🧵1/ In a pandemic, we have two urgent interests: that life saving vaccines/ treatments be created, manufactured, & distributed, and that the disease be quickly contained/eliminated worldwide without a potentially catastrophic resurgence. #covid19
2/ The financial interests of pharmaceutical shareholders accord with our first interest, but not always with the second.

Product allocations go to the highest bidders, rather than to where need is greatest or the pandemic may be contained most effectively. @ThomasPogge
3/ The system as it stands is designed to fail, because public health is a secondary goal behind financial recuperation & explicitly financial profit

In a pandemic, it can’t be that way.

But I don’t need to tell you all this- you have been watching it unfold already. #covid19
4/ In our new @bmj_latest, Dr. Pogge & I explore what it looks like to re-structure pharmaceutical incentives creatively to ensure that the health needs of the world align w/ a model that drives pharma to actually create & deliver products regardless of a country’s ability to $
5/ This would be a funding mechanism *in addition* to the existing traditional patent-protected pathway; there is large market potential that actually can be aligned with getting impoverished populations access to life saving treatments/vaccines urgently. #covid19
6/ We have written about this as well previously in the context of #Ebola and #Zika virus over the past few years. That this has come up once again is no surprise - & guarantees we will run into the exact same issues again in the future w/ more pandemic prone diseases.
7/ As a point of ethics, I personally have hesitated to think that helping rich pharmaceutical companies get richer is the “right”way to go about this.

But- if the urgent needs of the poor will most effectively be met through the market, then we must figure out how to do it.
8/ Because what is unjustifiably “wrong” is to continue with the system as it currently stands.

With that, we should also continue our more urgent push to increase COVAX $$ as well as create a sustained program like PEPVAR (see recent NEJM piece ⬇️) #covid19

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More from @AbraarKaran

1 Apr
“While more than six million of the country’s 18 million people have been vaccinated, a surge in infections has left intensive-care units operating with few beds to spare and the system at a breaking point.” From Chile @nytimes

2/ “Dr. Francisca Crispi, a regional president of Chile’s medical association, said that 20 to 30 percent of medical professionals in the country had gone on leave because they are so exhausted.”
3/ “No one questions that the vaccination campaign is a success story,” she said. “But it conveyed a false sense of security to people, who felt that since we’re all being vaccinated the pandemic is over.”
Read 4 tweets
30 Mar
1/ Sharing new piece: we have learned a lot this year about the deficiencies of the ‘test,trace, isolate’ system, but it is still going to be needed to burn out the epidemic once case numbers are brought down further.

W/ @RanuDhillon
washingtonpost.com/outlook/2021/0… Image
2/ With most of the focus on 💉💉 right now (as it should be)— our other pandemic tools like Test, Trace, Isolate (TTI) have taken a backseat.

Yet, they are still crucial to stopping the #covid19 epidemic- but we need to do each of them better.
3/ Having this infrastructure in place will be essential for future infectious disease outbreaks/pandemics.

I expect TTI will become especially relevant again this summer to stop ongoing transmission chains once we have vaccinated a majority of country

Cc @cshea4 @PostOpinions
Read 4 tweets
29 Mar
Hoping for less deadly surges

1/ An important piece of the puzzle that some have pointed to: 49% of 65+ in our country have been *fully vaxx*; 73% have received at least 1 dose

We know age is single most significant risk factor in mortality. #covid19

2/ While proposed plans to simply isolate the elderly are largely unachievable/ not how societies fundamentally function-- what many of us do agree on is that vaccinating the elderly as a priority group is critical; and we are doing it well.

3/ With real world data from @CDCMMWR today showing significant protection even 2 weeks after just the 1st dose of mRNA vaccines, I am optimistic that we should see a further notable reduction in mortality even w/ subsequent #covid19 surges

Read 5 tweets
29 Mar
Excellent news from @CDCMMWR today!

Under real-world conditions, vaccine effectiveness of mRNA (Moderna, Pfizer) vaccines:
-90% after 2 doses
-80% after one dose (both measured 14 days after dose) #covid19

2/ "Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks."

Data collected from eight U.S. locations during December 14, 2020–March 13, 2021 #covid19
3/ "CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19–associated illness."

Gets at one of the biggest questions since the vaccines came out: extent of reduction in asymptomatic cases
Read 6 tweets
29 Mar
1/ The key bottleneck to scaling mRNA vaccines is a "worldwide shortage of essential components... nucleotides, enzymes, & lipids", according to this piece.

But...companies that can do this are not licensing their manufacturing so that others can join in nature.com/articles/d4158…
2/ So, once again, the issues we are facing are *man-made*

They are issues with how financial incentives overpower global health equity

There are ways that we could scale up more right now; but that won't happen because it threatens wealth

@gregggonsalves @PeterHotez
3/ These are complicated matters. But the system as it stands is not designed for health emergencies: it generates products (i.e. vaccines) for the few who can afford them; everyone else is subject to 'charity'

Even during a pandemic.
Read 4 tweets
28 Mar
1/ As I reflect on the arguments people have put forward regarding individual rights...

Those opposed to masks likely would *not be opposed* (before #covid9) to a restriction of someone coughing/sneezing in your face if they were sick

Yet, we know the logic here is the same
2/ With asymptomatic spread, it doesn’t take coughing/sneezing; it just takes talking/breathing in a public space near others to infect them

So- the rules of the game haven’t changed here

Your right to do certain things is still limited by how they harm other people
3/ Yet their seems to be a perception/misperception that having people wear a mask in public spaces during a respiratory pandemic is somehow a restriction on freedoms

It is not

It is a restriction against harming others

We were never free to do that #covid19
Read 5 tweets

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