AMI Live Web Conference 2020 – Speaker Summaries
Compiled by Ashley Scott, IGHN Key Correspondent/MSc Global Health TCD
Ms. Emily O’Reilly, EU Ombudsman: Opening Remarks:
Ms Emily O’Reilly described how research capacity and access have come sharply into focus with the COVID 19 pandemic. Inequalities in access to medicine are already more affected, and she asked how will this play out if and when the Covid-19 vaccine arrives? How will differences in power of governments affect the distribution of vaccines and PPE? The gap between developed and developing world with HIV/AIDS was clear, with many factors involved in deciding who received antiretrovirals, long after they were needed. Governments will play an important role in determining how and when the covid-19 pandemic will be resolved. The ombudsman plays a role in ensuring that patients are protected by ensuring that pharmaceutical companies are truthful and fair in their manufacturing and distribution. This will be ensured with the COVID-19 vaccine.
Panel 1: Is the Current R&D Model Fit for the COVID-19 Challenge?
Prof Sam McConkey, Professor Infectious Diseases, RCSI; COVID-19 Treatments on the Horizon
Prof Sam McConkey described how he has been watching Covid-19 outbreak since January. He describes how the quickest way forward is to reprofile an existing registered medicine, and many current drugs that are being tested. Alternatively, a new drug will need to be developed which takes approximately 3-7 years before it is available. These drugs are being developed for three purposes: prevention of the virus, an antiviral at an early stage to reduce the impact of the virus and treatment for an inflammatory cascade. Funding of research and medication development depends on patenting and pharmaceutical companies involved. We need to look at new ways of developing drugs and rewarding development in an equitable way.
Prof Luke O’Neill, School of Immunology, TCD; A Frenzy of Activity: Vaccines, Antibodies, Anti-Virals and Anti-Inflammatories to Crack COVID-19
Prof Luke O’Neill describes how the spotlight is on politicians, healthcare workers, scientists and the drug discovery business. Pharma companies, biotechnology and drug pricing will change drastically as a result of this, and hopefully for the good.
He described how BCG vaccines are a powerful immunostimulant and were given for Tuberculosis and Measles. It boosts innate immunity and there are currently seven trials underway to see the effect on Covid-19. It may provide a non-specific boost that might protect you against Covid-19, but it is still experimental and being tested and handwashing and social distancing is still of vital importance. Johnson & Johnson is at the forefront of drug research and production funding for Covid-19. 41 vaccines are being tested, 23 anti-inflammatories are in trials, and 6 antivirals are being tested, however we need to wait for double blind placebo-controlled trial. Hydroxychloroquine has shown some evidence of antiviral protection, however has side-effects such as dysfunctional dysrhythmias. He remained optimistic and emphasised the need for scientific rigor in research.
Dr. Andrew Hill, University of Liverpool; Drug Shortages during the COVID-19 Crisis
Described how he looks at costing for drug production. He described an active pharmaceutical ingredients database, where cost per kg of drug ingredients are listed to track the cost of drug to make compared to the selling price. If the clinical trials for treatments work, they are hoping for the drug cost to be $1 per person per day. Hopefully medication could be mass produced, using Global fund or PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief) models to guide selling of drugs at prices close to cost production.
Dr. Ellen ‘t Hoen, Medicine Law and Policy; COVID-19: Learning from the Past
Dr Ellen described how the likelihood of cost-effectiveness of testing and treatment for all nations at the start of development will be low. Drug companies have so far been pushing to try and find ways of profiting from Covid-19 drug development. Political pressure is required to put pressure on drug companies for fairness. The Irish government has responded to issues regarding intellectual properties and international patent law has been changed to lift the monopoly on drugs. Public sector investment in medicine and vaccine development is needed and offers options to attach conditions to production at lower prices. She described the WHO Covid-19 Technologies pool, recommended by Costa Rica as a place for Covid-19 information and development to be shared and this is gaining rapid, significant support. However, Pharmaceutical company buy in is required and more governments need to support this.
