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.
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.
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.
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.
This article originally appeared on Forbes. The world needs an anti coronavirus drug as soon as possible-and there is something the United States government can do right now to achieve that. STAT News recently reported that most big pharma companies have been reluctant to join the search for a vaccine that treats 2019-nCoV, the new coronavirus that originated in Wuhan, China and has quickly spread around the globe. Given that the costs of vaccine manufacturing tend to run high-and the chances of profit, much lower-their lack of interest was to be expected. But there is a bigger issue at play. While 2019-nCoV may be the disease making headlines today, coronaviruses as a whole present a much more formidable threat to human health. This is the third coronavirus, after SARS and MERS, to attack us, and we'll no doubt be hit again. Big pharma should be focused on finding a drug to prevent and treat the family of coronaviruses. Instead, they've taken a back seat. Our government leaders could change that. It is well within the power of the United States government to issue an open contract at this very minute that guarantees, to whichever pharmaceutical companies willing and able, a sizeable purchase order for one broad spectrum, anti coronavirus drug. Other countries, China especially, could follow suit. In targeting the coronavirus more generally, rather than a single strain, such a drug could be deployed for immediate use and stockpiled for future outbreaks. Authorized financing for the contract could feasibly come from Project BioShield Special Reserve Fund, a program established in the wake of the September 11 attacks. In the fifteen years since, Project BioShield has functioned as a means of buoying up the Strategic National Stockpile with medical products and treatments that can protect Americans from "modern, evolving health security threats"-including new and emerging diseases. Imagine what would happen if the United States government actually took initiative and pursued this strategy, enlisting major players like the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention to help shepherd it forward. Pharmaceutical companies, allured by the promise of profit, would apply for the contract in droves, emptying out everything in their freezers for testing. Once clinical research is complete and safety requirements met, government and public health authorities would accelerate review and production to swiftly bring the drug to market. I predict that within two months-three months tops-an anti coronavirus treatment would be available. This proposal isn't without precedent, and the journey from lab to market of azidothymidine (AZT), the first AIDS treatment approved by the Food and Drug Administration, provides an excellent case in point. AZT began as a cancer drug that, in the 1960s, was shelved indefinitely after mice trials proved ineffective. When it became evident two decades later that AIDS was an incredibly lethal infectious disease, pharmaceutical company Burroughs Wellcome & Company resurrected the drug as part of their effort to identify anti HIV agents. In 1987, states secured $30 million in emergency funding from Congress to distribute the drug as fast as possible. Had the United States government, big pharma, and public health agencies not eventually triangulated their efforts to stop the spread of AIDS, the nationwide rollout of AZT would have come much later than it did. Now, we need to do the same-not just for a 2019-nCoV vaccine, but a broad spectrum anti coronavirus drug.
This article originally appeared on Forbes. To date, more than 4,500 people have contracted 2019-nCoV, the new coronavirus that first appeared in Wuhan, China and has spread to numerous countries around the world. The first death from the severe viral respiratory disease was announced January 11, and of those infected 100 more have died since. Although 2019-nCoV isn't the first disease of its kind, the world as we know it in 2020 is not the same as it was in 2002 or 2012, when the previous two coronavirus outbreaks, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), made their mark. The World Health Organization may not have declared a state of public health emergency just yet, but it's critical moments like these when the changing nature of twenty first century health systems comes into sharp relief. Technology, geopolitics, socioeconomic conditions-these colliding spheres of influence have always impacted human health, and they will no doubt shape the global response to 2019-nCoV. SARS, the foremost of the coronavirus epidemics, originated in southern China in November 2002. By the time it was declared contained in July 2003, the number of documented cases exceeded 8,000; the number of fatalities, over 800. Epidemiologists deemed the Chinese horseshoe bat the most likely reservoir of the disease, which was next contracted by the palm civets bought and sold in exotic markets across Guangdong Province. Traders who handled infected civets became the first human hosts of the coronavirus-and from there, it quickly spread person to person throughout China. Although cases of SARS were reported in countries near, like Vietnam and Singapore, and far, like Canada, nearly 90 percent occurred in China and Hong Kong. The pneumonia like symptoms common to most cases of SARS remained consistent with those of the next lethal coronavirus to emerge: MERS, which was thought to be transmitted from bats to camels to humans. Beginning in Saudi Arabia in fall 2012, the disease infected less people than SARS-about 2,500, to be exact-but claimed a proportionately larger number of lives across the Arabian Peninsula. (The mortality rate of MERS was triple that of SARS.) MERS reached 26 countries, including a notable 2015 outbreak in South Korea that killed dozens, before slowing down indefinitely. A new case of SARS hasn't been reported since 2004, and MERS has been on the decline since 2016. Since only time will tell just how viral and lethal the latest coronavirus outbreak can be, most comparisons between SARS, MERS, and today's 2019-nCoV are purely speculative. What we do know, however, is that the world is more interconnected-and its people more on the move-than ever before. In 2018, six times as many people flew in and out of China on a daily basis than in 2012-and that's to say nothing of the co-occurrence of 2019-nCoV with the lunar new year, a time when permanent living situations are suspended and countrywide travel surges stretch the limits of global infrastructure. Assuming the rough and tumble of itinerant travelers can be kept in check, whether infectious disease management is easier or more difficult under increasingly globalized conditions still remains to be seen. The Chinese government, to be sure, is taking deliberate steps to avoid the mistakes of responses past, such as cooperating with the World Health Organization and deploying biosecurity systems to surveil and apprehend the spread of 2019-nCoV. But it would do everyone some good, no matter their location or their travel plans, to exercise vigilance and practice basic hygiene. For me, that means taking precautions like avoiding crowds. Washing my hands often with soap. Avoiding face touching, a bad habit that occurs on average a few times each hour and accumulates over the course of a day. Wearing gloves and swiping surfaces with sterile cleaning wipes when taking public transport. Using nasal spray or a bit of petroleum jelly to maintain resistance to infection while traveling. Until trusted health institutions deliver their verdicts on what comes next, we'll have to rely on small protective measures like these for peace of mind.
