid-19 treatment that can treat critically ill, hospitalized patients, on the one hand, and protect healthcare workers on the other? Passive immune therapy has the potential to do both-immediately, and with major improvements over time. Broadly speaking, it involves giving antibodies, in this case specific to Covid-19 virus SARS-CoV-2, to people who need them. The first stage is sera from convalescents. The second is purified antibody fractions that are safer and more potent, but also achievable-hopefully by summer. The third is monoclonal antibodies, which will take more time but is already on the fast track. Each approach mobilizes antibodies against SARS-CoV-2 in unique ways, with varying degrees of safety, speed, and efficacy-and all three must be explored. A primer on antibodies When the body is under attack, the immune system's B cells produce antibodies specific to the invading organism that fit its viral proteins with utmost precision. This hand-and-glove binding mechanism either marks the target for destruction via other white blood cells, inhibits basic biological activity, or targets the invading organism for clearance from the body.  Some virus-specific antibodies linger on in the body long after infection has cleared. While immunoglobulin M (IgM) antibodies, the largest and first to be produced, disappear shortly after their role as the initial line of defense has been fulfilled, immunoglobulin G (IgG) antibodies remain in abundance in all bodily fluids, ready to leap into action should the virus ever return. If a patient makes a full recovery from Covid-19, the IgG antibodies their immune system weaponized to fight the virus will retain a memory of the disease at least for many months.  Shortest term solution: convalescent sera In the event of an infectious disease outbreak for which neither a cure nor a vaccine yet exists, such as the current pandemic, medical practitioners can transfer the antibody-rich blood plasma of recently recovered patients to those critically ill. Collected at least a few weeks after the donor has been discharged, this convalescent plasma, also known as convalescent sera, still contains antibodies against the virus that can treat patients in critical condition. Treatment, not protection, is the purpose of convalescent sera, which buys enough time for some to stabilize and recover. Use of convalescent sera dates back to the 1900s but has more contemporary precedents that suggest its viability as a somewhat reliable stopgap measure against emerging infectious diseases. From H1N1 influenza to Ebola to Covid-19's foremost predecessor, SARS, medical practitioners have repeatedly turned to this basic form of passive immune therapy and, in several cases, reported back promising reductions in mortality and viral load. Combined with small studies recently conducted with Covid-19 patients, the evidence is favorable enough that convalescent sera transfers, as of March 24, are FDA approved for emergency cases in the United States. That said, there are many valid reasons why convalescent sera therapy is still considered experimental and reserved for emergencies only. Although modern blood banking technology does a fine job of filtering rogue substances out of plasma donations, the principle worry is infection from hepatitis and other viruses. Patients with certain immunodeficiencies or lung-related comorbidities, among the most vulnerable to Covid-19, may be ineligible. With so many lives on the line, and so few options in the way of treatment, these risks may be worth it-but there are safer alternatives worth pursuing.  Shorter term solution: hyperimmune globulins  In New York City, the new epicenter of the pandemic, the New York Blood Center has already started to collect blood plasma donations from convalescent Covid-19 patients for therapeutic use. The ultimate distribution of donors and donations will be determined by patterns in caseload and recovery, with convalescent sera moving between hospitals accordingly. As both the number of recovered patients and the number of infected patients continue to rise, a good portion of incoming donations received by the 380 licensed plasma collection centers across the country should be pooled for the creation of a cleaner, more concentrated, and more effective passive immune therapy: hyperimmune globulins.  Unlike convalescent sera, which is processed and circulated through a network of hospitals and clearinghouses, the preparation of hyperimmune globulins-especially at a commercial scale-requires proper manufacturing infrastructure. First, in designated labs and manufacturing plants, samples of collected plasma are assessed for their potency. The goal is to locate and quantify highly neutralizing antibodies, those most adept at fighting the virus, and concentrate them into a clinical grade solution. Once identified, the highly neutralizing antibodies are pooled, purified, and incubated in large batches over the course of several weeks. If all goes well, the resulting hyperimmune globulin preparations should be safer and less variable than a dose of convalescent sera. They can be administered to critically ill patients as treatment and healthcare workers as protection. Hyperimmune globulins have already been produced for diseases like cytomegalovirus, H1N1, and hepatitis. They were even prepared for SARS, though these, like so many other potential coronavirus therapies, never left the lab. The process of industrial purification may be more labor intensive and time consuming, but with enough resources and facilities mobilized, it can also be accelerated. At this point, the coronavirus pandemic is so widespread that recruiting enough plasma donors for rapid manufacturing-usually one of the most significant challenges in yielding high volumes of hyperimmune globulins-will only grow in feasibility. Another technique that has demonstrated success in the past is the collection and refinement of equine plasma. Groups of horses would be immunized with a killed version of SARS-CoV-2, the Covid-19 virus, and develop antibodies in response. Because horses are larger animals, they produce more plasma than humans that can, in turn, be purified just as we purify that of convalescents. Either way, hyperimmune globulins would take longer to prepare than convalescent sera, but not nearly as much time as vaccines or antiviral drugs-meaning they're well worth the effort. Long term solution: Monoclonal antibodies The final, most advanced, and most specific of the passive […]

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Houston Public Radio Interviews William A. Haseltine

