This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in the Washington Post. Nature is teaching us a heavy lesson with this latest coronavirus outbreak. It warned us first with SARS and then with MERS, but we didn't heed the warnings. If we willfully ignore nature this third time, our global community risks paying an unimaginable price. In 2003, when SARS was first reported, the origins of the virus were a mystery. Scientists suspected it may have come from bats, but it wasn't until 2012, when the second major coronavirus outbreak was spreading across borders, that researchers confirmed its provenance. At the time of their discovery, they warned us of the outbreak potential of coronaviruses, urging the global community "to learn from our past to help us prepare." But we didn't pay attention. In the wake of the previous outbreaks, we scrambled to find a vaccine to prevent SARS and MERS specifically. But the coronavirus, much like the flu, is constantly evolving. In the same way that a flu vaccine doesn't work across multiple strains over multiple years, a vaccine for one coronavirus outbreak is unlikely to help us stop a new one. What was needed then and what is needed now is not just a new vaccine, but a drug - or more likely a combination of drugs - that can act against the family of coronaviruses. Since the SARS and MERS outbreaks, scientists have decried the lack of interest and funding for the study of coronaviruses as whole. While financing was available in the midst of the outbreaks, it petered out after each outbreak ended. Funding from the National Institute of Allergy and Infectious Diseases, for example, leveled off at around $27 million a year - peanuts in the world of drug development. The biopharmaceutical industry could have stepped in, but, so far, it has been loath to act. The intermittent nature of the outbreaks and the relatively small market for an anti-coronavirus drug means pharmaceutical companies have little incentive to pursue a solution. With scientists and researchers shackled by a lack of funds, and biopharmaceutical companies unwilling to step in without potential for profit, the government is the only one with the agency to act. There are concrete actions our government can take today to drive progress against the current coronavirus epidemic and to prevent future epidemics from occurring - a near certainty now according to scientists and researchers. The first step toward a solution is to list the coronavirus under the Biomedical Advanced Research and Development Authority (BARDA) and its Project BioShield. BARDA presides over the discovery, development and stockpiling of medical countermeasures to protect Americans against health security threats. This includes not just biological agents of warfare, but new and emerging infectious diseases - such as the coronavirus. BARDA bypasses the laws of supply and demand by allowing the federal government to pour hundreds of millions of dollars into procuring and advancing promising products. Listing the coronavirus as an emerging biothreat will create a market for an anti-coronavirus drug that doesn't currently exist. In the wake of the 2001 anthrax attacks, I worked through Project BioShield to develop ABthrax, a drug to treat and prevent anthrax infections. I can say with confidence that the U.S. government is fully capable of acting swiftly in the face of a public-health crisis. But it must choose to act now. To date, we have been lucky - insofar as one can use that term when lives are on the line - as none of the coronaviruses that have jumped to humans have been both highly transmissible and highly lethal. There will come a time though when a coronavirus outbreak will spread quickly and kill abundantly. When that happens, we will not be talking about deaths in the hundreds or thousands, but in numbers far greater. It is our collective responsibility to ensure that our government leverages the rapid response capabilities at its disposal to protect the health of our nation, now and for generations to come.