In response to the global outbreak of a new coronavirus, 2019-nCoV, ACCESS Health China team launched a new, internal research program to study the application of digital technologies for disease control during the current 2019-nCoV outbreak in China. Since the first coronavirus outbreak in China, SARS in 2002, there have been significant improvements in both medical technologies and internet and information technologies. ACCESS Health China's latest research project will focus on identifying best practices in the use of digital technologies in outbreak situations and an analysis of how digital technologies can empower the disease control procedure and fulfill the unmet needs of patients, doctors, and the public. Through the preliminary desktop research, we have selected around thirty cases in which digital technologies provided significant value, including how information systems improve epidemic surveillance, how big data can enable the mapping of population migration and travel of people with close contact to those infected, how artificial intelligence empowers the epidemiological study, how internet connected hospitals and telemedicine help both doctors and patients, and how the internet and social media platforms create impact in information communication and social support. As the research evolves, we expect to deliver a series of success factors based on these case studies and to develop guidelines for the use of digital technologies in disease control. In the spirit of collaboration, we will continue to engage with stakeholders working on the outbreak to collectively solve the challenges we are facing now and may be facing again in the future.
NITI Aayog, the premier government think tank in India, the Indian Ministry of Health and Family Welfare, the National Health Authority and the Bill & Melinda Gates Foundation participated in a learning exchange to Brazil and Colombia in December 2019. The visit was facilitated with support from the International Labour Organization, (ILO) International Centre for Health Systems Strengthening (ICHSS) United States, and ACCESS Health International. The Latin American countries made health a constitutional right and access to healthcare for every citizen a very high priority on policy and political agendas. Over the years prioritization has driven substantial increases in public and private allocation of resources and long term commitments to critical health system reforms. The learning exchange offered an opportunity for participants to examine first hand their experience on health insurance and purchaser regulation, primary healthcare, and public and private purchaser capabilities. In addition to the Brazil and Colombia experience, participants learned about the primary healthcare experience of Chile and Argentina and health sector regulatory experience of Chile. The participants engaged in technical discussions with several senior policymakers including the Minister of Health and Social Protection of Colombia Dr. Juan Pablo Uribe and head of various public and private health institutions, visited the health delivery facilities and interacted with the community health workers and providers. The learning exchange identified potential areas for discussion relevant for India. These include; steering regulatory equity across all insurers; evolving role of public sector from implementation to funding and regulating; potential role of public private collaboration in urban healthcare delivery and result based healthcare financing. Mr Alok Kumar, Adviser, NITI Aayog, tweeted, "Concluded study visit in Colombia today. Had tremendously productive meetings with the Health Minister of Colombia, Secretary Health Bogota, Director HMO Compensar, Director of ADRES - the regulator of insurance companies and also the ED of a not-for-profit hospital."(@IasAlok)
As part of work within the Bill and Melinda Gates Insurance Consortium, ACCESS Health India and the Clinton Health Access Initiative (CHAI) helped organize a one day workshop in the state of Maharashtra on Data Analytics and Measures to Control Fraud. The workshop, which was organized for the State Health Assurance Society, helped strengthen the capacity of stakeholders on data analysis, insurance related dashboards, state specific analysis, and fraud management. Team members from a variety of State Health Assurance departments were present. The ACCESS Health team took the participants through the requirements and framework of an anti-fraud audit investigation system, based on the guidelines prepared by the National Health Authority. The team also shared knowledge on ways to improve the hospital empanelment process. Participants were taken through a study that was conducted by ACCESS Health on the current processes followed by the Society, challenges, and avenues for improvement. The Clinton Health Access Initiative team walked participants through a module on the role of data and data analysis, and benefits of having data dashboards for better decision making.