ACCESS Health Chair and President William A. Haseltine recently appeared on Houston Matters: Special Edition with Ernie Manouse. The full interview is available to listen to HERE. A transcript of the conversation is also available, below. William Haseltine (WH): It is a pleasure to be here. Ernie Manouse (EM): It is sad that it is under these circumstances, but I am thrilled you accepted our invitation and can join us to talk about this. You have had a lot of experience in what goes on in these global pandemics and understand the way to treat it, the way to look at vaccines and medications. At this point, do you have hope? WH: We always have hope, and in this case, I have got a lot of hope. This is not a hard problem to solve from a drug point of view. This is a virus. It is not cancer. It is different from your body. It is a foreign invader. Not only that, there are many, many points of vulnerability. We have very powerful tools to find new drugs that target these specifically. We have a lot of drugs that we know work against viruses, not this one, but we are confident that because we have been able to find drug cocktails for HIV, we are able to cure hepatitis B, there are great drugs for herpes virus infections. This is a problem that can be solved. It will not be solved immediately, but I guarantee you we will solve this problem. As for vaccines. We are hopeful. Vaccines are more complicated. These viruses have developed ways to evade our immune systems in one way or another. That is why they are successful. We certainly will have vaccines. Vaccines will raise immunity, whether it is a perfect shield or not, we do not know yet. And for how long if you are vaccinated, whether protection be long lasting or not, we do not know yet. I am reasonably confident we will also have effective vaccines and that if they do not stop the disease will certainly weaken its impact on the human population. EM: The problem with vaccines, though, it is going to be a wait before we get them. No matter what we want to do, no matter what we hope for, there is a little lag time there. WH: There is going to be a lag time for truly effective drugs and there is going to be a lag time for the vaccines. EM: I was going to say, early on, the President was talking about different drugs we could use and it felt as though they were talking about it like no matter what your illness, just go into a drug store and just pick something up. There has to be more thought when people say what kind of drug can actually show potential to help with this particular virus. This is a little bit in the weeds of a question, I know, but how do you go about deciding where you should even look in the world of drugs that currently exist or even in vaccines that were started to know that they might show hope in this battle? WH: Let me answer that question in a couple of ways. First of all, I want to make sure whoever is listening knows there are no drugs that we are currently certain will work to treat this disease. No drugs. You may have heard about of a whole series of drugs. We do not know that any of them work for sure because they have not been done and tested under the proper conditions. The first place to look for drugs that we might already have approved that could be useful are drugs that are useful for cancer, as well as those that are useful for other viruses. So far those have not proved to work. That does not mean that they will not. It just means it has not been proven yet. The next place you look for drugs is all of those chemical compounds, drug candidates that were produced to fight SARS and MERS. There were many, as many as twenty possibly thirty, that were shown to be potent in their ability to stop the virus growing in the laboratory. That is different from showing that it is safe in humans and that it will stop it in humans, but at least it is a good start. Why you might ask, don’t we have those available today? Because we stopped all research when we thought SARS or MERS would go away, despite the fact that I, and many, many people who understood how dangerous these viruses were, urged that we bring those to completion. We did not. The third place to look: We know what this virus needs to grow. There are at least four or five absolutely critical parts the virus cannot do without. I have great confidence that we can find new compounds not yet discovered that will work to stop each one of those. So, we are very confident in the long run. The short run, I would say is still very much open. EM: When we talk about coronaviruses, we tend to use the term coronavirus to mean what we are talking about today, but as we know it is a whole family of viruses. Are there other drugs out there that are effective against other coronaviruses. Is that somewhere we might look? WH: There are a lot of coronaviruses.  There are eighty eight different families of coronaviruses and within each family there are many, many variants. There are no known drugs that are shown to stop coronaviruses. There is a short term potential treatment and a way you might even prevent these infections and that is being tested right now, passive immune therapy. Passive immune therapy initially uses convalescent sera. That sera can be used to treat those that are most critically ill. That is being done today. The next step […]

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Why Don’t We Have A Coronavirus Drug Yet—And How We Can Develop One As Soon As Possible

