By Jamie Bay Nishi, Director, Global Health Technologies Coalition

The US government has invested billions of dollars to create new health technologies — including tests, drugs, and vaccines — to combat COVID-19. These innovations could change the trajectory of the pandemic in the United States and other high-income countries, but unfortunately many of these tools may not work for people living in the world’s poorest places, where different challenges demand different solutions. 

That’s why one of the US government’s strongest players in advancing, adapting, and scaling innovations for low-resource communities, the US Agency for International Development (USAID), which has so far been left on the sidelines, must be brought into this fight.

To understand why, consider how COVID-19 technologies in development could benefit a hypothetical patient — let’s call her Mary — in a high-income country compared to a vulnerable person living in a low-income country. 

On day one Mary awakes with a cough and fever, so she books a telehealth appointment with her doctor who offers her an in-home COVID-19 test that arrives in the mail or a visit to a drive-thru testing center. Mary opts for the latter. Within three hours her test is rapidly processed alongside hundreds of others, and she is diagnosed with COVID-19. Two days later, Mary’s symptoms worsen. She’s taken to a hospital where her room was sterilized by an automatic fogging machine and cared for by an experienced team of medical professionals protected by full gowns, N95 respirators, and face shields. Doctors use an AI-based, handheld ultrasound machine to check Mary’s lung health and an array of biosensors to monitor her vitals in real time. The next morning, this system alerts Mary’s doctors that her blood oxygen levels are falling, so Mary is given a treatment that is delivered intravenously, like remdesivir. Fortunately, Mary survives COVID-19.

For patients like Mary who have access to high-quality health care, these cutting-edge tools could soon be reality. But for patients living in poor and vulnerable communities worldwide — which often lack basic medical supplies, highly trained health workers, and reliable electricity and clean water — these technologies might as well be science fiction. Centralized, high-scale diagnostic tests won’t work in countries without strong laboratory systems. Automatic fogging sterilization machines aren’t appropriate for clinics that lack clean water and sanitation. Wi-Fi-connected biosensors and handheld ultrasound machines are useless without reliable electricity. And access to IV medication is a long shot in places that face shortages of common drugs, not to mention the tools for preparing, refrigerating, and delivering them.

This innovation disparity is not unique to COVID-19: Most new technologies are funded by and developed for people in high-income countries, and it’s estimated that 70% of health technologies designed for health facilities in high-income countries cannot be implemented in low-income countries. 

But since we won’t defeat COVID-19 anywhere until we defeat it everywhere, this perpetual problem will hamper efforts to end this pandemic — unless the US government takes action now to advance health tools that work in low-resource settings.

With its decades of experience advancing treatments and technologies to help vulnerable communities fight deadly diseases like AIDS, tuberculosis, and malaria, USAID is uniquely equipped to take on this challenge. Working alongside other agencies and partners, the agency could be instrumental in spurring the development of COVID-19 technologies for low-resource settings, including:

  • Drugs that are easily transported and administered without the need for highly trained health workers

  • Rapid tests that can deliver results at point of care without using complex laboratory equipment

  • Vaccines that are single dose, can be stored at room temperature, can be rapidly produced and distributed, and are easily administered (ideally, through ingestion, a patch on the skin, or an electrical pulse rather than an injection) 

  • Medical devices, such as specially designed ventilators, IV infusion monitors, and oxygen delivery devices that require minimal technical expertise, have fewer and more easily replaceable parts, are quickly manufactured, and are battery operated

  • Personal protective equipment that is durable, reusable, open-source, and can be quickly manufactured and adapted in a variety of settings

Unfortunately, Congress has provided USAID with few new resources to support a global response, which is something the Global Health Technologies Coalition and other leading global health NGOs are calling on Congress to remedy in the next COVID-19 emergency funding bill. Science is our exit strategy from COVID-19, but only if everyone, everywhere can benefit.

Jamie Bay Nishi is director of the Global Health Technologies Coalition (GHTC), a coalition of 30 nonprofit organizations, academic institutions, and aligned businesses advancing policies to accelerate the creation of new drugs, vaccines, diagnostics, and other tools that bring healthy lives within reach for all people.


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