Navigating Global Health Priorities During a Pandemic

Posted on June 11, 2020.

By Amber Cortes

April 3, 2020 – COVID-19 testing in Madagascar. Photo: World Bank / Henitsoa Rafalia (CC BY-NC-ND 2.0)

Just a few short months ago (but what already seems like a lifetime ago), COVID-19 began to wreak havoc on the world. There’s been no sector left untouched by this pandemic—from work and economic growth to food security and education, and of course, global health.

COVID-19 and its economic consequences threaten to upend so much of the work that’s been done in the global health development community—and to stall progress towards the Sustainable Development Goals for 2030.

First, there are the immediate effects: disrupted supply chains, a squeeze on health system capacity and resources, confusion about health safety protocols, and lockdowns that prevent access to treatments and life-saving medicines.

The United Nations Children’s Fund (UNICEF) reported a 70% to 80% drop in vaccine shipments since March due to pandemic-related shipping and logistics challenges. Because of this, many preventable diseases like measles, polio and cholera are expected to rise. According to the Measles and Rubella Initiative, up to 117 million children worldwide could miss out on measles vaccinations since immunization campaigns were suspended to deal with the novel coronavirus.

Many organizations have had to shift their strategic goals for the year toward providing emergency response services, in many cases halting or significantly adjusting their regular programs and reconfiguring their supply chains in order to keep serving their populations, all while trying to navigate new realities, both known and unknown, of COVID-19.

But there’s even more at stake than that. COVID-19 has the potential to roll back decades of progress made in addressing many non-communicable diseases (NCDs). According to the Global Malaria Program, COVID-19 impacts could double the number of malaria deaths in sub-Saharan Africa from just two years ago. Another report by Stop TB Partnership projects an additional 1.4 million TB deaths during that same period. And a six-month interruption in the supply of anti-retroviral drugs (ARVs) could double AIDS-related deaths, essentially ‘setting the clock back’ to 2008 levels.

Then there are all the interruptions to regular and ongoing critical health services: for cancer patients who need chemotherapy, for example, or for women who need protection from gender-based violence or access to contraception and neonatal care.

When it has all been said and done, the COVID-19 crisis will have profound consequences for the world. The Global Washington community has stepped up in extraordinary ways to meet the immediate needs of this health crisis—and is working to build more resilient healthcare systems that are adaptable, scalable, and universal.

We know it’s a long road ahead, and that the complexity of the COVID-19 crisis has yet to be fully understood. There’s important, valuable work being done in all sectors right now. The following highlights some of the work being done by GlobalWA members.

Data-Informed Decision-Making

The Bill & Melinda Gates Foundation

The Bill & Melinda Gates Foundation is leveraging its twenty-years of experience in global health innovation to support vulnerable communities in African and South Asian countries. At home in the U.S., the foundation is focused on education-related needs, such as emergency aid to colleges to help mitigate closings, and developing online learning modules for K-12 students.

According the World Health Organization (WHO), Africa could become the next epicenter of the pandemic. There are severe shortages of both personnel and equipment, such as ventilators and personal protective equipment (PPE). A Reuters survey found that even in a best-case scenario, African countries would need at least 111,000 more intensive care beds and ventilators to meet the projected needs of patients. In response, the Bill & Melinda Gates Foundation is donating an additional $100 million to help prepare clinics to treat and isolate patients who may be infected with COVID-19, and to create protocols for contact tracing and infection control.

The Coalition for Epidemic Preparedness Innovations (CEPI), co-founded by the Gates Foundation in 2017, is helping scientists race for a vaccine with their COVID-19 Therapeutics Accelerator. In a bright spot of coronavirus news, the site reports that trials of potential treatments are already underway and the Gates Foundation says they will mass-produce any COVID-19 vaccine they develop to make it accessible and affordable.

Tableau Foundation

Software company Tableau’s free, publicly-accessible COVID-19 Data Resource Hub includes real-time data on case reports from Johns Hopkins University, the WHO and the CDC, as well as a curated gallery of visualizations from national news and health organizations.

The foundation has also ramped up its Community Grants Program, expanding the number of grantees and streamlining the application guidelines. Tableau has created two other giving campaigns for employees: one to support frontline health workers, and another, the COVID-19 Response Fund, to meet the needs of community organizations and non-profits serving at-risk communities that are disproportionately impacted by the disease and its repercussions.

Global Good

The Institute for Disease Modeling (IDM) is an institute within the Global Good Fund, a collaboration between Intellectual Ventures and Bill and Melinda Gates. IDM publishes models and studies disease transmission dynamics for malaria, polio, tuberculosis, HIV, pneumonia, typhoid, and more. Since COVID-19 struck, IDM has been instrumental in providing epidemiological models that predict transmission rates, collaborating with Fred Hutchinson Cancer Research Center, Microsoft AI for Health, and Washington State Department of Health officials to guide counties in Washington State towards an informed and safe re-opening.