ACCESS Health Southeast Asia Explores Fintech for Health in Bangladesh
Adrienne Mendenhall, Director of Business Development in Singapore and Tript Bhatia, Director, Startup Alliance visited Dhaka from January 19-22 to start Fintech for Health work in Bangladesh. Over three days the group attended more than a dozen events. The trip started with meetings with healthcare nongovernmental organizations, including the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), CARE, Marie Stopes International, BRAC, and Shakti Foundation. The team also met with two digital health startups to round out discussions on priority health financing needs for lower income populations in Bangladesh. Many of the discussions focused on the difficulty that women and their families have in saving for maternity care and the accompanying costs, including transportation. Nongovernmental organizations in Bangladesh have long focused on improving maternal and neonatal mortality through health messaging, including encouraging women to deliver in hospitals or at the very least with a skilled birth attendant. While the percentage of women delivering in healthcare facilities risen, half of births still take place at home. The reasons for this are multifold, including tradition, but also because of the costs involved in traveling to and delivering at a healthcare facility. Tript participated in a workshop held by Women's World Banking and funded by MetLife Foundation on financial inclusion for women garment factory workers. The government of Bangladesh mandated wage digitization in Bangladesh 5 years ago. 90% of garment workers will be brought under the digital wage system by 2021 as part of the government's push to build a cashless society. Banks such as Dutch Bangla Bank are taking advantage and are looking to increase uptake and use of their mobile financial service, Rocket by these factory workers. During this workshop, Women's World Banking shared their learnings from the pilot project that they launched with the bank with a readymade garment factory located on the outskirts of Dhaka. Specifically, they talked about the barriers to mobile account usage and how to address them. The group also met with three fintech companies: Bkash, the first to market and furthest reaching digital finance company in Bangladesh; Nagad, a public private partnership led by the Bangladesh post office; and Pathao, a ride sharing platform backed by Go-Jek. It was impressive to see the investments and traction that digital finance companies have gained in a short few years. The healthcare organizations we met said that almost everyone, no matter how poor or where someone lives, uses mobile money. The sector has gained a far reach that makes it a desirable partner for most merchants, from nonprofit organizations to SMEs and multinational corporations. Most healthcare organizations we met with are considering digital health financing models, including savings, lending, and insurance. There is significant mistrust of insurance in Bangladesh, with only 3-4% of the population holding insurance policies. For this reason, and combined with the messaging of maternity programs in Bangladesh, mobile health savings accounts are a likely starting point. The Singapore team will be returning next month to lead a roundtable discussion between healthcare organizations and one of the digital finance companies, and probably multiple times after that when activities ramp up.
Why Are We So Fearful of the New Coronavirus?
This article was originally published on Psychology Today. In the thick of a disease outbreak, the line between panic and preparedness can feel perilously thin. For individuals living with comorbidities like chronic lung and immunodeficiency diseases, the new coronavirus is deadly. To protect them, certain precautions are, indeed, necessary, including the lockdowns enforced by the Chinese government and the temporary travel restrictions placed in the United States and elsewhere. For those who don't fall into that category, there is little reason to fear-and a lot of evidence to suggest that even if infection occurs, chances of recovery are high. So far, the mortality rate outside Wuhan, the epicenter of the new coronavirus, has remained below 1 percent. But the anxiety and panic induced by the disease seem as contagious as the disease itself, depleting the surgical mask supply of pharmacies worldwide. Plenty of health challenges lurk at our doorstep that do more damage and take more lives than the coronavirus. Take seasonal influenza or the flu. So far, there have been no less than 19 million cases of flu-related illnesses recorded this flu season, as well as 10,000 deaths. The new coronavirus, on the other hand, has sickened upwards of 64,000 and killed almost 1,400. The raw numbers cast the flu as a mightier foe-and yet the coronavirus, if its continuing domination of headlines is any indication, has it overshadowed by a wide margin. Why does the 2019-nCoV outbreak rile our fears so? The discrepancy has to do with how humans perceive risks. Novel threats provoke anxiety in a way that everyday threats do not, triggering a fear response that begins with the part of the brain known as the amygdala and travels via activation of "fight or flight" motor functions throughout the body. While this evolutionarily honed instinct for the unfamiliar and foreboding can sharpen the senses-a sort of physiological priming for confrontation with a predator-it can also confuse the mind. Many of us, for example, fear plane crashes more than car crashes, even though death by automobile is far more likely. Reminding ourselves of this fact, however, does little to undo the knot that forms deep in the stomach as the plane prepares for takeoff. If we can't trust our gut reactions to guide our response to the 2019-nCoV outbreak, then what can we trust? One option is to rely on de facto voices of authority: in this case, national governments. But in today's world, this is easier said than done. In China, suspicion of misinformation, intentional rumormongering, and questionable leadership decisions are crippling the lines of communication that run between the Chinese people and their ruling party. The same could be said of the relationship between the President and the people of the United States, where "alternative facts" have become a recurring theme in political discourse. There is one thing the United States government could do not just to halt further transmission of the new coronavirus, but alleviate the fears surrounding it. Leveraging existing funding mechanisms, like Project BioShield, to develop and stockpile a broad-spectrum, anti-coronavirus drug would both curb the current coronavirus outbreak and prepare populations for outbreaks to come. Unfortunately, until federal commitments of this caliber are made, it will be up to individuals and their communities to find ways to avoid panic in the face of certain doubt. Some of the more concrete, universally applicable strategies for managing outbreak-related fear and anxiety are safety and prevention-oriented, such as washing your hands regularly, handling food with care, and practicing good hygiene in general. Other methods might involve education and mindful media consumption-for example, seeking out updates from credible health institutions, like the World Health Organization and the Centers for Disease Control and Prevention, rather than media outlets more likely to circulate incomplete or false information. Last but not least, we should keep in mind that even if the coronavirus outbreak demands some degree of social distancing or isolation, staying connected with friends, family, and loved ones-whether it's through Skype, social media, or a simple phone call-is one of the best ways to cope. Instead of allowing fear to drive us further apart, we can choose instead to reach out, band together, and hold out hope that this novel threat, like so many others before, will be overcome.
