Devex CheckUp: This COVID-19 pill may spark a new inequity crisis

This week, we mark one year since the launch of CheckUp, our weekly global health newsletter. At Devex, we set out to create a platform to keep track of the latest developments in global health for our audience, as well as to provide in-depth reporting and analysis that would help make sense of a fast-changing world.

This week is also the second anniversary of WHO officially declaring COVID-19 a pandemic. And while other recent crises have only added to the precarious nature of health care access, the past 2 years have been a reminder that there is no alternative to equity and that — as health leaders have repeatedly reminded us — nobody is safe until everyone is. We began CheckUp by reporting on the problem of vaccine hoarding by high-income nations, but one year on, the world is on track to repeat past mistakes with a new inequity issue:

• Pfizer’s Paxlovid, the most promising oral treatment for COVID-19, received emergency use authorization from the U.S. FDA in under two years — but at least one more year may pass until it is available in most low- and middle-income countries, according to new research. In a repeat of what happened when vaccines first became available, the 30 million courses of Paxlovid that Pfizer is expected to produce in the first half of this year have already been purchased almost entirely by high-income countries.

• “The nightmare that we’re sleepwalking into is upon us,” said Rachel Cohen, a regional executive director at the Drugs for Neglected Diseases initiative, during a policy discussion on COVID-19 treatments organized by Public Citizen last week. Cohen and other experts are calling for steps such as accelerating licensure for generic manufacturers and sharing critical production knowledge that would speed up their ability to distribute the treatment.

• Countries hoping to administer Paxlovid — which reduced hospitalizations in high-risk COVID-19 patients by nearly 90% in clinical trials but has to be administered within five days of symptoms appearing — will also have to step up rapid testing systems, which will cost money that many low-income nations’ health systems simply don’t have.

• Production of a generic version of Merck’s molnupiravir, another oral treatment for COVID-19 that reduces hospitalizations by 30%, is much faster moving. But access advocates worry this could lead to high-income nations using the far more effective Paxlovid while leaving molnupiravir for the rest of the world.

Vaccinating the world: The looming COVID-19 treatment equity gap

It’s time for your annual CheckUp

Are you a global health nerd? Do you pride yourself on knowing exactly when the first dispatch of doses from vaccine-sharing initiative COVAX reached their destination? Take our quiz to test yourself, and challenge your colleagues and friends to do the same.

Share your results on social media with the hashtag #MyAnnualDevexCheckup.

Weapons of war

Over the past two weeks, WHO has verified 24 attacks on health facilities, health workers, and ambulances in Ukraine, which led to 12 deaths and 34 injuries.

While attacks on health care personnel during wartime violate the Geneva Conventions, they’re hardly a new phenomenon. Physicians for Human Rights has documented over 600 attacks on health care facilities in Syria over 11 years of war, while Devex’s global health reporter Sara Jerving recently documented the killing of health workers and deliberate destruction of the health care system in Ethiopia’s Tigray region. “The evidence is clear,” says al-Nahhas. “People will suffer and die, and the health care system will eventually collapse if such attacks continue.”

Amid disruptions to health care, UNAIDS is concerned that Ukraine will run out of antiretroviral treatment for people living with HIV. “We have … needles and syringes for one week more in Kyiv,” Velta Parkhomenko, the chair of Club Eney, a community-based organization providing HIV prevention services, tells Jenny from Kyiv. Still, she hopes Ukraine will win the war in the next 10 days.

Upholding health: How can the world stop attacks on health care?

One big number

That’s the percentage of abortions performed each year that are unsafe, according to WHO estimates. The agency released new guidelines Wednesday recommending — for the first time — that health workers use telemedicine for medical abortions, which end pregnancies with medication rather than surgery.

“It doesn't solve everything,” Dr. Bela Ganatra, who leads WHO’s work on preventing unsafe abortion, tells Sara in an interview. “But it is super, super important.”

Health on call: For the first time, WHO recommends telemedicine for abortion

Tracking trends

The Gates Foundation has awarded nearly $800 million for women's empowerment since 2009. Check out how it was spent and which organizations won the largest grants — including a $25 million project to support women’s leadership in global health.

Devex Pro: How much has the Gates Foundation spent on gender initiatives?

In memoriam

Partners In Health — founded by legendary advocate Dr. Paul Farmer — is hosting a memorial service for Farmer on Saturday, March 12, at 10 a.m. ET (4 p.m. CET). Those who wish to pay their respects can tune in to this virtual event.

Dr. Paul Farmer's lasting legacy: The quest for equity in global health

After the coup

Five days after a violent coup shook Myanmar in 2021, Dr. Zaw Wai Soe turned down an offer from the military to act as its deputy minister, opting instead to join the quickly swelling ranks of the country’s civil disobedience movement. He now serves as minister for both health and education in the so-called National Unity Government, an underground opposition group that was established in April by leaders of the resistance movement.

“We are risking our lives,” the physician says. “Our doctors and nurses are risking their lives to provide health care for people. [The military] shoot us, they kill us, they arrest and torture. They burn our houses. All people are terrified and [are] being threatened. Every day we lose lives, we lose our people.”

Megan Tatum reports for Devex that the NUG’s effort to maintain a health system has been piecemeal, with new hospitals opened in safer regions to provide emergency medicine, while some areas under the control of the military have underground networks operating out of shipping containers, with images of injuries broadcast to remote health care providers for advice.

Myanmar’s health system: Torture, threats, and telemedicine

ICYMI: Myanmar one of 'most dangerous places' for health workers, NGOs warn

Falling short

ICYMI, CEPI had its replenishment event this week. The foundation, which invests in the development of vaccines for emerging infectious diseases, raised over $1.5 billion — a long way from the $3.5 billion it needs to implement plans for the next five years. Most of the pledges had already been announced prior to the replenishment. And the biggest pledge of $300 million came from Japan, and not from the United Kingdom, which hosted the event.

What do you think this could mean for other global health organizations also aiming to raise billions this year, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria? We’d love to hear from you! Email us.

What we’re reading

Austria is suspending a law mandating COVID-19 vaccinations for adults. [The Guardian]

South Africa’s Aspen Pharmacare will package and sell its own brand of Johnson & Johnson’s COVID-19 vaccine in Africa. [Al Jazeera]

Moderna says it won’t enforce its COVID-19 vaccine patents for the 92 countries under COVAX’s Advance Market Commitment. [Politico]