Adapting Public Health Efforts to a COVID-19 World

Like most aspects of life during COVID-19, global health programs have had to adapt. Task Force programs are deeply engaged in COVID-19 work while also continuing other health programs where possible and modifying operations that have been disrupted by the pandemic.

“In the same way that the HIV/AIDs epidemic changed the health infrastructure across Africa, this pandemic is becoming a catalyst for creating a coordinated effort to strengthen clinical and laboratory capacity now and to help ensure sustainable support beyond this pandemic,” said Lori Warrens, Director of the MedSurplus Alliance (MSA), a program within The Task Force’s health system strengthening sector that distributes medical products.

The pandemic has not only exposed weaknesses in health systems but has impacted routine services for other diseases and conditions, increasing the toll of the pandemic. From polio eradication efforts to tuberculosis, HIV, and malaria interventions, public health campaigns are being slowed and even halted due to COVID-19. Reducing services to at-risk communities and hindering efforts to control and eliminate preventable diseases, the pandemic is further increasing the gaps in health equity.

However, to ensure that health equity is not left behind, Task Force programs have pivoted to respond to the current impacts of COVID-19, strengthen systems for the future, and restart disease control and elimination efforts.

Adapting Today for a Greater Impact Tomorrow

MSA was ideally positioned for immediate COVID-19 response given its core mission to improve healthcare facilities’ access to quality medical products, both in  low-income countries and in US communities. MSA-accredited Medical Surplus Recovery Organizations (MSROs) have donated more than 9 million items of quality personal protective equipment (PPE) across the U.S. and the world.

Producing, finding, and delivering PPE to health facilities on this scale has been challenging. Warrens noted that the pandemic has highlighted areas needing improvement in the medical supplies and equipment supply chain to make it more resilient, internationally and domestically, for the remainder of this crisis, as well as in the future. For example, some hospitals that previously donated materials to MSROs realized that they were in need of materials themselves and received donations from MSROs, prompting MSA to find ways to make the supply chain bi-directional.

Demand has also led the MSA network to expand its reach beyond hospitals and clinics. Now, the network includes laboratories and clinical research sites, building point-of-care testing capacity with products that support quality testing and improve efficiency of testing services by preventing supply stockouts.

“Laboratories are a new area for MSA to support,” said Warrens, “and I’m inspired by how our hospital and pharmaceutical company donors are working with MSA to develop models that shift and surge healthcare response faster to where it is needed while maintaining quality standards.”

MSROs historically serve communities without access to basic health services and supplies. Soon, this could include an estimated 10 million Americans who are under threat of losing their health insurance due to unemployment. MSROs like Dispensary of Hope and Rx Outreach have expanded their operations and outreach efforts to provide essential medications to patients who have lost insurance or income due to COVID-19. Dispensary of Hope’s dispensing sites and Rx Outreach’s online mail-order pharmacy provides accessible and affordable access to essential medicines in all 50 states.

“We know that every order of medication that we deliver belongs to a patient that might otherwise go without,” said Dispensary of Hope CEO Chris Palombo. “So we knew that we had to find a way to protect ourselves and our communities from COVID-19 while also maintaining the stability and continuity of our work, and that’s exactly what we’re doing.”

Mitigating the impact

One of the collateral impacts of COVID-19 has been the disruption of other disease control and elimination efforts. Task Force programs on neglected tropical diseases (NTDs) like river blindness and trachoma, altered operations in line with the World Health Organization’s (WHO) guidelines to halt NTD health campaigns due to social distancing requirements. In response, The Task Force’s newest program, the Health Campaign Effectiveness Coalition, is tracking the impact of COVID-19 on health campaigns around the world, including those for NTDs.

Recently, the WHO issued new guidance on resuming health campaigns specific to NTDs – such as mass drug administration, active case finding, and population-based surveys – in the context of COVID-19. The Task Force’s NTD Support Center is working with the WHO, implementing partners, and social scientists to develop an evaluation protocol to help countries monitor the safety of resuming health campaigns and to guide efforts to improve safety and effectiveness as they strive to adhere to those guidelines.

The Task Force’s Polio Eradication Surge Capacity Support Team paused its activities and retargeted some of their expertise to address COVID-19 when polio vaccination campaigns were paused earlier this year. As campaigns are resuming, polio vaccination teams and ministries of health are planning the rollout of a novel oral polio vaccine called nOPV2 that provides comparable protection against poliovirus, with a marked decrease in the risk for paralysis, while also reducing the risk of spreading additional outbreaks of vaccine-derived poliovirus. The Surge team is pivoting its activities to provide remote technical assistance in preparing vaccination teams for distribution of this new vaccine and developing guidance for how best to conduct the rollout within the additional pandemic safety precautions.

Preparing for flu season

Another public health challenge that will test already-stretched health systems is the upcoming flu season. The Task Force’s Partnership for Influenza Vaccine Introduction (PIVI) works with country partners, ministries of health and technical partners like the WHO to create seasonal influenza programs in low- and middle-income countries. PIVI helps countries like Lao PDR, Mongolia and Albania prepare for seasonal influenza and other pandemic and epidemic threats through readiness assessments, as well as logistics and planning for vaccine delivery.

Influenza program infrastructure, like that built through PIVI, has proven to be critical to national and global response efforts during the coronavirus pandemic. Because influenza will co-circulate with COVID-19 in the upcoming influenza season, PIVI will continue to work with countries to increase influenza vaccination. Additionally, with supplemental funding from the Centers for Disease Control and Prevention, PIVI will tailor current support tools and technical assistance to aid pandemic response as countries prepare to deploy and evaluate COVID-19 vaccines when ready.

As the global health landscape and the current pandemic evolves, The Task Force and our partners will continue to tailor our expertise and programs to protect and empower the people with whom we work.

Header photo: Vaccination teams administer polio vaccinations to children. During the COVID-19 pandemic, polio vaccination teams are following special guidelines to ensure the safety of all participants. Photo courtesy of Malaysia Epidemic Intelligence Program.

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