Confusion and controversy in countering Covid-19 pandemic

Published : 18 Oct 2022 07:43 PM

Media reports originating from the United States regarding the Biden Adminis­tration’s latest plans pertaining to Covid-19 shots and treatment coverage are being monitored very carefully by health sectors all over the world.

Health analyst Stephanie Armour on 18 August, 2022 informed through the media that the Biden Administration is planning for an end to its practice of paying for Covid-19 shots and treatments coverage, shifting more control of pricing and coverage to the healthcare industry in ways that could generate sales for companies—and greater costs for consumers—for years to come. In fact, it appears that the US Department of Health and Human Services (HHS) is busy organizing discussions with representatives from drug makers, pharmacies and state health departments to reach agreements pertaining to the Covid-19 treatment industry.

In this context it would be useful to recall that since the emergence of the Pandemic both the Trump and Biden Administrations have always planned to shift the bill for Covid-19 shots and treatments from the US federal government to individuals eventually. With Covid-19 cases gradually reducing, officials in that country are trying to work out a response map of transition related to future pandemic support that would be available through government funding.

However an HHS spokesman has indicated that shifting payments for Covid-19 drugs and vaccines to the commercial market is expected to take months. Consequently, such a scenario is leading relevant government health officials to discuss with healthcare company representatives about reimbursement and coverage, regulatory issues and access to vaccines and treatment for the uninsured.

Such an effort on the part of the relevant stakeholders has been underlined in the comment made by Dawn O’Connell, Assistant Secretary at HHS for preparedness and response- “We have known that at some point we would need to move over into the commercial market, and we are approaching that time now.”  Anne McDonald Pritchett, senior vice president at Pharmaceutical Research and Manufacturers of America, or PhRMA, an industry trade group, has also underlined the importance of discussion pertaining to resolving differences of opinion related to important issues like reimbursement, distribution and equitable access to vaccines and treatment.

Stephanie Armour and other health analysts have shared with the media that such a change in dynamics also portends billions of US Dollars in potential profits for pharmaceutical companies such as Moderna Inc. and Pfizer Inc. as well as its partner BioNTech SE. It may be mentioned here that Pfizer reported US Dollar 8.1 billion in global sales during the second quarter of its activities related to Covid-19 treatment. As of February, 2022 companies including Pfizer and Moderna had reported at least US Dollar 79 billion in combined global sales of Covid-19 vaccines and treatments for 2021, according to a Wall Street Journal review of earnings reports.

The current US Administration had requested for as much as US Dollar 30 billion from Congress for antivirals, testing and shots against future variants, among other measures. Republicans have however opposed such a move and underlined that no new money should be allocated until existing Covid-19 relief funding was spent.

 However, it has been reported that as of mid-February, this year, no money was still left in HHS’s public-health and social-services emergency fund for healthcare providers. The Administration has in fact stopped supplying monoclonal antibody treatments since August. Eli Lilly & Co. has apparently shifted to commercial sales of its Covid-19 monoclonal antibody treatment to States, hospitals and other healthcare providers. The current US Administration has already also signed purchase agreements for updated vaccine doses for the coming winter.

In this context it needs to be also understood that switching vaccine purchasing to the commercial sector will mean that each insurer and pharmacy benefit manager will be negotiating with drug manufacturers. This has led to Larry Levitt; Executive Vice President for health policy at the Kaiser Family Foundation to observe that in such a matrix there will be a possibility for prices consequently to be possibly higher than what the federal government has paid.  Insurers will also have to start paying for the vaccines, he said, likely by raising premiums. Levitt has also pointed out that “without the United States government purchasing vaccine doses in advance, the U.S. may fall behind other countries in getting quick access to boosters and new variant-specific vaccines.”

Other challenges, in all likelihood, are also expected to surface after the US Administration’s latest move. This will include the timetable each drug or vaccine manufacturer has for when they want to move into the commercial market. In addition, Medicare and Medicaid, federal insurance programs for older and lower-income people respectively, will also face difficulties as they do not cover antivirals because they are only approved under an emergency use authorization.

