Across the world, the rise of nationalist leaders has prompted fears that democracy and international cooperation are endangered. Now the public health systems of many countries are also being menaced by the politics of authoritarianism in the Covid-19 pandemic era.
On June 29, the United States announced that it had more or less cornered the global supply of remdesivir, a drug that has been proven to shorten the recovery from the new coronavirus infection but is not a cure. Alex Azar, the head of the US Department of Health and Human Services, said in a statement:
“President Trump has struck an amazing deal to ensure Americans have access to the first authorized therapeutic for COVID-19. To the extent possible, we want to ensure that any American patient who needs remdesivir can get it. The Trump Administration is doing everything in our power to learn more about life-saving therapeutics for COVID-19 and secure access to these options for the American people.”
Azar added that the agency “has secured more than 500,000 treatment courses of the drug for American hospitals through September.”
This represents, he detailed, “100 percent of Gilead’s projected production for July (94,200 treatment courses), 90 percent of production in August (174,900 treatment courses), and 90 percent of production in September (232,800 treatment courses), in addition to an allocation for clinical trials.”
Azar said that the price of each five-day treatment course is about $3,200, and that Americans could rest assured that this staggering cost would be paid by medical insurance.
Response to this drug-grab was immediate globally as well as inside the US, where experts say that a cheaper generic is being withheld from the American market and other developed countries. In the latter, patients with limited or no cash income are often minority populations. There are also concerns about how and where the expensive version will be distributed in the US, given the Trump administration’s disdain for Democratic Party-governed states.
The drug is sold by the Gilead pharmaceutical company, which is based in California. The Los Angeles Times reported that nine drug companies — seven of them in India, which has an uneven record on safety and quality — had signed agreements with Gilead to manufacture the drug. It will be produced in much-cheaper generic as well as expensive brand-name forms. Gilead says the generic form will be made available to low-income and very poor countries.
“But the agreements [on generic versions] exclude countries with some of the worst coronavirus outbreaks — including the U.S., Brazil, Russia, Britain and Peru — leading to allegations that Gilead aims to sell only its much costlier, name-brand version of the drug in middle-income and wealthy nations that are desperate for the treatment,” the Los Angeles Times reported.
Another promising drug, dexamethasone, not a new therapeutic, showed in recent British studies that it could help prevent deaths of very sick patients on ventilators. The World Health Organization welcomed the success of the drug when preliminary study results were released in mid-June.
For patients on ventilators, the treatment was shown to reduce mortality by about one-third, and for patients requiring only oxygen, deaths were cut by about one-fifth, according to preliminary findings shared with the WHO. Similar benefits were not found in patients with milder Covid-19 infections.
“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”
Dexamethasone, a cortisone-like medicine, has been available since the 1960s and on the WHO’s list of essential medicines since 1977. It is now off-patent and much cheaper than remdesivir; prices start at under $1 per tablet. The Mayo Clinic says that taken orally as an anti-inflammatory drug that works on the immune system, it can treat various other problems, such as severe allergies, arthritis, asthma and blood or bone-marrow problems.
The WHO convened a conference on July 1-2 of health professionals and scientists from 39 countries who have joined the organization’s Solidarity project to pull together, discuss and analyze the fast-growing field of research and development on both Covid-19 therapeutic drugs and vaccines. Participants in the conference also addressed the issue of most internationally funded research projects having been awarded to high-income or middle-income countries and how to make allocations more equitable.
In South Africa, a rising center in the pandemic, officials are organizing a comprehensive data-collection and analysis system of their own, a report from Quartz Africa said on July 3. South Africa, with 196,750 confirmed cases of coronavirus as of July 6, accounts for roughly half of the nearly 461,000 confirmed cases of Covid-19 across the continent, the report said.
“Researchers at the University of Witwatersrand have teamed with scientists at IBM, the University of Pretoria and officials in surrounding Gauteng province to build a dashboard designed to bridge the gap between the tracking of Covid-19 at the provincial level and the spread of the virus among people who are most at risk of infection,” Quartz Africa said. “Time is of the essence.”
In India, the Hindu nationalist government of Prime Minister Narendra Modi, a great fan of Donald Trump, thought it had dodged Covid-19 when the virus first spread from China. But as of July 5, India overtook Russia as the country with the third-highest infection rate globally, behind the US and Brazil. In 48 hours over the weekend, India added 24,850 new cases, bringing the official total of infections to nearly 700,000.
India, with 1.3 billion people, is the largest and most powerful country in South Asia, and its influence can be overbearing for smaller nations in its orbit. Himal Southasia, a regional magazine, recently surveyed the effects the pandemic was posing to half a dozen countries with shambolic, often corrupt public health institutions struggling to control the crisis. It is not, in Himal Southasia’s view, an optimistic story.
“Lockdowns were never going to be a panacea for a region like Southasia, which contains some of the world’s most densely populated cities, such as Dhaka and Mumbai,” the author, Sophie Cousins, wrote in the July 3 issue of Himal. “The measure did slow the spread of the virus, but it didn’t reverse the trend of rising cases. As the region’s wealthy and middle classes were able to close themselves off, biblical scenes of millions of impoverished, hungry migrant workers marching home to their villages filled screens around the world.
“The World Health Organization continues to blast its very simple message: test, test, test. Countries in Southasia managed to respond to this urgent request only late and inadequately, given the weak public-health infrastructure and the paucity of test kits. By the end of June 2020, figures show that per day Nepal was testing 7.8 people per 1000; Pakistan 5.7; and India 6.0. While the testing rates have slowly increased, they’re some of the lowest ratios in the world.”
Himal Southasia has also reported separately on government officials in Bangladesh and Nepal charged with diverting health funds intended for treating the pandemic. Recordkeeping is so unreliable in the region that it is mostly meaningless. Journalists are being harassed and charged by state governments and Hindu nationalist mobs for writing about what they see on the ground.
“We know the best armor against the virus: testing, isolating cases and physical distancing,” Cousins wrote. “We also know that if this highly effective suppression strategy is implemented properly . . . it will save hundreds of thousands of lives. But how can the economically marginalised physically distance and isolate themselves when their living and working arrangements make that impossible? How do people wash their hands when they do not have the privilege of running water and cannot afford to buy hand sanitiser? How can we expect people to be concerned about viral infection when they are anxious about where their family’s next meal will come from?
“The peak of the pandemic is yet to hit most of Southasia, but it is on its way,” she wrote. “In a region with huge inequalities and a vast array of public-health paucities, it will continue to have devastating, far-reaching and long-term consequences.”
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