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The Action Thread Part Two

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“When the global community decided to make it a priority, the difference was staggering.” Dr. Jen Kates reflects on the lessons learned from the global HIV response.
Dr. Kates has taken over Connie Britton’s social media channels to talk about #COVID19 for #PassTheMic.
Sign and stand as #ONEWorld https://go.one.org/2Zk80Cr

 

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Foto de ONE.

“I’m starting to hear people talk about how coronavirus has amplified inequities that exist in the health system in our country and across the world.” #PassTheMic 🎤
Dr Craig Spencer, frontline ER doctor, is taking over Sarah Jessica Parker’s social media channels today to share his views on the global response to #COVID19.
Sign the petition now and join us in calling for a unified global response as we stand as #ONEWorld. ❤️ https://go.one.org/2Zk80Cr

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Can you believe it's been one week since Julia Roberts and Dr Fauci launched #PassTheMic 🎤
Here - you get to hear from experts on the frontline of #COVID19 instead of the celebrities! Thanks to those who have taken part so far... we have learned so much - have you?
Stay tuned because there's still loads to come! Today - Sarah Jessica Parker hands her channels to Dr Craig Spencer.
Find out more at #ONEWorld https://go.one.org/2Zk80Cr

 

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COVID-19

The collective effort gives me hope, but we can’t turn inward

27 May 2020 10:33PM UTC | By: DR. JENNIFER KATES

SIGN THE PETITION

Demand a Global Response to Coronavirus

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Dr. Jen Kates is senior vice president and director of global health & HIV policy at The Henry J. Kaiser Family Foundation. Actress Connie Britton interviewed Dr. Kates as part of our #PassTheMic series.

Here’s some of what she had to say.

One of the ongoing challenges that comes up again and again, whether you’re talking about testing capacity, supplies, or what’s going to happen when there’s a vaccine, is this tendency for everyone to pull inward and not realize that a virus doesn’t respect borders.

The idea that we’re going to restrict access to information, interventions, or supplies, and exacerbate an unequal marketplace with a global threat makes no sense from a public health perspective. People in the United States don’t live only in their communities. They travel or have families or jobs that take them places. So the idea that a state has to battle other states for supplies is not a solution.

Drawing from my experience of working on HIV — prior to a global recognition that there was a threat that was going to devastate likely the entire continent of Africa and certainly, if not, the whole of sub-Saharan Africa, infections were skyrocketing.

But when the global community, led by the US and others, decided to make it a priority, the difference was staggering.

With any preventive effort, doing it from the outset actually would save a lot more lives and money in the long run.

Likewise, with the 2014 Ebola outbreak the response didn’t start in the most perfect way. But once there was a global recognition that it could potentially have an incredibly devastating impact beyond those three countries, the global community dealt with it. It’s like with any preventive effort, doing it from the outset actually would save a lot more lives and money in the long run.

Diplomatic engagement

Because of the way that this virus transmits, it has incredible community health implications. This virus spreads through droplets. It’s not the same as a disease that spreads primarily through sex and drug use, so the implications of not distributing the vaccine globally are bad.

If you contain something over here, unless we have border closures (and I’m not saying to advocate for that), it’s not going to work. It would actually be so much more disruptive and economically devastating than to just provide everybody with a vaccine.

I think there are a number of priorities we should be working on at the moment. It would be smart for the US to redouble its efforts to shore up the systems of other countries to have their own ability to respond.

Shoring up systems means that lab capacity, testing capacity, all of those things are as good as they can be so that detection and attempts to control can happen quickly. The best example I can think of is after Ebola in 2014, the creation of the African Centre for Disease Control.

Another priority is coordination. This is where the World Health Organization comes in, to help coordinate a response around supply shortages and distribution.

It would be smart for the US to redouble its efforts to shore up the systems of other countries to have their own ability to respond. 

A third place where the US could be particularly helpful is diplomatic engagement. That has been historically a place where the US could make a lot of difference in a positive way, to ensure that everyone’s at the table to try to tackle these issues. The US has a pretty unique part to play in that, but has kind of walked away from it.

The final one is obvious: resources. It’s a hard argument, when you’re sitting in the US, seeing an outbreak and feeling anxious about providing money to other places. However, if we’re all connected and what happens in a different country affects us here, then it only makes sense to make that investment. So I think we have to reconceptualize the idea that spending something abroad is not about not spending here. It’s an addition that will do as much good as spending money at home.

What’s troubling and what’s inspiring

The thing that keeps me up at night is that it’s the virus’ job to live and it’s going to continue to try to do that. This one is particularly harmful for a proportion of people, so that is very devastating to see.

The other thing that worries me is politics getting in the way. The history of infectious diseases that I’ve studied is that whenever politics enters, you don’t make the right decisions. So, I hope that we can get beyond that, and make the best decisions for public health.