Prince Mahidol Side Meeting on Digital Technology to Achieve Universal Healthcare
ACCESS Health recently co-hosted a side meeting with Health Futures partner FHI360 on the use of digital technology in achieving universal healthcare. The side meeting was held at Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, a gathering that attracts hundreds of public health professionals from around the world to discuss key policy-related health issues. Our side meeting focused on the challenges that governments face in adopting digital technology for health and examples of on-the-ground digital health use cases. The side meeting began with a brief overview of ACCESS Health’s publication on the role of digital technology in achieving universal health coverage in ASEAN. Following this, a panel including experts in digital technology and infrastructure in Asia answered questions on topics around interoperability, building a national digital infrastructure, necessary human capital needed to build digital health ecosystems, supporting governments in establishing foundations for digital technology towards universal health coverage, and the importance of connecting doctors, payers, and patients to create this digital health framework. Panelist Dr. Krishna Reddy, Country Director at ACCESS Health India, opened the panel discussion by giving an overview of the India's path toward the National Digital Health Blueprint and the stacks built upon that strategy. The newly created program ACCESS Health Digital Health focuses on harmonizing digital health ecosystems using evidence-based approaches to bridge gaps between healthcare providers, payers, and the government. Dr. Boonchai Kijsanayotin, Chair of the Asia ehealth Information Network (AeHIN), discussed specifically about the importance of human interoperability – in addition to technical interoperability – in creating successful digital health ecosystems in ASEAN. He noted that many of these challenges have been persistent for decades. Paul Rueckert, Chief Technical Advisor at GIZ, discussed the current fragmentation of many digital health ecosystems and how some aide groups are contributing to this problem by funding multiple digital technology programs that are running in parallel to each other, instead of cooperatively. He also voiced a vision to create not just interoperable health information systems but rather interoperable government systems across sectors. Sarah Yee, Industry Consultant for Digital Transformation at Cisco, spoke about the great importance of private-public partnerships in creating national digital health infrastructures in ASEAN. Without these partnerships, we will fail to collect the right data needed – on a micro and macro scale – to make these ecosystems successful. Sarah also emphasized the need for infrastructure to underpin those government systems and why these issues standardization needs to be addressed preemptively. With more than 65 people in attendance, the audience was invited to participate in a Digital Health Challenge Tour, run by FHI360. The tour showcased three case studies on how they are using digital health to reach patients and clinicians directly, advancing access, patient education, and clinician engagement. The audience learned about the application of these platforms, discussed the challenges and successes of implementation, and brainstormed ideas to improve or expand the application of the platform.
ACCESS Health Aging Books Featured on Here’s To Your Health Radio
ACCESS Health Chair and President William A. Haseltine was interviewed by Joshua Lane on the radio program, Here's To Your Health. The program explores ideas that can improve the health of people of all ages and their communities. In the interview, Dr. Haseltine discusses ways to improve active aging and steps that anyone can take to prevent the negative consequences traditionally associated with aging. Click this link to download the interview: https://accessh.org/wp-content/uploads/2020/02/Heres-To-Your-Health-with-Joshua-Lane.mov
Want to Prevent Another Coronavirus Epidemic?