Interestingly, at about the same time as the report prepared by Stephanie Armour came out, another health analyst- Fawzia Moodley made some interesting observations. She has drawn attention to the unstable situation that has been created by the Covid pandemic in some other areas of the world and has suggested the need to be more cautious in framing the path forward. Her observations suggest that there is need for unified action as the pandemic is still not over. Relevant authorities of different countries also need to be more careful.

It has been pointed out that after two years of economic and social upheaval caused by the COVID-19 pandemic, many countries, including South Africa, have lifted the tough protocols such as lockdowns, the mandatory wearing of masks and social distancing. COVID fatigue, the global economic bloodbath, devastating social and mental health impacts, and the hope that large-scale vaccinations provided sufficient herd immunity, persuaded these governments to lift the suffocating protocols.

However, experts have warned that we should not be lulled into a false sense of security. Available statistics from the Statista Research Service have indicated that outbreaks of COVID-19 continue to be confirmed in almost every country in the world. The virus has infected nearly 566 million people worldwide, with the number of deaths at almost 6.4 million. The most severely affected countries include the US, India, Brazil, France and Germany. Bangladesh on 18 August reported one death from Covid and 170 positive cases in the past 24 hours.  

Thankfully, the deadly Delta variant is no longer a significant threat. However, the emergence of Omicron, which is more easily transmitted, has raised concern among scientists because it constantly mutates, as evident from its swift evolution from the BA.2 lineage to Omicron.B4 and B5. Dr Waasila Jassat of the South African National Institute for Communicable Diseases (NICD) has observed that South Africa has a high number of Omicron cases but fortunately has experienced only a small rise in hospitalizations and deaths during its BA.4 and BA.5 wave. Quoted in the scientific journal Nature, she warns that older adults are however still at high risk and that the new strains are more immune to vaccinations. This tends to suggest that time for commercialization of Covid treatment has still not arrived. It is still lurking in the shadows all over the world. We have learnt many lessons but still have to agree on alternate and less drastic methods on how to deal with this mutating virus in the near future.

There is also another dimension that has gradually risen to the surface. Psychiatrist Dr Surenthran Pillay has observed that the pandemic had led to an increase in mental health problems, including depression and anxiety, resulting not only from the illness and deaths but also from job losses and economic fallout. Dr. Pillay has also drawn attention to “the other complication that has to be managed is the associated increase in poverty that comes with COVID”.

It needs to be remembered that Africa, Latin America and many parts of Asia are not the wealthiest regions in the world. This, according to sociologists, means that there cannot be, during these troubled times, any neglect in giving attention to people’s community needs. There is also the psychiatric aspect associated with the lack of food or deficiency in housing or other economic complications that arose from COVID. They are equally important.

Pillay has also referred to the pandemic’s impact on children. His observation is interesting- “we have a whole generation of kids who spent two years behind masks, and important stages in their lives like recognising facial expressions were lost for them.” Dr Samantha Potgieter, an expert on infectious diseases has also joined Pillay through a comment that we need to work together so that future pandemics are better managed due to the lessons learnt this time. The connotation lies within the paradigm that future efforts to stop disruption in our lives should not be based on commercial rivalry.

The critical role of the media in disseminating “credible and scientifically backed” information about vaccines and treatment during a pandemic has also been brought to the forefront by Ogechi Ekeanyawu, the Sub-Saharan regional editor of the African Science podcast.  She has correctly observed that in the era of widening social media usage “where anyone can come with a camera or any text that they like to put out, it is important that all information is verified and authentic. We’re looking at science, listening to the scientists, making sure that they have a larger voice; so that we are not misinformed at any point in time.”

She has also noted that the media had ignored monkeypox, which the World Health Organization recently declared a public health emergency after it spread to Europe and other developed countries. Her comment was significant- “It has always existed here, particularly in West Africa in countries like Congo and Nigeria, but all of a sudden, it is now a global concern, and people are now talking about research. Monkey pox existed all the while here, and there was no spotlight on it.”

The message is clear: This is no time for complacency. We need to learn from our experience of COVID to be able to deal with future pandemics in a more constructive and less disruptive way. Thinking only of money and passing on the steering wheel to the commercial entrepreneurs, as is being done in the United States, will not help.

Muhammad Zamir, a former Ambassador, is an analyst specialized in foreign affairs, right to information and good governance