This article was written by ACCESS Health Chair and President William A. Haseltine for Forbes. How will the new coronavirus pandemic end?  It could prove to be seasonal, meaning it peters out with the weather with a chance of returning at this time next year. A significant plurality of all people on Earth could contract the disease-prolonging its duration, slowing it over time through a gradual buildup of herd immunity, and inevitability leading to the death of millions. Or one of the many pharmaceutical companies hard at work on inventing a vaccine could succeed and administer their product widely and cheaply, though at least a year will go by before this comes to pass.  Our best option-the option that will save the most lives in the least amount of time-is to accelerate the development of therapeutic antiviral drugs that treat infection and prophylactic antiviral drugs that prevent infection. Two approaches can realistically achieve this. The first is to repurpose existing antivirals. The second is to develop de novo, from scratch. Pharmaceutical companies and national health agencies have begun to pursue both strategies aggressively as the Covid-19 outbreak intensifies.  Lucky for them, a massive corpus of laboratory studies conducted around past coronavirus outbreaks already exists-remnants of drug discovery efforts marshaled around SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) that never came to fruition. Much of the preclinical and phase I clinical trials showed promise and, had they advanced to the stages required for FDA approval, we might have had therapeutic or even prophylactic antivirals in our possession on the eve of Covid-19. What happened to halt the pipeline then, and how can we accelerate it now? SARS & MERS: Why a drug was never developed The origins of the SARS outbreak can be traced back to November 2002, when cases of an "atypical pneumonia" first appeared in the Guangdong Province of southern China. Come February 2003, similar reports were surfacing in regions as near as Hong Kong and countries distant as Canada. These outbreaks, previously thought to be isolated, began to occur with more frequency in March, mainly in hospital settings and therefore mainly infecting healthcare workers. By early April, a slew of research groups had determined a novel coronavirus to be the epidemic's likeliest causative agent. Initially, the international research response was robust. Once the virus was identified, diagnostic assays and profiles of its clinical, virological, and epidemiological characteristics soon followed. Potential antiviral candidates were investigated, animal models were developed-mice, macaque monkeys, and Golden Syrian hamsters among them-and vaccine strategies were charted and advanced, sometimes as far as phase I clinical trials. In the meantime, most patients infected with the disease were treated using experimental combinations of ribavirin, interferons, steroids, and antibiotics, though it was never proven at the time whether these therapeutic interventions corresponded with actual rates of recovery. In July 2003, around 8,000 cases and 800 fatalities later, SARS was deemed to be officially contained. Efforts to research the SARS coronavirus, of which much remained unknown, continued, motivated by the certainty that it wouldn't be the first to wreak havoc on human life. The lack of knowledge around the molecular biology of SARS-CoV, i.e. ideal targets for entry and replication inhibitors, that impeded drug development during the outbreak was largely resolved in its wake. All the pieces needed to bring new antivirals to the finish line were falling into place. All except for one: the money. The funding streams funneled by pharmaceutical companies, governments, and nongovernmental organizations into labs around the world had all but dried up by 2006. No cases of SARS had been reported since 2004, and previously invested parties were losing interest. Thousands of scientific papers had been published on SARS, and yet nearly a decade later, when MERS first appeared in Saudi Arabia in late 2012, not a single antiviral drug was available for public consumption.  Since some of the more promising inhibitors identified in the SARS literature had yet to undergo large scale testing for toxicity, healthcare workers treating MERS stricken patients up and down the Arabian Peninsula reverted back to the experimental therapies administered to SARS patients-even though they were ultimately found to yield "little to no clinical benefit." The MERS epidemic went on to infect fewer people than its predecessor-around 2,500, to be exact-but racked up a mortality rate triple that of SARS. At first, it seemed like the momentum for finding antivirals had mounted anew. Calls came more urgently not just for a MERS vaccine, but a broad spectrum antiviral that could successfully neutralize future coronavirus threats. Yet by 2016, the year MERS cases definitively began to dwindle, the antiviral drug to make it furthest down the pipeline was only just entering phase I dose escalation trials. Three years later, that number had increased to three. The estimated date of completion? Ten years from now. Covid-19: Paying for our past mistakes and avoiding new ones  As of March 23, Covid-19 has infected nearly 350,000 and killed more than 15,000. The tally has increased so exponentially that it has become difficult to keep track. From the beginning, it has already been too late; we had almost two decades to prepare ourselves and instead met our enemy unarmed. Back when SARS research was still ongoing, the Singapore based biomedical research hub Biopolis commissioned a sculpture for their central plaza. SARS Inhibited (2006), the winning design conceived and actualized by artist Mara G. Haseltine, was erected as an homage to the notable contributions that Biopolis scientists made to the coronavirus drug discovery and development front. While their findings were unduly shelved, they are now seeing the light of day. The Covid-19 coronavirus is called SARS-CoV-2 for a reason. While their genomes aren't exactly identical, the two coronaviruses have between 80 to 90 percent of the same genetic material. Like SARS-CoV, SARS-CoV-2 penetrates a human lung cell by binding to ACE2, a receptor protein located on its surface. In an effort to expedite the search for efficient therapies, scientists […]

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Test, Trace, and Quarantine: The Only Way to Overcome SARS-CoV-2

