Philip Dunton: “India’s oxygen crisis could spread to East Africa” ​​| Future planet

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According to the World Health Organization, half a million people need medical oxygen daily. More than a million bottles are needed every day. Govt-19 epidemic has increased one of the simplest and most complex requirements of health systems. Even before the global health crisis, it was one of the main tools for treating, for example, the most dangerous infectious disease in the world, It claims the lives of 800,000 children annually: pneumonia.

Dr. Philippe Dunton attends an interview at UNITAID headquarters in WHO, Geneva. Unidoid was created in 2006 to accelerate access to the prevention, diagnosis and treatment of diseases such as HIV-AIDS, malaria and tuberculosis, as well as other co-infections. With innovative financial models, it has the support of many countries such as France, Brazil, the United Kingdom, Chile and Spain in addition to the Bill and Melinda Gates Foundation. Currently, the organization is providing its experience to meet the needs of Govt-19 in countries with limited resources, and is a partner of the Group. Accelerate access to tools against COVID-19 (ACT). One message that Dr. Dunetton makes clear is that access depends on placing vision and decision-making power “in the hands of the affected people.”

Question. UNITAID was developed to treat three major diseases: AIDS, malaria and tuberculosis. Now, oxygen?

Answer. Before the epidemic, UNITAID has expanded its horizons Work beyond what is strictly associated with the three diseases. For example, we face maternal and child health challenges or support access to child formulas. But we still had to do. For this reason, we are interested in accessing childhood pneumonia and oxygen, which is both a simple and complex matter at the same time. We saw the need to act because it was the demand of the people we worked with.

B. Why is it so simple and complex at the same time?

R. We know that access to oxygen was an important requirement even before the outbreak, and now it is increasing. However, very few countries had national plans or strategies for sustainable access. This is not a priority or not invested enough. The complexity of accessing oxygen It lives on three basic factors: sources of production (there are different types globally and can also be used locally); This will become an issue if the country does not have adequate logistics capacity for distribution; And the ability of technicians and personnel to utilize medical oxygen. It may seem simple, but when you have an emergency, the access situation becomes more complicated when you reach everyone.

B. Is there a key to strengthening health systems?

R. In global health, we often repeat that phrase a lot, but it is useless if power and skills are not in the hands of the people, in the most affected areas and with the least resources.

B. Picture of People want to breathe, In India, it has raised all the alarms. It is also the country with the highest oxygen production capacity.

R. Undoubtedly. Any health system is weakened when there is an increase in cases. This gives us an idea of ​​the problem with accessing oxygen. But there is no single solution, and there is no country that can have the virus automatically. In India, for example, they face great difficulties despite having a large industrial oxygen production capacity. That ability can be converted to medical oxygen production, which is not easy, but it can be done. Once reached, there is the challenge of distribution. The complex of oxygen requires all the components: the health system capable of producing, distributing and using it.

B. The WHO recently estimated that about $ 90 million ($ 73 million) is urgently needed to address the oxygen crisis in 20 low- and middle-income countries. Worldwide, demand is $ 1,600 million (1, 1,300 million). What does UNITAID do in response to this appeal?

R. United and Wellcome have provided the first installment of $ 20 million (, 16,450,400 million) to under-resourced countries. But the effectiveness of such assistance depends not only on funding, but also on integrated and collaborative work. Covit-19 has $ 3,700 million (3,000 3,000 million) in a global fund to go to the global emergency, and of course more funding will be available. But in addition to infrastructure, investment and human resources, space must be provided in which the need is determined and developed by the affected people and countries. That is why we help countries in assessing needs and embracing responses. India’s situation could extend to Pakistan or Bangladesh and East Africa, as it is an area with multiple contacts with countries such as Ethiopia or Kenya. We also need to look at what is happening in Latin America. We have seen the most severe situations in Brazil Or in Peru, For example.

In addition to infrastructure, investment and human resources, space must be provided in which the need is determined and developed by the affected people and countries.

B. Do you think the priority focus placed on vaccines has reduced resources and efforts to access oxygen?

R. Vaccines are not enough. Current tools against infection cannot be used in isolation. This is an extensive fight. Preventive measures, case diagnosis and care, as well as immunization or medical care for victims are part of that. The first level response is to stop or reduce the transmission and to go hand in hand with access to vaccines. This struggle must be done globally, while at the same time being suitable for every country.

B. For individuals in need of medical treatment, are the current tools adequate?

R. What has been shown in these months is that by accessing oxygen, corticosteroids and anticoagulants, death from covit-19 can be approximately halved. These are simple tools and all countries should guarantee access to them.

B. What do you need now?

R. We need to progress beyond the virus, not behind. We need treatments to cure it or stop it before its progression worsens. We do not have them yet. We hope to have antiviruses by the end of the year and they will work with most variants. This will help a lot to avoid deterioration of patients and deterioration of health systems. We must make sure that we have manufacturing solutions for all the countries in need in Africa. Without losing focus in Asia and Latin America.

B. Considering what is happening in India and the problem associated with access to oxygen, do you not think that all this can motivate potential financial providers?

R. No, because if you invest in helping access to oxygen, you will not regret it. The infection will pass, but the need for oxygen will not stop. It is necessary to give a few examples of serious health problems such as pneumonia, tuberculosis or postpartum hemorrhage.

We shift the focus: from the most technical and scientific point of view (including the hospital), to management at the community level

B. As a physician with 25 years of experience in the field of infectious diseases, do you have any past experiences that have helped you deal with the epidemic?

R. I started as a doctor when I was infected with HIV. People my age, at the time, were dying and we had no treatment. With the arrival of the first news about antiretrovirals (ARVs) in 1996, we moved on to the next challenge, which is access. I was part of the team at the first treatment access center in Tucker. Teaching then was the same as it is now: we need new tools, but they need to be accessible, so it is in the hands of people in countries where skills are needed. We shifted the focus: from a more technical and scientific perspective (including the hospital), to management at the community level.

B. What results will you get from this focus shift?

R. For example, in places where there are no health facilities, people should bring diagnostic tests that they can do on their own. Or reduce treatment doses to facilitate access and adherence. When we started with ARVs on HIV, sometimes we had to give up to 24 pills a day per person, which was already difficult even in developed countries. Making it as easy as one pill a day made a difference. This means thinking not only from health systems and people, but also from people and people. Solutions that can be implemented at decentralized levels.

Fighting is important, but so is the spirit with which we fight

B. What is the added value that the UNITAID task model brings?

R. We work with solutions that work for hundreds of millions of people affected by HIV, malaria or tuberculosis, as well as co-infections and comorbidities such as cervical cancer or hepatitis C. We seek to expedite responses to the prevention, diagnosis and treatment of diseases with global funding and with us alienated from the most affected countries. We supported the diagnosis of early cervical cancer and the finding of quick, inexpensive and highly effective solutions such as a treatment model for less than a dollar per woman. In public health, a small investment can bring massive benefits. Now, we use our experience in responding to the challenges of new treatments and diagnoses for infection. But most of all, it’s about finding people who are most willing to help around the world. It gives you hope. Fighting is important, but so is the spirit in which we fight.

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