By Kaouthar Lbiati

The growing success of efforts to contain the spread of Covid-19, the disease caused by the virus, may present yet another hurdle – How to end lockdown without causing a second wave? There is no modern analog for the shutdown of economic activity. Ending the lockdown needs unparalleled capabilities in testing, tracing and most importantly it needs researchers to deliver a new vaccine!

This paper makes the case for low and middle-income countries (LMIC) to be part of the clinical evaluation of the efficacy and safety of the COVID-19 future vaccine, the ramping up of regional manufacturing capabilities for local immunization and underscores the critical importance of reaching an advanced purchase agreement with manufacturers and suppliers as well as building up multilateral financial partnerships with key institutions before even a vaccine is made available in either North America, Asia and/or Europe.

Kaouthar Lbiati is Medical Doctor, (MD) with a MSc in International Policy and Health Economics from the LSE, Health Policy Expert at the Moroccan Institute of Strategic Intelligence (IMIS), Member of the strategic advisory board of CYTOVIA Therapeutics.

Is there an Optimal Strategy to end the lockdown in LMIC?

Decisions to impose or remove restrictions could be extremely challenging politically. Governments must find an appropriate middle ground between a long, broad lockdown that damages the economy and a reopening that is too soon and too fast, risking public health and potentially subsequent lockdowns. A decrease in new cases and relatively low hospitalization and death rates should be used to guide this important decision.

LMIC should focus on providing testing primarily to key public hospitals (where patients are likely to show up in order to rapidly determine their COVID-19 status) and to public health laboratories throughout the country. In parallel, LMIC should conduct random population testing to determine the virus’ prevalence across regions and provinces. However, Do LMIC have the resources to build up sufficient testing capacity within short time span as well as a robust contact tracing with the ability to rapidly inform and quarantine affected individuals?

However, Do LMIC have the resources to build up sufficient testing capacity within short time span as well as a robust contact tracing with the ability to rapidly inform and quarantine affected individuals?

Restarting social and economic activity on the basis of transmission risk (see Note 1) while continuing strict isolation for vulnerable populations such as the elderly or patients with cancer may be the right strategy in the near term for low-income countries (LIC) that are unable to rapidly build up health care and testing capacity. However, can people who live in the most densely occupied households and neighborhoods in the world isolate their vulnerable and elderly?

Most importantly, governments need to execute a lift of lockdown in a way that allows for adjustments as conditions change.

LMIC must make sure they are part of the coronavirus vaccine’s journey

The world is currently focused on the development of vaccines for COVID -19. It is vital for LMIC to take part in the solution. There are already at least 254 therapies and 95 vaccines related to Covid-19 being explored. And the urgency to develop a vaccine quickly is eclipsed only by the need to make sure it is very safe. Traditional international regulatory pathways need to adapt (shorten timelines) to enable reach this important milestone.

The first nation to develop a vaccine for Covid-19 could have an economic advantage over others as well as a tremendous public-health achievement. China is making rapid progress, with three vaccines entering advanced development. The US is entering the race with five or six companies which operate primarily in the U.S. The Europeans are also making great progress and the laboratory sprinting fastest is at Oxford University in London whose first few million doses of the vaccine could be available by September. However, the challenge for the 3 competing powers (USA, China and EU) is making enough vaccines for their population and other nations who cannot develop their own vaccines and medicines.

The first nation to develop a vaccine for Covid-19 could have an economic advantage over others as well as a tremendous public-health achievement.

LMIC must make sure they are part of the search for a coronavirus vaccine. In this context, it’s important to look at how prepared LMIC scientists and institutions are to lead clinical trials locally and/or regionally for vaccines and medicines. Research which takes place in LMIC is predominantly funded by northern sponsors, with national academics and clinicians partnering in the research process and international research organisations providing oversight.

LMIC: Start Preparing Factories NOW!

Poorer countries in Africa, Latin America and Asia would be served last if market power were to decide who gets access to a vaccine. Thus, it’s important for LMIC to take steps to prepare to manufacture the vaccine on a local and/or regional scale once a vaccine is available. More than one vaccine would be needed in any case as this will help avoid bottlenecks in manufacturing. The most prepared country among LMIC could inoculate its own population quickly and perhaps share the product with other countries, particularly those who need protection the most.

Vaccine’s factories however follow strict guidelines governing biological facilities and usually take around five years to build, costing at least three times more than conventional pharmaceutical factories. Manufacturers may be able to speed this up by creating or re purposing existing facilities, including in LMIC, long before the experimental vaccine receives approval from the international healthcare authorities.

In parallel, governments ought to secure advanced purchase agreement preferably with more than one supplier.

Funding through Partnership building with world institutions

Generally speaking, LMIC are ill-prepared and vulnerable to the persistent threat of pandemics and large-scale disease outbreaks. LMIC are dependent on partnerships for short-circuiting transmission, securing vaccines and preventing future pandemics.

Over the past several years the World Bank Group has established itself as the leading international financier for health emergency preparedness and response in LICs and LMICs. However new catalytic financial mechanisms are needed to respond to the dramatic outbreak of the novel coronavirus (COVID-19).

Usually, the Emergency Reserve Fund for Contagious Infections Diseases at the US Agency for International Development (USAID) is directed to the World Health Organization (WHO) under the Strategic Preparedness and Response Plan (SPRP). However, President Trump’s unilateral decision at the peak of COVID-19 crisis to cut financial contribution of the USA to WHO (15% of WHO’s GDP) would necessarily impact LIC/LMIC.

New catalytic financial mechanisms are needed to respond to the dramatic outbreak of the novel coronavirus (COVID-19)

Luckily, on May 4th, a high-level meeting of government leaders took place with representatives of the European Union and the Bill and Melinda Gates Foundation to discuss raising €8 billion ($8.6-billion) in funding for a global vaccine distribution agency to be established at the World Health Organization (WHO). LMIC are expected to benefit greatly from this multilateral initiative.

Recently, Bill Gates said that his foundation would fund factories for the seven most promising potential vaccines. Most importantly, Bill Gates wants production capacities to be built up in the developing world.

In conclusion, COVID-19 crisis will have a major and long lasting impact on the developed world and LMIC alike. Novel Vaccines and medicines designed to defeat COVID-19 will save lives and allow the world economy to recover. LMIC ought to be considered partners of the developing countries in the solution for COVID-19.

Partnering through commitment to financial investments and technology transfer in research and manufacturing will create self-sufficiency, national security and economic prosperity in LMIC. Helping these countries improve their abilities to respond to epidemic threats creates health capacities that can address future threats. By contrast, Ignoring LMIC may result in harmful geopolitical consequences worldwide; economic recession, surging unemployment, financial hardship, political instability, rise of radicalization and a surge in refugees and immigration from LMIC are among the issues the developed world would have to deal with otherwise.

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Note 1. Restarting social and economic activity on the basis of transmission risk involves to First, reopen the most essential operations, such as medicine, energy supply, logistics, and food, followed by activities with medium transmission risk, such as manufacturing, construction, and retail and lastly businesses with high transmission risk, including restaurants, hotels, and education institutions.