This piece originally appeared in Project Syndicate. Kentucky Senator Rand Paul's behavior over the past two weeks is exactly what's wrong with America's response to COVID-19. Paul has a compromised lung, so he decided that he should be tested for the disease out of an abundance of caution. From the time of his test until he was confirmed positive six days later, Paul did nothing to protect those around him. On the contrary, he met with other senators, cast votes on the Senate floor, played a round of golf at a private club, and even squeezed in a few laps at the Senate pool. In the countries that have contained the coronavirus outbreak, such irresponsible behavior has not been tolerated, and even could have landed Paul in jail. As a physician (ophthalmologist), he, more than anyone, should know that if he was concerned enough about COVID-19 to be tested for it, he should have been equally concerned about the risk he was posing to others. Containing the transmission of any infectious pathogen - especially one as contagious as COVID-19 - requires aggressive action. Defensive moves like closing businesses or social distancing are effective only when combined with rigorous, systematic efforts to get ahead of the spread of the disease. In Singapore, South Korea, and other countries that have stanched the spread of the coronavirus, public-health authorities have followed a simple process. First, widespread testing has identified those who are infected even before they show symptoms (which many never do). Then, aggressive contact tracing has identified everyone with whom the infected person has interacted. Finally, everyone identified has been subjected to a mandatory 14-day quarantine. This process not only contained the outbreak; it also avoided some of the extreme lockdown measures used elsewhere. Success lies in an uncompromising approach involving mass testing, contact tracing, and selective quarantining - all of which the US has failed to do. In Singapore, the moment a person tests positive for COVID-19, a team of contact tracers is deployed. Someone sits with the patient for hours asking where he has been and with whom he has been in contact in the previous days. Others track down names, phone numbers, addresses, and anything else the patient can tell them that might help identify more positive cases. The team then delivers its findings to the Ministry of Health, which corroborates the information through phone calls, CCTV footage, and traditional detective work like reviewing retail receipts or checking rideshare apps to find drivers and passengers who might have interacted with the patient. Once the list of potential contacts is known, everyone on it receives a call, and those most at risk of having been infected are required - not asked - to quarantine themselves for 14 days. Depending on the closeness of the contact, some are moved to a secure quarantine facility, whereas others may be permitted to remain in their homes. Earlier this month, a close friend of mine returned from Europe to Shanghai and lived through the quarantine experience. Three days after arriving in China, he received calls from the police, the Shanghai Municipal Center for Disease Control and Prevention (CDC), and the district CDC telling him that a passenger on his flight had tested positive. My friend and his wife were then put into controlled quarantine, in a hotel that had been converted for the purpose. They resided in separate rooms, received three meals a day (along with other amenities), and were prevented from leaving until 14 days had passed since the point of initial contact on their flight. In China, quarantines are monitored through an app. Everyone receives a unique QR code showing their status - green if you're clear of infection, yellow if you've been instructed to stay indoors, red if you are under quarantine. If you're roaming the streets and your QR code flashes red, you will immediately be moved back to quarantine, or else you may face fines or jail time. Singapore has taken this technology even further, launching a new TraceTogether app that people can download to help protect themselves and those around them. If a user passes within two meters of someone who is found to be infected, the app immediately notifies the user of the risk. Since late January, when Singapore reported its first case of COVID-19, more than 6,000 people have been identified through contract tracing and put into proactive isolation and quarantine. Owing to these efforts, infections have been contained, hospitals have not experienced a major surge in new patients, and only three people have died of the disease. By contrast, although the US has many of these methods at its disposal, it has failed to deploy them effectively. The Centers for Disease Control and Prevention has trained more than 3,600 disease detectives who are skilled in identifying those infected, tracing their history of contacts, and mitigating the wider risk to the community. But they have been unable to do their jobs, owing largely to early testing failures, which still have yet to be resolved. Contact tracing is costly and time-consuming even in the best of times, when an outbreak is still small. With large outbreaks that have gone undetected because of a lack of tests, it becomes nearly impossible logistically. But failure must not be allowed to follow failure. Tests are finally becoming available to more Americans. Widespread testing, together with exhaustive contact tracing and selective quarantines, can still help us wrestle the outbreak back under control. As Paul himself said when defending his reckless behavior, "America is strong. We are a resilient people, but we're stronger when we stand together." True, but we are stronger when we stand together and act responsibly.

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Is This Coronavirus Epidemic The Big One?

This article, authored by ACCESS Health Chair and President William A. Haseltine, was originally published on Forbes. When a friend asked me if this was the big one two weeks ago, I was not sure.  Today I can answer: Yes. This is a big one in terms of lives that will be affected and lost, and economies destroyed. But... It is a big one, not as a consequence of an intrinsic property of the virus, but entirely the result of human action and inaction. The course of the epidemic in China shows that the epidemic can be controlled without an effective vaccine or antiviral drug. Rigorous people to people contact control can halt the spread of infection. Lack of short-term and long-term preparedness has doomed both the US and Europe and may well devastate other continents as well.  Forewarned long in advance that a pandemic respiratory infection from an influenza or coronavirus was inevitable, our government failed to prepare and to support the research needed to create the vaccines and drugs needed to prevent and treat infections. We also failed to develop the necessary health system infrastructure needed to cope. This despite repeated warnings over the last thirty-five years since the advent of HIV/AIDS that this day would surely come. Failures over the past three months are of a different sort. They are failures of leadership and of government. We are plagued by a President who, more than three quarters through his term, still claims that the buck stops with Obama. He is deaf to the agonized pleas of our health care professionals who, unprotected, must risk their lives and those of their family to treat the ill. The economic toll is yet to be measured but surely will include an unprecedented global depression, bankruptcies of national and state governments, businesses large and small and untold millions of people around the world that depend on their jobs for food and shelter.  What may mount to well more than 100 trillion dollars in economic damage could have been prevented by a few billion dollars of investments in research and a few hundred billions in health infrastructure. I fear ten years from now (one, two, three Presidencies hence) we will revert to our natural state of complacency, distracted by present exigencies and fail to prepare for nature's next inevitable big one.

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Healthcare must be Affordable and Accessible, but also High Quality