Their comprehensive COVID-19 Infohub incorporates data on COVID-19 transmission rates along with economic impact projections in Washington State and around the world. It includes two powerful models: one for COVID-19 epidemic analysis, and a health systems model to help hospitals determine the number of ICU beds and waiting times needed for COVID-19 patients.

Fred Hutchinson Cancer Research Center

When COVID-19 first hit, the Hutch rallied its global teams of scientists and researchers who have experience tackling global health threats like AIDS and Zika. In addition to keeping those efforts on track, they are now working to track and assess the COVID-19 pandemic’s viral spread, developing diagnostic tests, and designing vaccines to prevent future outbreaks.

One way the Hutch is gaining insights into the virus is through a rapid genome sequencing tool called Nextstrain that builds viral “family trees” to track how and where the virus moves. It’s a “genetic jigsaw puzzle” that can provide clues to viral mutations in samples across the globe.

Keeping Non-Communicable Disease Targets on Track

PATH

People with underlying health conditions caused by non-communicable diseases (NCDs), whether cardiovascular disease, diabetes, respiratory diseases, or cancer are at higher risk for COVID-19 complications and death. Now, it’s even harder for these patients to get access to medications and diagnostic services—challenges that already existed before in many areas, but have been intensified by COVID-19.

During the Ebola outbreak in West Africa, health service disruptions caused 10,000 preventable deaths from HIV/AIDS, malaria, and tuberculosis. Citing the lessons from Ebola, PATH recognizes how crucial it is to protect the progress made on malaria prevention—which saves nearly 600,000 loves per year. As a result, they are adapting their delivery channels to continue bringing essential health services and important preventive measures like insecticide-treated bed nets to communities, while minimizing COVID-19 transmission.

In partnership with the WHO, Bill & Melinda Gates Foundation, Global Fund, PMI, and other organizations, PATH is also using data to detect new COVID-19 hotpots around the globe and modeling scenarios for how the virus may impact malaria transmission rates in high burden areas across Ghana, Kenya, and Malawi. PATH is also partnering with leaders in Senegal and the Democratic Republic of the Congo to integrate data visualization from information provided by national Emergency Operations Centers and National Malaria Control Programs.

By mapping out health priorities with real-time data and monitoring delays in drug manufacturing supply chains, PATH and its partners are able to build a sustainable tracking system that can respond to diseases long after COVID-19 is fully contained.

Malaria No More

“People all over the world now have an all-too personal experience with how a deadly, infectious disease can upend health systems and economies—and, more personally, how it can do the same to our families and communities,” says Martin Edlund, Chief Marketing Officer of Malaria No More.

Malaria deaths and cases were at their lowest levels ever recorded in 2018. Since then, progress has stalled, and now, COVID-19 could bring malaria back to 2000 levels—erasing the progress of the last twenty years. With the rainy season on its way in many parts of the world, Malaria No More has been intensifying its routine distributions of long-lasting insecticide-treated bed nets in the highest-burden villages.

“We have a critical window to support high-burden countries in taking actions that will save hundreds of thousands of lives and prevent health systems from being overwhelmed with tens of millions of additional malaria cases,” says Edlund.

Along with PATH, the Malaria Atlas Project, and the Bill & Melinda Gates Foundation, Malaria No More helped create a modeling analysis for the WHO with nine COVID-19 scenarios—and detailed what countries can do to save lives through early intervention efforts. The study found that India and many countries in Africa face a “dangerous double jeopardy” with peak transmission of both malaria and COVID-19 colliding in the next few months.

“The Ebola outbreak taught us that the best defense is a good offense,” says Edlund. Relying on data-driven decisions to stay ahead of both COVID-19 and malaria outbreaks will save lives. “By preventing, screening, diagnosing and treating malaria symptoms at the local level, countries can avert a devastating surge in severe-malaria cases at district and national hospitals.”

The Max Foundation  

For The Max Foundation, COVID-19 has made it harder to fulfill their mission—getting crucial cancer medications across borders and into the hands of patients in low- to middle-income countries.

“In the case of The Max Foundation, our work in supply chains has been impacted in a number of ways directly as a result of COVID-19,” says Neal Parry, The Max Foundation’s senior supply chain manager.

There have been new restrictions on importing medicines, changes in cargo flight availability, and points of entry closures. But The Max Foundation is finding new solutions for home-delivery of medicines through local distribution partners, shifting from paper to digital prescriptions, and having physicians dispense a few months-worth of treatments ahead of time to last patients through the shutdowns.

“This pandemic has shown that there is no “one-size-fits-all” approach that will be successful in global supply chain operations,” Parry says. “However, it has shown that leveraging an organization’s network can create additional opportunities for collaboration.”