We have the best minds in the world working on this, so that is inspiring.

However, on the positive side, there are so many amazing researchers and scientists who have gained their knowledge and experience through HIV. The amount of collective effort they are putting in together is staggering and gives me a lot of hope. We have the best minds in the world working on this, so that is inspiring.

These excerpts from the interview were edited for length and clarity.

Hear more from experts in our #PassTheMic campaign, where global health experts take over celebrities’ social media channels to share the data, facts, and science we need to know to end COVID-19. Follow us on Instagram, Facebook, and Twitter for more.

Demand a Global Response to Coronavirus

People all over the world are standing in solidarity with each other to fight coronavirus, but the virus keeps moving fast.

The pandemic will inevitably wreak its worst on the communities and countries that are least able to withstand the shock. Let’s stand with the most vulnerable whether they live across the street or across the ocean.

We are one world and it’s time to fight for humanity against the virus. Sign our petition telling governments that a global pandemic demands a global response.


Dear World Leaders,

The world needs a Pandemic Response Plan to:

  • Protect the vulnerable, support essential workers, and make a vaccine available to everyone
  • Support people worst hit economically
  • Strengthen health systems so we’re ready if this happens again

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Today on #PassTheMic - Connie Britton has donated her social media channels to Dr. Jen Kates, director of global health & HIV policy at the Kaiser Family Foundation.
Dr. Kates will discuss how we can use lessons learned from the global response to HIV in the fight against #COVID19: “When the global community decided to make it a priority, the difference was staggering.”
Demand action to protect everyone, everywhere now and stand as #ONEWorld. https://go.one.org/2Zk80Cr

 

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COVID-19

We risk a second spike if we don’t get a coordinated response

26 May 2020 11:25PM UTC | By: DAVID ANDERSON

SIGN THE PETITION

Demand a Global Response to Coronavirus

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David Anderson is director of quality and infection prevention and control at Nightingale Hospital in Manchester, UK. He is a frontline nurse and humanitarian health advisor with UK-Med. He worked in Sierra Leone in 2014 during the Ebola epidemic. We interviewed David as part of our #PassTheMic series.

Here’s some of what he had to say.

If you had an absolutely coordinated global response to coronavirus, one of the beauties would be that you’d have greater control. We would have a much better galvanised approach to dealing with this globally. For example, the flight restrictions wouldn’t have come in with such a scattered approach. That would have been done more systematically and then would have slowed down the spread, in particular into major hubs.

All of the learning that comes out of that helps us understand how we control this pandemic. It helps us to understand how we treat it and hopefully, eventually, get vaccines and decent treatments for this particular coronavirus.

One of the key things we should tackle now is looking at how we can support other countries that are not as well developed. That means making sure the correct vaccination programmes are in place and the correct healthcare is in place to deliver that.

It’s not just about having the vaccinations. It’s about having all of the support that sits around that to make sure you can deliver the correct aid to the right place. That, in turn, has a huge economic impact for a country. So it’s not just about giving a vaccine — it’s got a very broad reaching end goal.

Lessons learned from Ebola in Sierra Leone

PTM_2020_Day7_Anderson_Quote2_1200x1200_

A global approach also allows you to control things in a much better sense, and it would probably have had a far lesser economic impact than we’re currently seeing.

The economic numbers are bad enough in the UK, but I dread to think what it will be like in other countries. Think of the fallout in Sierra Leone after Ebola, for example. Before Ebola, Sierra Leone was starting to become a country where people would go on holiday. Now it’s one of the poorest countries in the world again, so they’re still living that nightmare of having had a dreadful disease.

It’s very difficult to think about priorities in a global response, because you want to solve everything at once. Ultimately, if we can get a vaccination against the disease, let’s get that done.

 

The risk of a second spike

One of the big risks if we don’t get a reasonably well coordinated response is a second spike. If you look at the Spanish flu, for example, the first spike was big enough, and then that second spike was just horrific. So what we really want to be able to do is make sure we mitigate against that as much as possible.

That needs to be balanced against the economics and all the other things we need to consider. Because if we don’t tackle this in a controlled and sensible fashion, then my worry would be that we will see another massive spike, and that would be appalling.

We’re seeing this kind of controlled approach in some places, but I’m not sure that everywhere is as well equipped to deliver that. The economic imperatives in some countries will be very different to others, and the response in some areas politically are very different to others.

I don’t think it’s necessarily the approach that we’d wish for — but, what you do see is that most countries are trying their utmost to do this the best way they possibly can and to deliver that huge balance again of healthcare versus the economy. I think some areas will struggle heavily with it, and it’s not going to be easy.

What crisis tends to do is galvanise the population to do the right thing.