This post, authored by Valerie Shelly (ACCESS Health International), Susann Roth (Asian Development Bank) and Kirthi Ramesh (Asian Development Bank), originally appeared on the Asian Development Bank blog. Universal health coverage must be high quality to improve patients' health outcomes Shakina lives in a developing country. Although there is a public hospital near her home, she chooses to travel four hours by bus to go to a well-liked, private hospital in the city. She has heard from her friends and neighbors that they were pleased with the care they received at this hospital and to her they seem healthier and happier when they get back. She has heard bad stories from other friends who went to the closer, more affordable, public hospital – they returned home sicker than when they left. Shakina's story reminds us that all people, regardless of socioeconomic class and means, want high-quality healthcare and that they will often choose higher quality care even if it is more expensive and less accessible. Under the World's Health Organization's definition of universal health coverage, all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. The concept of quality has only recently been built into universal health coverage policies and has not yet been sufficiently addressed. If health investments are to lead to the emergence of more productive and equitable societies and economies, countries need to focus on improving quality. The three priorities of health care delivery - cost, quality, and access - need not be at odds with each other. Greater use of health care facilities due to lower costs and shorter distances to travel will only lead to better health outcomes if quality of care is guaranteed. Therefore, we must make high-quality healthcare services affordable and accessible in order to effectively implement universal health coverage. Simply providing access for more people to lower quality care won't achieve universal health coverage. Poor-quality care is wasteful, costly, and dangerous. It is estimated that between 5.7 million and 8.4 million people die each year in low- and middle-income countries due to poor-quality care. In other words, in many countries, a person has a greater chance of dying from receiving poor quality care than from going without care entirely. In addition to the human cost, poor quality also has an economic cost. Poor productivity and wastefulness, resulting from poor quality of health care, costs these countries around $1.4 trillion to $1.6 trillion per year. Poor-quality care proves costly for societies when unhealthy adults are less productive at work and unhealthy children cannot perform well at school. High-quality care is cost-effective and leads to an earlier and higher return on investment. Approximately 15% of hospital expenditures in high-income countries are used to correct preventable complications of care and patient harm. This is a price that is an inconvenience to high-income economies and completely unaffordable for low- to middle-income countries. In addition, poor-quality care affects the poor and vulnerable disproportionately. While investing in higher quality health systems costs more upfront, costs are lowered over the long-term through more efficient workflow; fewer medical errors and preventable complications; elimination of ineffective treatments and procedures; fewer duplicated services; and less waste overall. Even during a crisis or epidemic, resilient health systems can deliver high-quality services Quality health services make health systems resilient. They are prepared for anything, can maintain core functions amongst changing situations, and are informed by lessons learned, constantly adapting and improving. Even in a crisis during times of political unrest, or during an epidemic, resilient health systems can rely on their basic processes to deliver high-quality services. Secondly, quality health services make health systems trustworthy and transparent. Poor- quality care, even when taken to the far reaches of the world, erodes trust, puts patients at risk, and is completely unsustainable. High-quality care builds trust in the health system, nourishes a culture of respect towards individuals, improves patient safety and produces better patient outcomes. A truly transparent healthcare organization is open and honest about successes as well as failures, ensuring care is based best practice clinical protocols, building complete trust and long-lasting relationships with their patients. Finally, quality health services make health systems patient-centered. A central feature of quality health services is that they are patient-centered and give great consideration to the patient's individual needs, culture, and beliefs. Patient-centered care is vital to the implementation of universal health coverage, as we know that people who are engaged in their own care suffer fewer complications and enjoy better health and overall happiness. A central aspect to achieving patient-centered care is seeking feedback on patients' care experience. Improving quality requires a holistic approach. Countries that want to improve quality of care need to consider interventions across different domains (leadership, information, patient and population engagement, regulation and standards, organizational capacity, models of care) across different levels of the health care system. Building a national strategy for quality is an important first step to agree on a clear set of goals, define suitable interventions and tools and align different stakeholders' efforts to improve quality of care. Shakina chose to travel a long distance for high-quality care instead of taking her chances on accessible, poor-quality care. We need to make it easier for Shakina to receive the high-quality care she deserves, at a reasonable distance from her home, from a skilled health professional that puts her at the center of her care. By doing this, we will see that in the end, high-quality care really does pay off.  

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Digital Solutions to Manage and Contain Disease Outbreaks

