Director of the Uganda Virus Research Institute (UVRI) and Director of MRC/UVRI and LSHTM Uganda Research Unit
COVID-19 has affected nearly the entire globe, with numerous countries in either lockdown or near lockdown. In most low- and middle-income countries (LMICs), infections are still low but they are rising. There is concern that if infections increase substantially, health systems may be quickly overwhelmed, due to limited health care facilities, human resources, personal protection equipment, clean water, and disinfectants. Vaccines and therapeutics are urgently needed to prevent the spread of the infection and treat and manage patients.
LMICs should not be left out of the global R&D effort. There is a strong scientific rationale for involvement, given the need to understand how diverse populations will respond to interventions. Environmental differences, including prevalent infections, nutrition, and genetic composition could affect responses, especially to vaccination.
Over the last 20 years, clinical testing for HIV, TB, malaria, and Ebola vaccines and therapeutics has developed capacity which can be rapidly transferred to pandemic response. High-functioning laboratories and clinical sites capable of conducting large scale trials and sample analysis are well established; regulatory structures and approaches have been bolstered; networks of research scientists have been established across the continent with linkages to major global health institutions; and strong ethical frameworks and community engagement structures have been established to engage and protect local communities. These networks and capacity stand ready to be engaged in the COVID-19 context.
That said, just as we prepared for HIV vaccine trials, there may be a need for vaccine preparedness studies to help ensure willingness and acceptability of trials, and to rapidly address any obstacles hindering clinical studies. Stakeholder engagement and protocols to participate in therapeutic trials such as WHO’s Solidarity program should be prepared well in advance. Populations must be guaranteed that trials will be conducted in a transparent manner and in consideration of ethical, legal, and human rights standards.
At the end of the day, no country will be spared by the COVID-19 epidemic – as such, we all must be part of the solution.