Burkitt’s Lymphoma Fund for Africa

Burkitt lymphoma (a form of non-Hodgkin’s lymphoma that’s highly curable with chemotherapy) is the leading cause of pediatric cancer deaths in equatorial Africa. Met with the sudden challenge of needing to procure personal protective equipment (PPE) for front-line healthcare workers, Burkitt’s Lymphoma Fund for Africa (BLFA) is now channeling immediate funds into procuring PPE in their grant network.

“In addition to sorely needing PPE, there are other situations that we are helping our grantees address (COVID-19) through this emergency fund,” says Karen Osofsky Michelson, a BLFA board member. They’ve helped one grantee in the network, a shelter in Tanzania where children and their families can stay during cancer treatment, to create an “isolation house” for quarantine purposes. They are also meeting transportation and meal costs for their patients and clinic employees.

“In essence, our fund provides a holistic, full life-cycle approach to keeping children safe and healthy. It goes way beyond the needs for PPE,” Osofsky Michelson says.

Meeting Healthcare Needs in a Crisis

Adara Development

A recent report released by the medical journal The Lancet modeled two COVID-19-related scenarios affecting some of the more vulnerable groups that Adara serves: pregnant women, and children. If maternal coverage and newborn interventions are reduced by 15% over the next 6 months due to COVID-19, there will be an almost ten percent increase in child deaths (under 5 years old) per month.  If coverage reduces by 45%, the situation becomes even more dire: likely a 44.7% increase in mortality per month.

Adara is meeting the immediate needs of the COVID health crisis by delivering PPE, including thousands of N95 masks, to remote districts in Nepal, distributing soap to midwives in Uganda, and working on guidelines and protocols for staff in maternity and neonatal wards in both countries.

“Many of our programs are being adapted to respond to COVID-19 and its associated impacts. However, our goal is to maintain delivery of these critical health and education programs in order to help countries continue to drive toward the SDG targets,” says Brooke Magnusson, the global health partnerships manager (USA) for Adara.

Adara is shifting some of its educational programs, for example, by delivering curriculums through radio. And since the economic impacts of COVID-19 have affected food security, Adara has also been providing midday meals to children who can’t go to school right now.

Americares

Americares has a long history of disaster response, in particular to other outbreaks such as Ebola, Zika and measles. This experience makes the organization well-prepared to mobilize and distribute protective gear and infection control supplies that can help keep healthcare systems from becoming overwhelmed. Right now, Americares is mainly focused on maintaining capacity at under-resourced primary care clinics in Colombia and El Salvador. But Americares is also delivering masks (more than 2 million!), gowns, gloves and disinfectants to health facilities in 12 countries, and developing training modules on COVID-19 for healthcare workers.

Amplio

For Amplio, mobilizing communities is what they do best. The Amplio Talking Book is an audio device designed for low-literate adults and youth around the world to learn about such topics as malaria prevention, hygiene and sanitation. In response to COVID-19, Amplio is using its technology to link community media with district health experts and helping governments and media organizations align their key health messages to keep information consistent and credible.

PRONTO International

PRONTO International understands the language of urgency—the organization provides emergency training materials for health care providers in obstetrics and neonatal care. The organization was able to respond quickly to COVID-19 threats among its teams in Africa, India, and Central America.

For example, they’ve developed multiple COVID-related SIMPACs, or simulations—artificial scenarios where trained facilitators can use real-world events to educate others—to help teach providers to triage among COVID-19 obstetric patients and their babies. And for healthcare workers who are not trained as simulation facilitators, PRONTO International plans to release how-to videos and guidelines regarding COVID-19 management.

Spreeha Foundation

The Spreeha Foundation meets the challenge of poverty with a three-pronged, holistic approach—providing healthcare, education and skills training to underserved communities in Bangladesh. Now, COVID-19 has forced the foundation to temporarily close education and training services in order to ramp up its healthcare response.

“Overall, our SDG global health target has not changed,” says Ferdouse Oneza, CEO of Spreeha Foundation. “Although we are engaged in emergency responses, we’re keeping our long-term goals in focus. To that end, we are even pre-positioning ourselves with (a) more robust healthcare delivery system using telehealth.”

At the moment, Spreeha is working closely with the government of Bangladesh in providing health awareness messaging and door-to-door coronavirus screening services.

VillageReach

VillageReach solves health care delivery challenges in low-resource communities. When it comes to continuing its work amid COVID-19, “we need to be more creative than ever about how to do this,” says VillageReach President Emily Bancroft. This can mean using advanced technology—including deploying drones for delivery of medications or analyzing powerful datasets through OpenLMIS to forecast where medicines may be needed most during outbreaks.

The organization is also leaning into predictive analytics, such as in Mozambique, where VillageReach is collaborating with machine-learning firm Macro-Eyes to allow health workers to engage their communities. In Malawi, VillageReach has been collaborating with Global Good’s Institute for Disease Modeling (IDM) to predict COVID-19 transmission using datasets from sources like local health phones lines.

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Besides the above highlights, check out our entire list of GlobalWA members who are working to improve health and healthcare in developing countries:

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