Since the outbreak of the new coronavirus at the end of 2019, Chinese citizens have united to fight against the epidemic. The United Nations, the World Health Organization (WHO) and the international community have given high praise to China’s effective measures in preventing the spread of the epidemic. Here, the ACCESS Health China team summarizes the efforts and contributions of our alliance members who provide innovative digital solutions to the outbreak control in China. We hope the cases would give insights and lessons to our partners and related enterprises all over the world. At the same time, we sum up the experience and the lessons we learn from the shortcomings exposed in the process of epidemic prevention, and promote the application of digital health in disease control, and further improve China’s capability in responding to public health emergencies. 1. Disease prevention, treatment and management: Telemedicine Case 1: WeDoctor In order to minimize the risk of cross-infection and reduce the burden of first-line Health facility, WeDoctor launched the "WeDoctor Consultation and Prevention Center" on January 23 to support the prevention and control of the new coronavirus. More than 40,000 doctors in respiratory, infection, general and critical disease gathered at the platform and provided free online consultation to patients across the country. At the same time, in response to the panic caused by the virus,  the platform has also set up a psychological consultation sector. Citizens can conduct self-assessment of post-traumatic stress disorder, anxiety and depression, and can also consult online experts. on March 10th , the platform had more than 120 million visits, and provided a total of 1.599 million medical consultation services. On March 14th, partnering with China International Exchange and Promotive Association for Medical and Health Care (CPAM), WeDoctor launched the Chinese-English bilingual WeDoctor Global Consultation and Prevention Center. This digital health platform brings together medical resources at home and abroad and provides medical consultation to more than 60 million Chinese citizens and international friends overseas.Users can access to free online health consultation (graphic, voice and other forms of service) and clinically proven epidemic prevention knowledge through the WeChat official account “WeDoctor Health”. The service is not limited to any countries and has unlimited times of uses, the purpose of the service is to help people around the world to scientifically protect themselves from and overcome the disease. Case 2: More Health More Health undertook the data collection of “Healthy Wuhan” mobile application led by Wuhan Health Commission. More than 10,000 copies of thermometers and oximeters were presented to Wuhan citizens free of charge through the app. Citizens only need to log in to the "Healthy Wuhan" APP, fill out relevant information to get such medical equipment.  These batches of thermometers, oximeters and other disease prevention equipment are smart devices with data transmission functions. Symptoms of COVID-19 infection are not obvious at first, the common clinical diagnosis is persistent high fever and sudden decrease in blood oxygen concentration. With data connecting smart thermometer and oximeter, residents can continuously monitor their own bodies at home and ask for online diagnosis when abnormalities are found.  By doing this, a large amount of common cold patients can be diagnosed and treated online and avoid cross-infection in hospital. Case3: JuniperMD In order to support the country’s relentless effort on preventing the virus, reducing the burden on hospitals and eliminating possible cross-infection during medical treatment, JuniperMD teamed up with Healthfutures partners China Primary Health Care Foundation and jointly launched a series of free live broadcasts. During the broadcast, experts from Sino-US medical service institutions such as Columbia University Medical School, Boston Medical Center, Shanghai Jiao Tong University School of Medicine, and New York Presbyterian Hospital provided patients with remote healthcare consultation. The lectures also focused on  topics such as “How to distinguish between common flu and new coronavirus “, “Traditional Chinese and modern at home treatment techniques for common diseases”, and “psychological health maintenance during self isolation”.  Case 4: Judong Health Judong Health launched a 5G CT screening vehicle with Campo Imagining based on the original integrated first-aid platform. Compared with the traditional CT screen equipment, the 5G CT screen vehicle has extremely high mobility and flexibility. This vehicle is equipped with the latest 5G wireless data transmission function, which enables remote transmission of image data for remote diagnosis and serves hospitals and patients at the fastest speed. 2. Social Support Case 1: Viewhigh Technology (Social Support: Online Donation Platform) Based on smart supply chain technology, cloud services and big data technology, Viewhigh technology launched  “hospital emergency supply management platform”, the platform help establish rapid communication channels for hospitals, material suppliers, non-profit organizations, individuals at all levels throughout the country. Among them, Viewhigh cloud and the supply-side system has the level 3 national information security protection, which is the highest level of national certification for non-bank institutions. The platform iteratively launches information on hospital emergency supplies needs and purchase orders to over 40,000 medical material suppliers. Hundreds of medical institutions, such as Wuhan Jinyintan Hospital, Wuhan Central Hospital, Wuhan Lei Shenshan Hospital, Wuhan Children’s Hospital, and other frontline hospitals against COVID-19 have issued emergency material shortage announcements through platform, and successfully obtained emergency supplies. As of February 24, a total of 154 registered hospitals, 79 announcements have been issued, 7.1 million RMB have been traded and donated. Case 2: Wonder Technology (Mental Health) People, while accepting an exploration of virus related information, are easily vulnerable to depression, hopelessness, anger, fear, and other emotions. At the same time, front-line medical staffs not only face high-intensity work load and lack of rest, but also bear the anger from some patients do not cooperate. Pressure on both physical and mental health are tremendous.  Wonder Technology carried out an “emotional mask” project, where people can use mobile app capture their own voice and get a 3-minute plan that is suitable for solving current emotional problems. The application is developed base on world’s most accurate emotion perception AI model, the accuracy can reach to 88.5-95%. The project  has radiated more than 20,000 users, and will continue to grow in the future. 3. Epidemiologic study Cooperating with Tsinghua University, More Health’s officially launched the first version of “New Coronavirus Open Knowledge Graph […]

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Partners In Health Rwanda: Lessons In Eliminating Barriers To Care

