Coronavirus globally: WHO plans for next wave

A pandemic isn’t a problem any country can solve on its own - after all, eliminating the coronavirus in your own home doesn’t do much good if it can easily return from your infected neighbours. So the World Health Organisation has been coordinating the international effort, despite criticism over its initial handling, and threats from President Trump to pull American funding. Soumya Swaminathan is the World Health Organisation’s Chief Scientist. She spoke to Phil Sansom about the global balancing act...

Soumya - We've been working particularly with those countries with weaker health systems, and our teams have gone into many different countries now to work with the national governments in developing strategies. So 80% of countries now have a national strategic response plan for COVID-19.

Phil - How do these strategies vary country by country?

Soumya - It depends a lot on the state of the health system and the resources that are available. And in fact after the Ebola outbreak, WHO actually went out and said very clearly that an unknown pathogen could really threaten the world, and the only way to deal with that is to really have good surveillance systems, good primary healthcare systems. And of course now we realise that in many countries this is not the case. And what we are seeing I think is very telling, because what we're seeing is a devastation that's happening in the high-income countries - in countries where we think health systems are very robust. And we see the intensive care units and the hospitals being overrun by patients, and healthcare workers just unable to cope.

Phil - Is that a case of where the pandemic actually is? Or is that a case of, there's more testing in the higher-income countries?

Soumya - The testing for this virus is a molecular test; it's what we call a PCR test. You need a PCR lab. Many countries in Africa do not have it. And that was a reason for the late picking up of cases, but I think that's not the only reason. The epidemic is maturing at different times in different parts of the world. And you see the wave from Southeast Asia, then in Europe, now North America, potentially Africa, the Middle East, South Asia.

Phil - In one of these lower-income countries, can you give me an example of what one of your strategies might involve?

Soumya - One is of course to get people to build up the capacity to do the testing, and so in the last two months we've sent out more than a million and a half diagnostic kits to many of these countries. We had training of lab technicians and labs in every country in Africa for example. Then it was building up the national response plan; making sure that hospitals have enough equipment like oxygen, personal protective equipment; training of healthcare workers; and then community information and education of the communities, because in many ways this is asking people to change their behaviour. You're being asked to stay at home, cut all your social activities and connections; and of course again in the low-income countries we have to deal with situations where people have to go to work on a living and to eat. We're still grappling with: what is the right approach, what's the right balance? On the one hand, you need physical distancing and avoiding people getting together in one place in order to cut transmission. On the other hand, there's the economic need and the human need to make sure that people are not starving and they're not suffering.

Phil - What about the scientific research into dealing with the coronavirus? What have you done so far?

Soumya - We developed a multi-country large randomized trial called the SOLIDARITY trial to look at potential drugs that could have activity against this virus, and currently we have over 80 countries that will be enrolling patients. The first drug is Remdesivir, an antiviral drug that was tested against Ebola was not found to be effective; but this is also an RNA virus, so we are testing it against this. Chloroquine and hydroxychloroquine, which of course are old drugs and are used, other than malaria, for other diseases. A drug called Lopinavir and Retonovir, it's a combination anti HIV drugs. And the fourth is a combination of Lopinavir/Retonovir with interferon beta one which is an immune stimulant. Within a couple of months, I hope that we will have results.

Phil - If any of these drugs that you're testing do end up really working, what's the plan then? Especially with regard to some of the poorer countries that we were talking about?

Soumya - That's a really good question and I think that's something that WHO always has right up front: equitable access, to people all over the world, regardless of whether they're able to pay or not. We have organizations like Global Alliance for Vaccines which distributes vaccines in 73 countries, mostly low-income countries. We also then have to think about middle-income countries, where most of the world's poor actually live today. And then of course the high-income countries also certainly need the vaccine. So it's a question of, what could be a formula or principles to decide this? For example, if we had the first few tens of millions of doses of a vaccine, who would we prioritise? Would it be healthcare workers around the world? Healthcare workers plus the elderly? We may have to face some of these questions.