Flattening the COVID-19 curve in low- and middle-income countries
Low- and middle-income countries (LMICs) must develop their own playbooks to prevent widespread devastation from the COVID-19 pandemic, tailored to the realities of their populations and economies. Community-based delivery of health interventions, the linchpin of success against malaria and other diseases, will be at the heart of a successful response.
A new global initiative, led by the Global Health Group at the University of California San Francisco Institute for Global Health Sciences, IDinsight, and Evidence Action, has rapidly mobilized to help countries develop those playbooks. The Pandemic Community Response and Resilience Initiative is focused on three core pillars:
- Mapping the spread of the virus, and identifying hotspots and high-risk populations, with tools suited to local circumstances;
- Deploying the most appropriate diagnostics available to determine current and previous infection and direct resources accordingly; and
- Developing interventions for treatment and prevention, utilizing both drugs (that have been shown to be safe and effective) and behavior change to reduce the impact of the virus in communities.
Work in all three pillars has already been launched in focal countries. Additional funding is urgently needed to ensure that this work has a rapid and widespread impact.
The COVID-19 pandemic is surging in low- and middle-income countries (LMICs) and will take a devastating toll. Few LMICs can hope to follow the same path being taken by wealthier nations. Their minimal hospital capacity will be quickly overrun, any hospital-based interventions will affect only a minority of COVID-19 infected people, and social distancing and lockdown are more challenging and carry a much greater economic and human toll.
Global donors have begun channeling billions of dollars to LMICs to mitigate the pandemic. However, without the development of relevant and effective models of community intervention, these investments may not prevent an unfolding catastrophe.
The Solution: Developing Community-based Interventions
Optimal pandemic response models for low-income countries must focus heavily on community-level interventions. These interventions are the backbone of successful initiatives against malaria and other infectious diseases and can be leveraged to mitigate the impact of COVID-19.
The Pandemic Community Response and Resilience Initiative, led by three organizations with deep experience in translating new evidence to rapid change in health policy and programs – the Global Health Group at the University of California San Francisco, IDinsight, and Evidence Action – will develop, assess, and support the uptake of new community-based COVID-19 mitigation models specifically designed for LMICs.
From Evidence to Impact
The Initiative will embrace the partners’ proven approach that carefully assimilates the needs of key decision-makers, rapidly generates evidence that addresses those needs, and then actively supports the requisite policy changes and the rollout of large- scale programs.
The partnership is well placed to pursue this approach to attenuate the pandemic. IDinsight has a team embedded within the Indian Prime Minister’s office and deep working relationships with several African governments. Evidence Action and the Global Health Group work closely with key leaders and experts in countries across Africa and Asia.
SURVEILLANCE AND TRACKING
The dearth of timely data has been a major cause of the weak and haphazard response to the pandemic in many countries. In addition, the data gathering and tracking models used in wealthy countries are poorly suited to the realities of low-income settings. Innovations in real-time data collection (building on partners’ experience from malaria and other diseases) as well as symptom-based surveillance (given severe testing shortages) are core to realistic COVID-19 monitoring systems in LMICs.
Time-consuming PCR-based molecular testing has been the mainstay of COVID-19 diagnosis to date. Several manufacturers have recently announced new rapid tests that could be more easily scaled in LMICs. Those countries need to select diagnostic products and build testing protocols that match their human and financial capacity. Such protocols, with the appropriate testing technology, are needed both for the detection of active infection and the detection of antibodies indicating a history of infection.
THERAPEUTIC + AND BEHAVIORAL INTERVENTIONS
Several drugs show promise for mitigating the impact of the virus. However, the focus of trials to date has been on therapies for severely ill, hospitalized patients in wealthy countries. There is an urgent need to develop evidence and appropriate delivery models that demonstrate efficacy and safety in early treatment and prevention in community settings in LMICs. To have impact in the first wave, a drug must be available, cheap and administered orally.
With or without safe and effective drugs for community use, the Initiative will urgently investigate practical behavior change interventions which may slow transmission and flatten the curve in disadvantaged communities. These may include forms of targeted quarantining and social distancing, modified behaviors at home or work and the use of masks or other protective equipment in high-risk populations.
What We Are Seeking
The Global Health Group is urgently seeking an additional $250,000 to drive the critical first phase of the Initiative over the next six months.
Substantial additional resources will be required in late 2020 and into 2021 to scale-up in light of early results. Given the nature of the pandemic in low- and middle-income countries and the need to address its long-term impacts, we anticipate requiring $5 million over the next three years. These funds will allow the Global Health Group to optimize impact and appropriately address the surveillance, diagnostic, therapeutic and behavioral challenges entailed in mounting an effective community response to the pandemic.
For more information, please contact [email protected].
UCSF Global Health Group (GHG) is an “action tank” dedicated to translating major new paradigms into large-scale action to positively impact the lives of millions of people. GHG works with researchers, policymakers and implementers to better understand and address health challenges and tackle neglected global health priorities. Through boldness, focus, collaboration and innovation, GHG reduces the burden of disease and enhances economic prosperity for people around the world. Founded in 2007, GHG works closely with a wide range of public and private partners, both in-country and internationally.
Evidence Action scales evidence-based and cost-effective programs to reduce the burden of poverty. We bridge the gap between research about what works and solutions for people in need to effectively serve hundreds of millions in the world’s poorest places. Evidence Action partners with governments across Africa and Asia, a key foundation of our approach to drive scale, and maintains a last-mile service delivery network in rural sub-Saharan Africa, together resulting in measurable impact on the lives of over 275 million people each year.
IDinsight is a global advisory, data analytics and research organization that helps leaders maximize social impact. IDinsight tailors multidisciplinary analytical capabilities spanning epidemiology, economics, data science and data system disciplines to decision-making needs and constraints. IDinsight’s work spans Africa, India and Southeast Asia, including offices in India, Kenya, Philippines, Senegal, South Africa, Zambia and government partnerships in Ghana, India, Malawi, Morocco, Philippines and Zambia.