This article, authored by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. In late February, Dr. Krishna Reddy, Country Director of ACCESS Health India, and I traveled to Rwanda to learn more about health systems strengthening from an organization that has proven itself to be a formidable leader in the field: Partners in health and the affiliated University Global Health Equity.  Partners In Health was officially established in 1987 by co founders Ophelia Dahl, Paul Farmer, Thomas J. White, Todd McCormack, and Dr. Jim Yong Kim (former President of the World Bank). It was partly chance that brought them together: Dahl and Farmer met years earlier while volunteering in rural Haiti, where they ran a community clinic that thrived despite a lack of institutional support. Their grassroots gumption, combined with their steadfast commitment to health as a social good and human right, has landed Partners In Health opportunities everywhere from Malawi and Sierra Leone to Mexico and Peru.  As might be expected, partnership-"accompaniment", Farmer calls it-is the organization's preferred mode of engagement, whether with national governments or community workers at the frontlines of health systems. Training and supporting local health providers that can deliver nonclinical services to people in their villages and homes is a top priority, so much so that nearly all of the Partners In Health employees stationed around the world are actually from the places where they work. Former Minister of Health Dr. Agnes Binagwaho first invited Partners In Health to Rwanda in 2005, having taken note of their success protecting poor communities in Haiti and Peru from tuberculosis and HIV/AIDS. In the fifteen years since, their partnership with the Rwandan government has resulted in the renovation or inauguration of three district hospitals and dozens of community health centers, as well as the employment of thousands of community health workers. Partners In Health in Rwanda (Inshuti Mu Buzima)  When Partners In Health first came to Rwanda, it was to pilot an HIV treatment program that had been  successful in Haiti and Peru. Partners In Health accompagnateurs equipped members of participating communities with the skills, tools, and knowledge they needed to dismantle the barriers that keep HIV patients from seeking and receiving treatment. Many of those trained to provide counseling, transport, food, and other forms of support were HIV patients themselves. Other early and ongoing projects include the Program on Social and Economic Rights (POSER), dedicated to mitigating social and economic barriers to healthcare; the provision of nutritional support, in the form of thousands of food packages, to patients with HIV and tuberculosis; and the renovation and refurbishment of community health centers and district hospitals. In Rwanda, Partners In Health is known as Inshuti Mu Buzima. Dr. Joel Mubiligi, executive director of Inshuti Mu Buzima, showed me and Dr. Reddy during our stay how the organization's projects interface multiple dimensions of health service delivery: Community health workers, community health centers, district hospitals, and district leadership.  Butaro District Hospital, a collaboration between Partners In Health, the Clinton Foundation, and the Ministry of Health located on a hilltop adjacent to the University of Global Health Equity works in all four dimensions. Butaro Hospital After Partners In Health had success implementing an innovative rural healthcare model in two of Rwanda's poorest districts, the Rwandan government invited them to lead the creation of a hospital in the Burera district in northern Rwanda. Plans for Butaro Hospital were first hatched in late 2007. To build Butaro Hospital, Partners In Health made the decision not to enlist major contractors or suppliers, but local labor and, when possible, local materials. Construction began in December 2008 and was finished expediently, in just two years. When the hospital opened its doors to the general public in early 2011, visitors found themselves amid the vegetal handiwork of Jean Baptiste, a Rwandan "master gardener" who collaborated with MASS Design Group to design facilities that felt open ended and restorative-even capable of healing. Far from frivolous-though some locals, exploring the property at first sight, did ask Farmer if it was a resort-the landscape of gardens, terraces, and courtyards functions as a low tech, cost efficient strategy for infection control. Poor ventilation is a major cause of airborne tuberculosis transmission and the "biggest problem for hospitals in Africa," according to Farmer. At Butaro Hospital, air cycles in and out of the wards a dozen times an hour at the least-an arrangement as practical for the health of patients as it is a source of pleasure.  Butaro Hospital is also home to cutting edge health facilities, technology, and services, furnished by $1.4 million dollars of medical equipment courtesy of the Ministry of Health. Among its specialized treatment centers and surgical programs is a neonatal intensive care unit created to address health problems prevalent throughout the region, such as prematurity, malnutrition, and low birth weight. There is also an outpatient mental health specialty clinic run by government employed psychiatric nurses and a psychologist-one example of a nationwide effort, another partnership between Partners In Health and the Ministry of Health, to decentralize and integrate mental health care into primary care. Prior to the construction and opening of Butaro Hospital, Burera district, home to more than 320,00 residents, had not a single hospital or even a doctor. Reaching the nearest hospital took several hours by foot and two hours by vehicle. Health indicators were at rock bottom-the country's worst. Within a year of opening, Butaro Hospital had served almost 25,000 patients total. The hundreds of successful surgeries, deliveries, and HIV screenings completed from 2011 to 2012 have since multiplied into thousands. One area of care in particular stands out as a landmark addition to health service delivery systems not just in Rwanda, but East Africa: the cancer center. Butaro Cancer Center of Excellence Infectious diseases currently cause more deaths in Africa than noncommunicable diseases like cancer, but this won't always be the case. Noncommunicable diseases are expected to become the most common cause of death as early as 2030, beating […]

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Study Shows Hydroxy Chloroquine Is Ineffective Against Covid-19 — So What Now?

This article by ACCESS Health President and Chair William A. Haseltine originally appeared in Forbes. Results from a controlled clinical trial from China on the use of hydroxy chloroquine as a treatment for Covid-19 have shown no significant differences in health outcomes between the control group and patients who received the experimental drug.  Thirty patients hospitalized for Covid-19 participated in the trial. Fifteen were treated with 400mg of chloroquine for five days and fifteen received standard supportive care. A week after the treatments started both groups were evaluated and results showed that no measurable difference in the progression of the disease. There are still important lessons to draw from the results. We must redouble our efforts towards the best and quickest medical solution — the development of therapeutic antiviral drugs that treat infection and prophylactic antiviral drugs that prevent infection. In the wake of the SARS and MERS outbreaks, a number of highly promising drug candidates emerged, though none of them were brought to fruition due to a glaring lack of funding and flagging interest in coronaviruses once each outbreak ended. Now, with renewed interest and resources, these drug candidates are moving quickly to clinical trials. Recently a small trial was held to determine whether lopinavir-ritonavir, a combination HIV treatment that inhibits coronavirus proteases, would deter the virus in Covid-19 patients. Unfortunately, as researchers recently reported in an article for the New England Journal of Medicine, the drug failed to cure or diminish infection.  But those early and unimpressive results aren't conclusive and, more importantly, the clinical trial only focused on only one of the virus' most promising targets, the protease. SARS-CoV-2 has favorable targets for antiviral drugs: the proteases, the helicase, and the RNA-dependent RNA polymerase.  A second takeaway from the Shanghai hydroxy chloroquine study is also critical — while medical solutions are promising, they are no guarantee. It is far too soon for us to abandon more aggressive actions that can be implemented immediately and effectively to slow the spread of Covid-19 in the United States.  To date, our response to Covid-19 has been among the worst in the world. Testing per capita here lags far behind other developed nations — including countries like Italy and the United Kingdom who are faring poorly in the face of this disease. In countries like Singapore and South Korea, aggressive contact tracing combined with widespread testing and selective isolation and quarantine has contained their outbreaks, dragging down the number of new infections each day and helping those countries avoid the extreme lockdown measures that have been used elsewhere, including here the United States.  There are now more than 55,000 cases of Covid-19 in the United States. In New York, the number of cases is doubling every three days. Thousands lie in hospital beds. Hundreds have already lost their lives. This is not the time for excuses or inaction – we must test, we must trace the contacts of those infected, and we must isolate all those at risk of spreading the disease further. And while we do so, we wait for a medical solution that will hopefully soon be at hand. Tara Haelle discussed the Chinese hydroxy chloroquine study in an earlier post today.