This article was originally published on Scientific American. Once again we stand unprepared as the third epidemic of a new and deadly coronavirus races around the world. This need not have been the case. We should have learned from the SARS epidemic of 2003, which claimed nearly 800 lives, that coronaviruses can turn deadly. Until then, most health officials and scientists regarded coronaviruses simply as one of many causes of the common cold; some 30 percent of common colds start from coronaviruses. Then came the MERS epidemic in the Middle East in 2012, a coronavirus that killed 858 people. The irrefutable lesson from SARS and MERS: coronaviruses can spread quickly and be deadly. Why, then, is there no way to prevent or treat the disease in 2020? Science had the tools in the immediate aftermath of the previous two epidemics to develop the drugs to control future outbreaks. But health officials, scientists and governments, especially but not only in the United States and China, dropped the ball. There is no doubt that coronaviruses are wily opponents. Like all viruses of this type, the coronavirus mixes and matches components to create novel versions of itself. Bats are the natural hosts of the virus. There are more than 1,100 species of bats, each infected with one or more coronavirus variants. Think of the virus as a genetic safecracker, constantly evolving new combinations to extend its range and find new host species. Humans are on that menu. Each infection, deadly or not, is different from the last, which makes an effective vaccine or cure for the whole family of coronaviruses highly unlikely. Though we may not be able to develop a cure for those already ill, we can develop drugs that will prevent the disease from spreading. If we had done so after SARS and MERS, governments could have stockpiled the drugs years in advance of this latest outbreak and within one-day delivery to all locations where the virus has been detected or suspected. All patients, hospital workers and any other persons suspected of contact would have been treated to stop the epidemic in its tracks. I led the effort to develop an effective drug to prevent and treat anthrax following the 2001 attack and was a pioneer for the concept of using drugs to prevent transmission of HIV/AIDS from mother to child and between adults. Assessing the genome of this new virus, I see what we describe as a "target-rich" environment; that is, a virus that has many vulnerabilities to antiviral drugs, similar to those that have been exploited successfully for the treatment of HIV, hepatitis B and herpes viruses. The drugs, or combinations of drugs, that control those diseases bind and block the enzymes the viruses need to grow. These enzymes are very similar to one another in all coronaviruses. This is a critical point. This common molecular pattern of all coronaviruses makes the challenge of identifying drugs to control coronaviruses less daunting. Scientists design drugs to inhibit the growth of specific virus enzymes. Once the genetic code of a virus has been sequenced, the targets for effective drugs appear. We now have witnessed three deadly coronavirus outbreaks in humans within 17 years. Once this new epidemic has faded into memory, will it be five or 10 years until the next one? We can and must develop, test and stockpile combinations of drugs that can protect against what is certain to be another coronavirus outbreak. In the wake of the 9/11 attacks, the U.S. government established the legal authority and executive process to do this. Known as BioShield, the program authorized funding to develop and stockpile effective means to prevent and treat "new and emerging biological threats." BioShield works. At Human Genome Sciences we developed the drug Anthrax to prevent and cure anthrax infections after the 2001 attacks. That drug is now stockpiled by the government. BioShield created the market for our work, committing many millions of dollars in purchase orders. The coronavirus is not now and has never been on BioShield's approved list of "new and emerging biological threats." It should have been added after SARS, then again after MERS. It should be added now. We have been forewarned. The departments of Homeland Security, Health and Human Services, and Defense should convene a working group immediately to add coronaviruses to the BioShield agenda. The Centers for Disease Control and National Institutes of Health then can initiate contractual discussions with the biopharmaceutical industry. Biopharmaceutical companies have the expertise to create the drugs we need quickly to prevent a fourth outbreak. Collectively, scientists at these agencies and companies then can, and will, soon identify the drugs and produce the stockpiles that we need, that the world needs, to prevent a fourth deadly outbreak from a coronavirus, any coronavirus.
