2020 ELECTION SERIES: THE NEXT PRESIDENT NEEDS TO THINK GLOBALLY ABOUT COVID-19

BY THOMAS J. COATES

I joined the University of California, San Francisco faculty 38 years ago in 1982 when that city was ground zero for the HIV-1 epidemic. I had no choice but to get involved, both personally and professionally. I have devoted my entire professional career to research in HIV prevention, here in the United States and in Africa, Latin America, and Asia.

The international response to HIV-1 teaches us important lessons about what America needs to do globally for COVID-19. Both viruses share in common the fact that they are worldwide pandemics transmitted across borders and affecting low- to high-income countries alike.

I was diagnosed with HIV-1 in 1985. I am alive today the age of 75 because the United States joined forces with other countries and pharmaceutical companies, to develop and deliver therapies that require one or two pills per day to completely suppress HIV-1 so that the virus is not attacking my body and I cannot transmit it to other people.

The reaction is universal when I tell people that my research in HIV-1 is focused in southern Africa. Many will sympathize with me and tell me that this work must be terribly difficult and hard. My response is immediate. The work is gratifying and hopeful because the United States, other high-income countries and international agencies work together so that everyone in the world, no matter where they live, has access to live-saving HIV medications and prevention technologies. There were 38 million people living with HIV in 2019; 81 percent of them knew that they had HIV and 67 percent of them were accessing treatment. An astounding 85 percent of pregnant women living with HIV had access to HIV medicines to prevent transmission of HIV to their child.

President George W. Bush, with strong congressional bipartisan support, launched the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 to help countries hardest hit by HIV. PEPFAR has provided more than $80 billion in cumulative funding for HIV/AIDS treatment, prevention, and research. The United States worked with everyone else in the world to ensure that developments in science resulted in access to diagnostics and care that would be made available to people all over the world, not only those living in the United States or other high-income countries.

International collaboration and cooperation resulted in the eradication of smallpox and will do the same for polio. Multilateral health collaborations provide a clear roadmap for COVID-19.

International collaboration and cooperation resulted in the eradication of smallpox and will do the same for polio. GAVI—the Global Alliance for Vaccines and Immunizations—was created with the goal of increasing access to immunization in poor countries. Major funders have been the UK, the Bill and Melinda Gates Foundation, the United States, and Norway. The impact has been phenomenal with over 800 million children immunized and 85 percent of the world’s children reached by routine immunization.

Multilateral health collaborations provide a clear roadmap for COVID-19. The world can achieve great health successes when the countries of the world come together with the international agencies to collaborate scientifically to ensure that we have the tools to combat serious diseases. But having the tools is not enough. The tools need to be deployed all around the world to low-, middle-, and high-income countries alike.

Why? The first reason is to protect the public health. Pandemics never stop at international borders. This is true of all of the pandemics in recent history including HIV-1 but also H1N1, Zika, Ebola, and now COVID-19.

The second reason derives from “global health diplomacy,” bringing together government, industry, and philanthropy to develop and implement sustainable solutions to improve global health. An example is The Global Fund to Fight HIV, TB, and Malaria, launched under the leadership of UN Secretary General Kofi Annan in 2001 and endorsed by the UN General Assembly. Initial and continuing funding has come from the G-8, with the largest contributions coming from the United States, France, the UK, Germany, and Japan but also Sweden, Norway, the Netherlands, and Spain. Substantial funding also came from philanthropy as well as Project Red.

The third reason is humanitarian. President George W. Bush, writing in the Washington Post on April 7, 2017, about his and Mrs. Bush’s Pink Ribbon Red Ribbon campaign to address cervical cancer, said: “It is clear that the generosity of the American people has had a huge impact—one that reflects the view that all lives are precious and to whom much is given, much is required….When we confront suffering—when we save lives—we breathe hope into devastated populations, strengthen and stabilize society, and make our country and world safer.”

The United States’ record for working globally and collaboratively is the perfect roadmap for the next president to follow in addressing COVID-19. What are the steps?

• The next president needs to embrace and work closely and collaboratively with the World Health Organization (WHO) and the other UN agencies battling COVID-19 and all of its consequences. President Trump announced, on May 29, 2020, that the United States would terminate its relationship with the WHO. No one would argue that the WHO is a perfect organization, but it is governed by the health ministers of the member countries and is highly respected all around the world. It is the place where the world comes together, decides priorities, and engages in strategic action together.

• The next president needs to commit funding to the collective WHO’s Strategic Preparedness and Response Plan which includes providing personal protective equipment (PPE) to low- and middle-income countries, supporting therapeutic and vaccine trials in all counties, strengthening laboratory and biomedical capacity, providing technical assistance and training for in-country personnel, and combatting misinformation globally. Partners in this effort include most of the countries of the world but also international agencies such as the International Chamber of Commerce, the World Economic Forum, the World Trade Organization, and others.

• The next president needs to commit to the WHO COVID-19 vaccine distribution plan, rather than buying up and hoarding all available supplies of an effective vaccine. The WHO Director-General put it succinctly on September 15, 2020: “The first priority must be to vaccinate some people in all countries, rather than all of the people in some countries….Vaccine nationalism will prolong the pandemic, not shorten it.” A total of 78 wealthier countries have endorsed the program and 170 nations intend to participate. The United States is not now one of them.

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, put it well in his opening remarks at the September 28, 2020, media briefing on COVID-19: “If we act together, we will win together.” The next president of the United States must help to make the U.S. part of the solution, and not continue to have the United States be part of the problem.

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Thomas J. Coates, PhD, is a Pacific Council member, a Distinguished Research Professor of Medicine at the UCLA David Geffen School of Medicine, and the director of the University of California’s Global Health Institute.

The views and opinions expressed here are those of the author and do not necessarily reflect the official policy or position of the Pacific Council.