Panel 2: COVID-19: The Opportunity for Socio-Cultural and Political Reform
Ms. Kay Curtin, Patient Advocate; Living with the Uncertainty of not having Access to Treatment
Ms Kay Curtin described what it is like to live without access to medicines. Although healthcare professionals want to do everything possible, there are limitations on what you can access. She described the reality of accessing medication similar to a “roulette wheel of access” where factors involved in the chance of a positive outcome are timing of diagnosis, geographical location, knowledge of your physician, your government’s policy on reimbursement or ability to pay. There are currently no changes in reimbursement, with Ireland being one of the last to reimburse innovative treatments. The human cost of treatment is not being taken into consideration, versus treatment costs. With the Coronavirus, access to treatment will be further reduced, and the vulnerable need to be prioritised.
Ms. Jacqui Browne, Patient Advocate, IHREC Disability Advisory Committee; Ethical Concerns, Questions and Imperatives from a Patient Perspective in a Pandemic
Ms Jacqui Browne described how in this time of crisis, a position paper was developed by the department of health without consultation with vulnerable groups, disabled persons and the general public and without reference to important documentation such as the EU convention of protection of human rights and the Irish constitution. Ethical principles and values should be further described and simplified to be distributed among the general population in this difficult time. People with disabilities should be reassured that their health is a priority and she urges states to establish clear protocols for public health emergencies to ensure that when medical resources are scarce, access to healthcare does not discriminate against people with disabilities. Public health campaigns must be accessible to all including sign language, braille and e-health measures. All lives have equal value and allocation of resources should not be given based on presence of a disability, only medical status should be considered.
Dr. Gaelle Kirkorian, Médecins Sans Frontières, Doctors Without Borders; COVID-19: The Need for Radical Changes to Ensure Access to Essential Health Tools
Dr Gaelle Kirkorian describes how MSF knows the challenges of not being able to provide medicines due to cost or availability in the countries it serves. We need to reassess whether the reliance on the current market mechanism is fit to provide healthcare to all people who need them. Society as a whole is experiencing the outcomes of the current pharma industry situation, which MSF has been dealing with for years including medicine and equipment shortages. The number of people who need access to medication is growing and countries are experiencing shortages of cheaper medication due to low profit in producing cheap drugs. Public health policy based on rationing is spreading globally, due to incapacity to provide general access e.g. decreasing access PPE. We are in a key time where we can change these trends towards improving health, planning of conditions of access openly, and collaborating with stakeholders while defining terms of a social contract with organised collective governance.
Mr. Darren O Rourke, TD and PhD Scholar; COVID-19 and the Politics of Access to Medicines Reform
Mr Darren O Rourke described how the expectation in Ireland is that vaccines and treatment will be available to everyone free of charge. However, questions raised about vaccine development being driven by profit rather than for societal health. The Covid-19 pandemic is a shock to the system and we will create new ways of living, causing seismic changes and development to occur e.g. nationalised child and health care, frozen rents etc. New recognition of interdependence is presenting an opportunity for positive change. System reform is possible, but will require political will. We need to focus on what is said and what is not said in government, and too much is currently happening behind closed doors. We need to hear directly from pharmaceutical companies and we need to have real and open conversations with different stakeholders.
Mr. Diarmaid McDonald, Just Treatment
Mr Diarmaid McDonald described how Covid-19 is a devastatingly costly way to learn lessons. He works with people whose lives have been negatively affected by inaccessibility to medication. He described how viruses exploit existing failures and vulnerabilities in society, which we have created. We knew that the next pandemic was coming, and opportunities to be further along in the development of vaccines and medications have been missed. Incentivising production of new medicines through monetary gains does not benefit global health. The current system is failing to deliver, and if it is seen that there will not be a monetary gain, then no advancement is made despite the fact that it was known that the next pandemic was coming and a drug was needed. We can rebuild a stronger, more equitable society that values life and dignity through collaboration, solidarity and accountability, not competition and profiteering.
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