The US isn’t defenseless against the coronavirus, but it is unprepared
This article was originally published on Quartz. "We have it totally under control." "It's going to be just fine." Those were the words of US president Donald Trump when he recently weighed in on news of the potential spread of the new coronavirus, dubbed the 2019-novel coronavirus, or 2019-nCoV, to the United States. He's wrong. It's true, we're not defenseless in the face of this disease. But we are unprepared. Wuhan, the capital of China's Hubei province where the coronavirus has broken out, is a major transportation hub. The city is larger than New York in both population and size. I was in Wuhan recently chairing the US-China Health Summit. I can assure you that in the US we are, like those in Wuhan were, woefully unprepared. I've led research teams assembled in the wake of two previous US public-health crises: the HIV/AIDS epidemic in the 1980s and the 2001 anthrax attacks. In both instances, lives were lost due to our inability to coordinate and execute a proactive response. It's baffling to see that the US might fail, once again, to learn from the past. Déjà vu? This isn't the first time we've seen a coronavirus epidemic of this kind. In 2003, SARS appeared. In 2012, we saw MERS break out. These epidemics have sickened and killed thousands, seemingly attacking every eight to 10 years. The coronaviruses we're facing today has been found to be both highly transmissible and highly lethal-a particularly dangerous combination. Over a course of eight months, SARS spread to about 8,100 people and killed nearly 800. It was highly contagious, but weakly lethal. MERS, on the other hand, infected about 2,500 and killed 858-not as sweeping, but far more deadly. The 2019-nCoV is spreading fast-so fast that from Jan. 27 to Jan. 28 alone, the number of confirmed cases jumped by almost 60%. The disease has traveled beyond China to reach countries including Japan, Singapore, South Korea, Thailand, and the United States. So far, 2019-nCoV has claimed the lives of more than 100 people, a figure that is sure to increase with every passing day. Economic risk of epidemics The 2019-nCoV outbreak is not just a threat to public health, but to the global economy. It is fully within the power of a country like the United States to leverage scientific knowledge and resources into a solution that protects populations from further exposure. Going about business as usual will only serve to intensify the economic ramifications of the crisis, not mitigate them. Ignorance, denial, and complacency are as much an enemy to human health today as 2019-nCoV itself. All three are endemic human traits. All three proved deadly with HIV/AIDS and the previous coronavirus outbreaks and likely may do so again. Being forewarned is being forearmed. We have been warned by nature time and time again. Now is the time to arm ourselves against this new threat. Drugs and money The first step is to focus on finding a drug or, more likely, a combination of drugs that will not just treat coronaviruses but protect those exposed from infection. As many companies don't see a market for such therapeutic drug seems to have bred inertia in the pharmacology field, however. There's also the challenge that the window of time when therapeutic drugs would work occurs before a patient even knows they're sick. To drive action, we need to train our sights not only on treating those infected but also on prophylactic drugs. For example, the same cocktail of drugs used to treat HIV can prevent mother to child transmission and protect exposed adults. When it comes to funding, it's up to the government to lead the way. Like the Cooperative Drug Development Grants program the US government invested in for the treatment of cancer and HIV/AIDS, the government should create cooperative programs between academic laboratories and the biopharmaceutical industry to discover, develop, and bring to market new drugs to attack coronaviruses. The US already has the tools to do this. Bioshield, the US program that protects people against bioterrorism, legislates a rapid response to "new and emerging biological threats," whether natural or man-made. I can tell you from a life of experience that threats from nature are far more dangerous to humans than humans are to each other. Today, we are at war not with a foreign country, nor with terrorist factions, but with nature itself. There is an old adage, "Fool me once: Shame on you. Fool me twice, shame on me." Nature has warned us three times now: First with SARS, then with MERS, and now with 2019-nCoV. Fool me thrice, shame on all of us.
Solving The Coronavirus Identity Crisis: A Strategy For Prevention
This article was originally published on Forbes. The new coronavirus, like its predecessors, is a beast to be reckoned with. And yet its working name, 2019 novel coronavirus (2019-nCoV), is curiously tame. So technical and nondescript a label is hardly befitting of an epidemic that will not only harm thousands, but also demands an urgent, timely response. At a time when onlookers must be spurred into action, a name like 2019-nCoV inspires the opposite impulse: to forget or file away. We need a name that is both memorable and searchable. It must be capable of anchoring an ongoing conversation between scientists, government officials, and the general public-one in which crucial information about safety and protection is routinely relayed. Severe acute respiratory syndrome (SARS), the name of the first outbreak, did the trick. Why can't we do the same now? Government and public health officials, to be fair, aren't keen to repeat the mistake they made with Middle East respiratory syndrome (MERS): creating a lasting association between an infectious disease and its place of origin. MERS traveled to countries well beyond the Middle East, and the new coronavirus is following suit. The longer they hesitate, however, the longer media outlets and their audiences will continue to fall back on "Wuhan coronavirus" and, even worse, "Wu flu" as shorthand for the disease. Wuhan is not the enemy. The coronavirus is. Unless we give the new strain a name that suggests continuity with the outbreaks of decades prior, we risk losing sight of our target. In this vein, the name I propose is Coronavirus Acute Respiratory Syndrome Epidemic 3, or CARS-3. Like SARS, it rolls off the tongue. Unlike SARS, it reminds us that this is the third time we've suffered from a fatal coronavirus attack. If we want it to be our last, we can't let it slip from our collective memory. Something has to stick-and it's not going to be 2019-nCoV.