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Making Global Health Equity The Basis Of Health Education

This article, authored by ACCESS Health International President William A. Haseltine, originally appeared in Forbes. In a world where the dream of global health equity is made real, every single person-no matter who they are or where they come from-has the ability to lead a healthy and productive life. Health equity has become a hot topic, a guiding principle, and in some cases a main objective for many in the health sector. Few institutions, however, can profess as pragmatic or pervasive a commitment to this ideal as the University of Global Health Equity, a private, Rwanda based medical and public health school founded in 2015 and wholly owned by Partners In Health.  Run in close cooperation with the Rwandan government and key development partners in the region, the University trains students in the art of "not just building, but sustaining" health systems strong enough-and savvy enough-to solve our biggest global health challenges. Last month, I was invited to visit the University with my colleague, Dr. Krishna Reddy. It was an honor and great privilege to meet the students and speak to them about health systems strengthening.  The aspiring health professionals admitted are as brilliant and passionate as they come, but for many reasons-funding not the least among them-many once considered quality medical education to be a goal out of reach. Thanks in no small part to the generous support of international donors, to date the University of Global Health Equity has been able to give every single student scholarship funding, with the average award somewhere in the ballpark of 91 percent of their tuition fees. Until last year, classes were held on a provisional basis in Kigali, the capital. Today, the University has its own 250 acre campus in the hills of Butaro, a rural, low income region 80 miles away. Reaching the campus takes about an hour on paved roads-on dirt roads, another hour and a half. Neither the Uganda nor the Democratic Republic of Congo border is far.  Partners In Health, known by locals as Inshuti Mu Buzima, has worked in Rwanda since 2005, and both Dr. Joel Mubiligi, the executive director of Inshuti Mu Buzima, and Paul Farmer, co founder of Partners In Health, know the area well. So did my host John C. Urschel, a director of partnership development at the University. They may not have accompanied me on my gorilla trekking expedition, but they certainly taught me a thing or two about how a single place of learning can tackle health problems we experience worldwide. Why Rwanda? As a nation and a people, Rwanda has much to teach us about resilience, recovery, and the difficult task of building a better future for all. The 1994 genocide that took one million lives and harmed millions more had an immeasurable impact on the health of Rwandans and their ability to heal. Health facilities were in ruins, drug supply chains had fallen to pieces, and health workers who hadn't been killed, fled. Of the nurses and physicians who stayed behind, there remained a deep suspicion of complicity with the genocide. Understandably, trust in the health system was at an all time low-and for the health system to survive anew, trust would have to be rebuilt in tandem. In the years that followed, a health policy platform was pieced together that prioritized access and accountability. Solidarity and equity had also become part of the framework by the early aughts, as policymakers gradually devolved the power to manage healthcare and make health related decisions to the community level. Civil society representatives became regular attendees of once exclusive parliamentary meetings. Community based health insurance was piloted in a handful of districts, then scaled up nationwide in 2005. Community health leaders were elected by each of Rwanda's 15,000 villages and trained by the Ministry of Health to care for their neighbors, creating a base nearly 60,000 members strong by 2019. Population trust in the health system has since skyrocketed-and so has the availability and uptake of health services. In 2018, Rwandans reported levels of confidence in their hospitals and health clinics higher than those of any other population in the world. Nearly 100 percent of Rwandans have healthcare. Life expectancy has doubled, immunization coverage has more than tripled, and premature mortality rates have plunged. These accomplishments are nothing short of remarkable. But according to Agnes Binagwaho, who served the Rwandan government as Minister of Health from 2011 and 2016 and now leads the University of Global Health Equity as Vice Chancellor, one critical gap remains: education. Without more training opportunities for aspiring doctors and health professionals, what Rwanda has taken two decades to build might still be lost. Medical program: Bachelor of Medicine and Bachelor of Surgery For Rwandans aspiring to become doctors and health professionals, the options for quality medical education are limited. The only public medical school in the country-one of four total, including the University of Global Health Equity-offers training programs for general practitioners, but to specialize students must study abroad.  To fill this outstanding gap, the University of Global Health Equity created a dual degree program-a joint Bachelor of Medicine and Bachelor of Surgery, plus a Master of Science in Global Health Delivery-open to all Rwandans. The six and a half year program ensures that students meet all existing requirements for medical doctors, but radically departs from traditional paradigms of medical education otherwise. The minds behind the design of the curriculum, such as Vice Chancellor Binagwaho and Deputy Vice Chancellor Abebe Bekele, knew what it was like to receive training in a Western context and leave ill equipped to treat people in remote areas. Health equity isn't just one component of the University curriculum-it's the foundation. Speaking to various faculty and staff over the course of my trip, I found they embraced this vision wholeheartedly. First item on the docket for a new student? Six months of lessons on African history. This is accompanied and followed by coursework on human rights, gender studies and social justice, patient […]

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