Providing appropriate, timely, and effective treatment for people with severe COVID-19 is critical in saving lives. But access to lifesaving COVID-19 treatment was one of the earliest challenges during the pandemic and remains difficult in the Pacific. Progress has been made to bring these treatment options to people who need them the most, through the leadership of Pacific ministries of health and in collaboration with local and international partners. Here are four things you should know about COVID-19 treatment in the Pacific.
1. A variety of COVID-19 treatment options are being used in the Pacific
At the start of the pandemic, there was no specific treatment available for COVID-19. Scientists around the world worked doubly hard to develop new treatments, while health workers used existing treatment options to ease symptoms. A variety of treatment options are now available, and they work in different ways. To understand how they work, first we must know how COVID-19 affects those infected with severe to critical disease.
People with severe COVID-19 are more likely to produce cytokines, which help regulate the body’s immunity and stop viruses from reproducing. But sometimes the body’s immune system overreacts to viral infections by producing too many cytokines – known as the cytokine storm. This can create excessive inflammation which can be fatal. Other known serious symptoms of severe COVID-19 are blood clotting and respiratory distress. When these severe symptoms occur, there are several treatment options available:
- Oxygen is a life-saving essential medicine used to treat patients who have low levels of oxygen in their body. Oxygen therapy is used to treat COVID-19 patients to normalize their oxygen levels. Medical oxygen is usually delivered to the lungs via a tube that goes in through the nose or a mask covering the patient’s nose and mouth.
- Corticosteroids are medicines used to treat inflammation. In COVID-19 patient care, corticosteroids like dexamethasone are recommended for patients with severe or critical COVID-19 to treat excessive inflammation.
- Interleukin-6 receptor (IL-6) blockers are medicines that suppress the immune system’s overreaction that leads to a cytokine storm. IL-6 blockers like tocilizumab or sarilumab, in conjunction with corticosteroids, are recommended for patients with severe or critical COVID-19.
- Oral antivirals are medicines that fight against viral diseases. For COVID-19, specific antivirals are now available, such as molnupiravir and nirmatrelvir/ritonavir, which help prevent the SARS-CoV-2 virus from replicating in the body.
- Anticoagulants, also known as blood thinners, are medicines used to prevent blood clots. The anticoagulant heparin is recommended for hospitalized patients with COVID-19 since they are more susceptible to blood clots.
Detailed information about these treatment options and more are available in the Therapeutics and COVID-19: living guideline and Clinical management of COVID-19: Living guideline developed by the World Health Organization (WHO).
2. Access to some of these treatments is still a challenge in the Pacific
The small population size of many Pacific island countries and areas (PICs) sometimes puts them at a disadvantage. Some of these treatment products are only available to be purchased from manufacturers in large quantities which may exceed the needs of a small island country and push up the cost per usable dose. In addition, given that supplies of products like IL-6 blockers tocilizumab and sarilumab as well as antivirals molnupiravir and nirmatrelvir/ritonavir have been limited due to manufacturing constraints and other issues, larger countries with greater purchasing power have sometimes been prioritized.
These medicines are developed outside of the Pacific, which means that it is costly to ship them to PICs while maintaining the right temperature, especially for injectable medicines like tocilizumab. Distributing these treatments within country is difficult as well, particularly to remote locations like in outer islands or the highlands.
Through the Access to COVID-19 Tools (ACT) Accelerator initiative, WHO is working with partners to overcome inequities in access to COVID-19 treatments. At the start of 2022, only a few countries had access to COVID-19 treatments. However, these life-saving tools are now becoming increasingly available in the Pacific.
WHO’s Director of Pacific Technical Support Dr Mark Jacobs (left) and WHO staff Adrian Chand (right) inspect the medicines, oxygen concentrators and other medical supplies stored at a warehouse in Nadi, Suva, that will be delivered to neighbouring Pacific island countries. Photo: WHO/Jason Chute
3. WHO and partners are working together to make these treatments more widely available
WHO, with support from partners such as the European Union and the United States, is scaling up access to existing and new treatments in some Pacific island countries through the global ACT initiative. WHO procured and delivered over 700,000 units of medicines like dexamethasone and tocilizumab to American Samoa, Fiji, Kiribati, Marshall Islands, Federated States of Micronesia, Nauru, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu, while other medicines like molnupiravir and nirmatrelvir/ritonavir are currently being procured as well.
WHO has also been working to support access to medical oxygen across the Pacific since the pandemic began in 2020. The Organization has provided more than 65,000 units of equipment and supplies related to medical oxygen including portable ventilators, portable oxygen concentrators, oxygen masks and nasal cannulas, thanks to donations from Australia, Germany, India, and the United Kingdom. In addition, WHO, with funding from the European Union, France, and Germany, is supporting better access to quality medical oxygen by setting up oxygen-generating plants in Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Samoa, Solomon Islands, Tonga, and Vanuatu.
To help health workers across the Pacific use these treatment options safely and effectively, WHO, through the Division of Pacific Technical Support and its country offices in the Pacific, has also worked closely with ministries of health and local partners to build technical knowledge and capacities. This includes support for planning and needs assessment, local adaptation of clinical care guidelines, training of healthcare professionals, and development of tools to determine what treatments to use and to prioritize patients.
In addition, given that many Pacific island countries and areas have no formal government body responsible for reviewing and approving new medicines, WHO has supported countries to review the scientific evidence and to navigate the regulatory approval process required to import and introduce new COVID-19 treatments.
WHO Vanuatu Country Liaison Officer Dr Eunyoung Ko hands over 16,000 units of tocilizumab to the Ministry of Health. Photo: WHO
4. These treatments are safe and are being monitored regularly
Some of the treatments that already existed pre-pandemic have been in clinical use for a long time and are known to be safe. As for the new COVID-19 treatments that are now being rolled out in countries, though they may have been developed rapidly, they went through all the steps of the usual rigorous process (such as randomized controlled trials), just in a shortened period of time.
Following a review of the evidence by a group of independent global experts, WHO has approved these medicines and granted them emergency use listing. Similarly, leading authorities like the US Food and Drug Administration, European Medicines Agency, Australia’s Therapeutic Goods Administration, and New Zealand’s Medicines and Medical Devices Safety Authority have signed off on their safety and effectiveness.
Available data suggest that newly introduced COVID-19 treatments are generally well-received by patients who need them, with minimal to no side effects. However, since the efficacy and safety of existing and new treatments have not been observed for long-term use in treating COVID-19, WHO is helping countries to monitor the use of these medicines over time. WHO also continuously collects new evidence from randomized control trials and other research studies for existing and new treatments for COVID-19 and brings together global experts through the WHO Guideline Development Group (GDG) to review the latest scientific evidence and develop recommendations for clinical use. These recommendations are published in the Therapeutics and COVID-19: living guideline and Living guidance for clinical management of COVID-19.
WHO will continue supporting the Pacific in improving and strengthening drug safety and quality assurance of medicines, safety monitoring, and providing continuous technical guidance and training tailored to country needs and clinical practice. A “Regulatory Platform for Pacific Island Countries” website that facilitates information-sharing on the regulation of medicines, including treatments for COVID-19, is under development and is expected to be available to Pacific island countries and areas by the end of this year. This platform will allow clinicians and healthcare professionals working in PICs to have ongoing access to the latest information on medicines, their safety and effectiveness.