There is an urgent need to better protect the populations of developing countries from Covid-19. In response to this, on the 3rd of April, scientists, physicians, NGOs and policymakers from 30 different countries announced the launch of COVID-19 Clinical Research Coalition. This international coalition should make it possible to carry out more clinical research on Covid-19 in developing countries in Africa, South America and South-East Asia.
Why is this important? So far, very few cases of Covid – 19 have been detected in developing countries. However, experience from China and Europe, which is several weeks ahead of the Global South, suggests that the numbers will rise significantly. These countries are poorly equipped, meaning that the situation could become very dangerous. They lack not only the hospitals and staff, but also the medicines, medical equipment and protection that the rich and infected countries are already scrambling to obtain.
Even though the African population is, on average, younger than the European population, there is an increased rate of diseases such as tuberculosis and AIDS, which weaken the immune system. It is therefore crucial to ensure that these countries have access to the protections and treatments tested in ongoing clinical research.
The coalition. Behind the project is a Geneva-based NGO, the Drugs for Neglected Disease Initiative (DNDI), which has federated more than 70 health organisations around the world around this coalition. Each of the signatories must bring either expertise in a specific area of clinical research, or expertise in the field.
The organisation has two aims: to accelerate the development of drugs and vaccines, and more importantly, to ensure that these treatments are used correctly in the field. The coalition also intends to set up a network that will guarantee equal access to experimental treatments and medical equipment.
Bernard Pecoul, the director of DNDI, hopes to reduce mortality and transmission of the virus in these countries:
“ If a drug works in Europe, it should also be effective in Africa, that's not really the issue. The problem is that most of the treatments being tested at the moment are used in the advanced stages of the disease, when patients are already in hospitals or even in intensive care units. In Africa, however, intensive care facilities are very limited. The therapeutic response will have to be adapted: the difference will have to be done before that, with rapid tests and a high level of diagnostic efficiency.”
The power supply is under strain. One of the areas he hopes to develop rapidly in developing countries is prophylactic treatment, which would help to prevent the disease among caregivers. However, there is still a major problem to be solved: supply.
“When you look at the already limited access to masks in Europe, you can imagine that this access will be even more limited in the Global South. Not only are resources difficult to access, but also hygiene measures are often insufficient. Together with the WHO, we would also like to coordinate and speed up the supply of medicines. With the current difficulties in terms of transport, this is already a big problem.
Rather than each country negotiating individually, we are trying to centralize them through one or more partners who would take care of them globally.”
The stakes. The coalition plans to facilitate and standardize clinical trials in developing countries in order to centralize rapid and efficient coordination, and to ensure open source access to all research results. A four-step strategy will be adopted:
Simplify interactions between ethics committees and national agencies, similar to the response adopted during the Ebola crisis. According to Bernard Pecoul, it should be easy to adopt most of these provisions for Covid-19.
Shorten the procedures for authorizing imports of experimental treatments and medical devices.
Show that since it has been possible to carry out good clinical trials in Africa and to standardise them during Ebola, it should be simpler to carry out new ones in the face of a less dangerous virus. Mortality of SARS-Cov-2 is currently estimated at less than 3%, compared to 60-90% for Ebola.
Make scientific results available as quickly as possible and openly accessible- even in advance, before official publications.
The opinion of a signatory. Jürg Utzinger, the Director of the Swiss Tropical and Public Health Institute in Basel, is sounding the alarm about the upcoming health situation:
“We estimate that it is only a matter of days or weeks before the disease spreads on a large scale in poor or developing countries.”
He hopes to bring the expertise of his Institute, as well as locally – available trained staff, to the coalition. "Some of our expertise is overseas, in Africa, Asia, and South America," he says, “In particular, we have a long-standing partnership with the Ikafara Health Institute in Tanzania. This allows us to bring relationships of trust to the coalition, with medical personnel who have been trained and have been working in these regions for decades." However, it draws intention to the reality on the ground, which is not tainted by official figures.
“There still seem to be few cases in Africa, but is this because the disease hasn't progressed very far, or is it because there are very few diagnostic tests available?”
Above all, he points out that the risks on the continent are specific, because the demography is very different from that of Europe: there are fewer elderly people, who are particularly affected by advanced forms of Covid-19.
“The danger also comes from the number of people suffering from tuberculosis or AIDS. We think they may be more vulnerable, but we don't yet know to what extent. Clinical research will have to be carried out quickly to assess the impact and to come up with appropriate solutions. This is also why the formation of this coalition is of crucial importance.”
Respect for human rights. Patrick Durisch, the head of the health programme for Public Eye, finds the coalition very promising and hopes that its actors will push the WHO to provide further measures. He argues that the open sharing of scientific information is essential, but that often poorer countries pay the price. He explains that:
“Let's take the example of Indonesia, which was heavily affected by avian flu in the early 2000s. It provided samples of the H5N1 virus to the international medical community. The pharmaceutical companies created a vaccine for this, without any compensation. However, rich countries were the first to use it.”
After being bailed out, Indonesia entered into complex negotiations that lasted three years before it won the case, and which gave rise to a specific mechanism, he recalls.
“There is now an international legal framework: each country can safely exchange viruses within the WHO laboratory network. But if entities outside this network want access to the virus, they have to make certain guarantees. They must commit to contribute; to allow contract negotiations; and to secure part of the future production for the WHO. That is all very well, except that the mechanism only works at the moment for influenza viruses, and therefore not for the coronavirus. But the States and the WHO could use it as a model for SARS-Cov-2.”
Article translated from French by Boroka Zita Godley.