12 May Medical oxygen and respiratory pandemics
This was the focus of the first of three High Stakes Conversations on the role of medical oxygen and respiratory therapies hosted by Every Breath Counts on 30 April 2024. The event, Respiratory Pandemics and Access to Medical Oxygen, brought together four leading experts on pandemic preparedness and response – Nita Madhav from Ginkgo Bioworks, Ramanan Laxminarayan from One Health Trust, Priya Basu from the Pandemic Fund, and Nina Schwalbe from Spark Street Advisors.
The conversation kicked off with the new Global Burden of Disease estimates of the number of excess deaths caused by the COVID pandemic – a massive 16 million; six million in 2020 and 10 million in 2021. Most excess COVID deaths occurred in South Asia (2.8 million), Sub-Saharan Africa (1.6 million), and Latin America and the Caribbean (1.4 million). In contrast, one million occurred in high-income countries.
This massive COVID death toll dwarfed deaths from respiratory infections (2.5 million) and also deaths from the two leading causes of human death – heart disease (9.1 million) and stroke (6.6 million) – prior to the pandemic. The authors concluded: “For adults worldwide, the COVID pandemic has had a more profound impact than any event seen in half a century, including conflicts and natural disasters…Life expectancy declined in 84% of countries and territories during this pandemic, demonstrating the devastating potential impacts of novel pathogens.”
Leith Greenslade of Every Breath Counts and session moderator introduced the panel by posing the question: Why did so many die in 2021? After all effective COVID vaccines arrived in 2020. But while the southern hemisphere waited and waited and waiting for them, most lacked the basic medicines that could keep them alive – medical oxygen and related respiratory therapies. What is the risk this will happen all over again?
“Our results suggest that over the next 25 years, there is a 66% probability of a respiratory pandemic that would kill 10 million people or more.”
Nita Madhav kicked off the conversation by presenting new estimates that respiratory pathogens are the dominant driver of pandemic risk and that the odds of a pandemic as severe or worse than COVID occurring in the next 25 years are “more substantial than generally believed.” Madhav said that there was a 66% chance of another respiratory pandemic that would kill on average 2.5 million people annually – 580,000 in Sub-Sharan Africa, 450,000 in India, and 340,000 in China alone. Madhav said that these estimates are at odds with observed patterns of COVID mortality due to the high levels of underreporting of COVID deaths in Africa. She concluded that this high risk can be substantially reduced with appropriate investments in pandemic preparedness and response. More details are available in the report, Estimated Future Mortality from Pathogens of Epidemic and Pandemic Potential.
Ramanan Laxminarayan from One Health Trust recalled the devastating oxygen shortages in India during COVID and his efforts to rally supplies by setting up Oxygen for India, the largest, non-government effort to mobilize medical oxygen for COVID patients anywhere. Post-COVID, he underscored the need for new solutions so we can be better prepared next time, highlighting a new initiative – the National Medical Oxygen Grid – to help hospitals and governments plan and manage medical oxygen supplies so that no hospital runs out. Laxminarayan is also one of 20 Lancet Global Health Oxygen Commissioners who will release their report in 2025 with specific recommendations on how governments, industry, and global health agencies can work more effectively together to increase access to medical oxygen to save lives now and prepare for the next pandemic.
“The Pandemic Fund is the first of its kind, multilateral platform dedicated to making investments in pandemic preparedness during “peacetime.”
Priya Basu from The World Bank explained how the Pandemic Fund is helping low- and middle-income countries finance pandemic preparedness. The first round of funding granted $US338 million to 37 countries, 75% low- and lower-middle. The second round will provide $US500 million with announcements expected on 21 October 2024. The first two rounds have a strong focus on funding One Health initiatives to prevent zoonotic spillover events and strengthen anti-microbial resistance (AMR) surveillance. Basu explained that the Pandemic Fund is considering different approaches to future funding rounds including possible rolling deadlines, periodic open calls for all eligible countries, and targeted calls for regional and sub-regional entities. It will be vital that these future funding rounds specifically call for respiratory pandemic-related initiatives. For example, a member of the audience, Dr Eric McCollum, raised the issue of pulse oximeters as respiratory pandemic surveillance tools that could detect spikes in hypoxemia and pointed to a current African trial of a new type of “surveillance-friendly” pulse oximeter with a sensor (rather than a probe that must be fixed to a person’s finger or toe). To help governments apply to the Pandemic Fund for medical oxygen-related initiatives, international NGO PATH released a briefing note with helpful guidance: Pandemic Fund Opportunities for Medical Oxygen and Pulse Oximetry Financing.
Finally, Nina Schwalbe from Spark Street Advisors, presented the state of play as the Intergovernmental Negotiating Body (INB) enters its final stage of negotiations for a Pandemic Agreement prior to the World Health Assembly in May 2024. Live from the INB meeting in Geneva, Schwalbe reiterated that the goal of the Pandemic Agreement is to create a legally binding instrument that strengthens global collaboration and equitable access to lifesaving tools to prevent, prepare for, and respond to, a pandemic. Highlighting several thorny issues with the negotiations, including pathogen access, benefit sharing, research and development conditionalities, financing, intellectual property, rights and waivers, and more, Schwalbe also decried the lack of independent monitoring and civil society involvement in the deliberations. With countries divided into several “negotiating blocs” (e.g., Group for Equity, Africa Group, Anti-sanction Group, Manufacturing Countries, and more), Schwalbe concluded that the jury was still out on a successful outcome from the negotiations.
The sobering conclusion of the first High Stakes Conversation was that the world is not ready for the next respiratory pandemic. National governments and global health agencies and their donors must pay closer attention to the high risks of respiratory pandemics and prioritize interventions that help the world prevent, prepare for, and respond to respiratory pathogens with pandemic potential. This will require greater investments in respiratory pathogen surveillance, rapid diagnostic tools that can identify respiratory infections and their consequences (hypoxemia), and a suite of more accessible and effective respiratory infection treatments (medical oxygen, new medicines, etc.,).
It is vital that the Pandemic Fund, the Global Oxygen Alliance (GO₂AL), the WHO Oxygen Resolution, the Lancet Global Health Oxygen Commission, and the final Pandemic Agreement lead in this area. Specifically, the third call of the Pandemic Fund should focus on respiratory pandemic prevention, preparedness, and response, and the GO₂AL should provide pandemic support to a subset of countries with the highest respiratory pandemic mortality risks and the weakest health systems. Implementation of the WHO Oxygen Resolution should pay close attention to respiratory pandemic-proofing health systems, and the Oxygen Commission should recommend ways governments can monitor their progress to protect their populations from a repeat of the devastating COVID experience. And the Pandemic Agreement should acknowledge the higher risks of further respiratory pandemics so that signatories understand how to prioritize investments for maximum protection.
You can watch the entire conversation here.
More information on the Pandemic Fund can be found here, including: Guidance Note, Electronic Application Portal, “How To…” video and FAQ, Scoring and Weighting Methodology, PDF application template, Information Session recordings and presentations, and Additional Questions. Please email: pandemicfundcfp@worldbank.org, and follow X/Twitter account @Pandemic_Fund.
High Stakes Conversation #1, April 2024