ACCESS Health Southeast Asia has been working closely with partners in Singapore to drive a new bone health initiative, Bone Alliance Singapore, to improve awareness and to build new partnerships, ecosystems, and communities of practice for better bone health. The Bone Alliance was recently featured in the Singaporean newspaper the Straits Times. The article below originally appeared in a December 2019 issue of the paper and is available online here. Fighting against fractures A new group, Bone Alliance Singapore, aims to raise awareness of the potentially serious consequences of osteoporosis By Timothy Goh Fractures due to osteoporosis have an incidence rate eight times higher than that of breast cancer here and often result in high treatment costs and serious consequences – in some cases, even death. But although there are medicines that can reduce fracture risks by 30 to 70 per cent, many patients and doctors here are not aware of the threat that osteoporosis poses, said Dr. Chionh Siok Bee, president of Osteoperosis Society Singapore. Osteoporosis, which means "porous bone", is a bone condition characterised by low bone mass or decreased bone strength. Calling the current general sentiment towards osteoporosis "laid-back", Dr Chionh said: "It's like the attitude towards diabetes 10 to 15 years ago, that it affects only old people who aren't working. Then, people realised diabetes was occurring in younger and younger people be- fore we finally had a war on diabetes. "We don't want an epidemic of fractures before we start doing more for public awareness and prevention of fractures." Citing a local study which found that 27 per cent of those with hip fractures died within a year, she said: "If they're fit for an operation, they may have to undergo general anaesthesia to get their hip fixed and may suffer a heart attack or stroke as they're usually older people. "If they're not fit for operation and remain lying in bed or a wheel- chair, the chances of them getting pneumonia, bed sores, or clots in the veins are very high." A 2012 study found that Singapore had the highest hip fracture incidence rate among independent Asian countries. Although this has declined in recent years, the absolute number of patients with such injuries is likely to increase, given the republic's ageing population, said Dr Chionh. Warning Signs There are two ways to diagnose osteoporosis in a person. The first is if he gets a fracture during an activity that would not normally injure young and healthy bones, such as a fall from a standing height or less. Fractures in smaller bones such as the fingers, neck and toes are typically not considered for such a diagnosis, said Dr Chionh. Second, a bone mineral density test, called DXA, can be carried out using a special machine. There are also two screening methods to tell whether one should go for a bone mineral density test or if one is at higher risk of fractures. Asian women who have reached menopause can assess their risk of osteoporosis using their age and weight. "If your age in years minus your weight in kilograms is more than 20, the chance of you having osteoporosis and it being detected by a bone density test is quite high. You should go for bone density screening," said Dr Chionh. People can also assess their risk of getting a fracture using an online tool known as Frax. Some people may be more genetically predisposed to the condition, but there are other risk factors as well, said Dr Chionh. These include smoking and drink- ing, as the chemicals in cigarettes and alcohol act negatively on bone formation cells in the body. "If we break a bone, these cells will start to put new bone in. If you disrupt this process, you're going to get into trouble," she said. She highlighted that the Health Promotion Board has recommended that men consume no more than two alcoholic drinks a day and for women, no more than one. Certain diseases, including rheumatoid arthritis and diabetes, also put one at a higher risk of developing osteoporosis, as does having a low muscle mass. In particular, those with diabetes are thought to be more susceptible because their condition affects the blood supply to their bones and the strength of their bones. Anyone who has a height loss of 3 to 4cm from their peak adult height taken in one's 20s is also highly likely to have osteoporosis. Dr Chionh said that it is good to spot osteoporosis early as the cost and risks associated with treatment rise as one ages. However, misconceptions about treatment are prevalent. "Some patients say 'I'm so old already, why should I take medicine? I can die any time', but within one year of treatment, the risk is already greatly reduced," said Dr Chionh. Some patients are also reluctant to take their medication after get- ting their broken bones fixed as they no longer feel pain. "They don't realise that the chance of them breaking another bone is very high," she said. Reducing One’s Risk Dr Chionh said that a person's bone mass typically reaches its peak between his mid-20s and early 30s. If one's peak bone mass is low, one could break a bone at an earlier age compared with one's peers. In order to reach their maximum potential peak bone mass, people should engage in physical activity, get judicious exposure to sunlight in order to obtain vitamin D necessary for calcium absorption and bone crystal formation, and consume more calcium-rich foods. Such measures are most effective before one hits his peak bone mass, but it is important to continue them throughout one's life, said Dr Chionh. "Even after you hit peak bone mass, if you keep active, your rate of decline will be less steep." However, she noted: "A lot of children are not going out to play in the sun, they're not drinking milk any- more, they're drinking sodas. Hopefully this will change." Alliance Fights Back Helping raise awareness and dispel […]