FOX Business Interviews ACCESS Health on the Latest Coronavirus Outbreak
ACCESS Health Chair and President William A. Haseltine was recently interviewed by Liz Claman, host of the Claman Countdown on the FOX Business Network, on the latest coronavirus outbreak which started in Wuhan, China. Dr. Haseltine recently returned from Wuhan where he chaired the 9th US-China Health Summit. As part of the team who developed the anthrax vaccine in the wake of the 2001 bioterrorist attack and as author of the strategy to develop the first treatment for HIV/AIDS, Dr. Haseltine is known as an international expert in the field of new and emerging disease threats. Watch the full interview below.
Escalate Federal Action Against The Coronavirus Before It’s Too Late
This article was originally published on Forbes. The 2019 coronavirus, otherwise known as 2019-nCoV, is spreading faster and further each day. This past Sunday, infectious disease experts told The New York Times that a full blown pandemic is increasingly likely, if not inevitable. Why, then, is the response of the United States government lagging so far behind? To date, the White House has assembled a task force, called for airport health screenings, and issued a variety of travel restrictions. Most recently, Alex Azar, Secretary of the Department of Health and Human Services, declared the coronavirus outbreak to be a public health emergency. None of those measures, however, confronts the epidemic for what it is: a danger to national health security, and to human health at large. One federal agency that specializes in neutralizing threats of this sort is the Biomedical Advanced Research and Development Authority, or BARDA for short. Established in 2006 and directed by Deputy Assistant Secretary for Preparedness and Response Dr. Rick Bright, BARDA presides over the discovery, development, and stockpiling of medical countermeasures that protect Americans against health security threats. This includes not just biological agents of warfare, but new and emerging infectious diseases-like the coronavirus. Medical products capable of effectively countering the coronavirus, such as novel drugs or vaccines, lack the immediate market that usually lures major players in the pharmaceutical industry. BARDA bypasses the laws of supply and demand by allowing none other than the federal government to pour hundreds of millions of dollars into procuring and advancing promising products. Project BioShield, one of several programs in the BARDA arsenal, is tasked with funding and fast tracking countermeasures from early to late development. Once FDA approved, the federal government can either deploy the countermeasures or send them to the Strategic National Stockpile, where they will remain until another occasion for deployment arises. Were BARDA, with the support of other federal agencies like the National Institutes of Health and the Centers for Disease Control and Prevention, to open up the Project BioShield pipeline to a broad spectrum drug that targets the entire coronavirus family, any leftover quantities would be diverted to the Stockpile in case of future coronavirus outbreaks. The financial health of BARDA and Project BioShield is sound, with both institutions faring better budgetarily than in 2019. BARDA was recently allotted a $562 million in public health emergency appropriations for the fiscal year of 2020, while Project BioShield received $735 million. Is it so much to ask that the United States government commit a fraction of these funds to targeting a soon to be pandemic? Countering threats to national health security like the coronavirus, after all, is the reason BARDA and Project BioShield were created, which means this intervention would be continuous with legislative action against outbreaks past. In fifteen years, Project BioShield has amassed a portfolio of 27 products. Among the countermeasures procured by BARDA and shuttled to the Strategic National Stockpile through Project BioShield are an anthrax vaccine and two anthrax antitoxins. As one of the researchers who, in the wake of the 2001 anthrax attacks, led the development of these drugs, I can say with confidence that the United States government is fully capable of acting swiftly in the face of a public health crisis. It is in the best interest of the White House Coronavirus Task Force-and the health of the nation-to add an anti coronavirus drug to the Project BioShield portfolio. If the federal government waits too long to leverage the rapid response capabilities at its disposal, we will not only be vulnerable to 2019-nCoV, but epidemics to come.