However, the thing that makes me joyous is seeing people working together so well. You see it all the time — it doesn’t matter whether it is in South Africa where I was working, or Manchester, or at the Nightingale. It doesn’t matter whether it’s Ebola, coronavirus, diphtheria, or measles. It is inspiring to see people working together so well.

What crisis tends to do is galvanise the population to do the right thing, and that is really wonderful.

These excerpts from the interview were edited for length and clarity.

Hear more from experts in our #PassTheMic campaign, where global health experts take over celebrities’ social media channels to share the data, facts, and science we need to know to end COVID-19. Follow us on Instagram, Facebook, and Twitter for more.

Demand a Global Response to Coronavirus

People all over the world are standing in solidarity with each other to fight coronavirus, but the virus keeps moving fast.

The pandemic will inevitably wreak its worst on the communities and countries that are least able to withstand the shock. Let’s stand with the most vulnerable whether they live across the street or across the ocean.

We are one world and it’s time to fight for humanity against the virus. Sign our petition telling governments that a global pandemic demands a global response.


Dear World Leaders,

The world needs a Pandemic Response Plan to:

  • Protect the vulnerable, support essential workers, and make a vaccine available to everyone
  • Support people worst hit economically
  • Strengthen health systems so we’re ready if this happens aga

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FEATURE STORY

Modelling the extreme—COVID-19 and AIDS-related deaths

25 MAY 2020

Kimberly Marsh, a senior adviser on modelling and epidemiology, has worked for UNAIDS for six years. She supports countries in estimating the impact of the HIV epidemic globally and regionally.

 

Can you tell me more about the latest modelling report that you are a co-author of, which examines the potential for HIV service disruption in times of COVID-19 in sub-Saharan Africa?

This work looks at potential disruptions in sub-Saharan Africa owing to the COVID-19 pandemic on HIV services that might have an impact on HIV incidence—the number of new HIV infections—and on the number of AIDS-related deaths in excess to those we might have observed if we hadn’t had the COVID-19 pandemic.

We are particularly interested in those question because we know that more than two thirds of all people living with HIV worldwide are living in sub-Saharan Africa. That’s 25.7 million people living with HIV, 1.1 million new HIV infections and around 470 000 deaths from AIDS-related causes in 2018. Among all people living with HIV in the region, 64% of people are on life-saving antiretroviral therapy, which also prevents further new HIV infections.

It is really important that we’re able to ensure they will have access to services. In the models, we looked at service disruptions—a complete disruption of any HIV-related services over a three-month and a six-month period of time. And we looked at the impact after one year and five years. Now remember, these are just scenarios, and extreme ones. We don’t expect this to happen, but it helps us to answer two questions: what HIV-related services are most important to prevent additional deaths and new HIV infections and what might happen if we don’t mitigate or address those disruptions.

Interruption%20of%20HIV%20treatment%20se

 

From this huge amount of work, what are the two key takeaways?

The modelling work predicted that with a six-month disruption in HIV treatment there could be an excess of 500 000 deaths in sub-Saharan Africa. So, when you look at UNAIDS estimates of AIDS-related deaths over time, that would take us back to about 2008, when we had nearly a million deaths.

There is no doubt about it, HIV treatment is critical. Ensuring that HIV treatment is available to people who need it during the three- to six-month periods is the most important thing that countries can do to prevent excess deaths and HIV incidence. All countries should work to ensure that supply chains are providing them with enough medicines to distribute and that people have sufficient medicines so that they can take them over the coming months.

The second thing to say is that these are projections and that there is still time to ensure that people get the HIV treatment services they need.

Let’s prevent what this model potentially predicts and let’s get HIV medicines to the people who are living with HIV.

 

What about HIV prevention? Does condom availability have an impact?

The models showed that when you look at prevention services, condom availability impacted the results. I think it is important to say that this is a treatment lesson primarily, but things like access to condoms is really important. We saw around a 20–30% relative increase in HIV incidence over one year if condoms were not available for six months. This is definitely something that we should be focusing on.

 

Can you tell us a little bit more about the impact on mother-to-child transmission of HIV in these scenarios?

In the scenarios, we looked at the potential for HIV testing services to be disrupted as well as for women to not get medicine to prevent transmission of HIV to their children. And what the various models found was that by removing those medicines—which have had an extremely important impact in terms of reducing new child HIV infections over the past five to 10 years—you could see rises in new child HIV infections in selected countries anywhere up to 162%. It really is critical to maintain prevention of mother-to-child transmission of HIV services.

 

You have said this was an extreme scenario, not a prophecy, but yet you still believe in modelling?

Models are very important for exploring questions that countries routinely pose to UNAIDS and the World Health Organization in terms of thinking of strategic approaches to responding to HIV in their countries. Models aren’t perfect, but they have a lot to tell us and I think in this instance it really highlights some of the strategies that will be important over the coming months as COVID-19 impacts or potentially impacts sub-Saharan Africa. 

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