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Ending Covid-19 (Coronavirus): The Management of Public Market Cluster for Breaking the Community Transmission (Contamination) in Developing Worlds

Introduction

The developing worlds within the low- and middle-income countries, and even some areas of high-income countries, may represent more than 75% of the world population. The developing worlds don’t usually use the private markets (malls), but they use the public markets with different levels from a village market to a large city market. The low-income populations don’t usually have the fridges and freezers to store food for many days. They don’t even have money to buy food for many days. The population goes to the market daily in cities and once or twice a week in villages where the markets complement the family production. Meaning the market connects daily the cities populations and once or twice a week the village families. During the confinement, it is not possible to close the public markets for the reasons mentioned above. To end the Covid-19 pandemic the public market contamination or transmission cluster needs strategic, practical options and customized ways to prevent the contamination or transmission.

Engaging and Capacity Building of the Public Market Management

Having the public market management engaged to put in place the preventive measures is key. The entry door should be to build their capacity and confidence as well as their leadership. The capacity building should be customized to the specificity of the market including the users (sales and buyers). Many public markets are open spaces, without clear entrances and exits. Very few may have cameras to monitor the respect of the barrier’s preventive measures. Supervisors don’t have in their terms of reference and capacity to monitor the disease’s transmission. In fact, the Covid-19 programs should build it for Covid-19 but also for potential other epidemics or pandemics. 

Handwashing or Disinfection

Many public markets, especially the ones of the small cities and rural areas may not have the capacity to organize the public markets to have official entrances and exits as well as handwashing and disinfection stations. Even the public markets in bigger cities may be in that situation. For the disease’s prevention, in occurrence for ending the Covid-19 pandemic, the support should ensure the persons using the public markets can wash and sanitize the hands at the entrance and exits, and as necessary. It is an important contribution that may have a global impact considering the big number of people using the public markets and who connects more than 75% of the families around the world. In normal situations, hand washing prevents an average of 40% of diarrheas, especially of children.

Wear of Mask and Social Distancing

Having the public market’s users wear properly the mask and social distancing is necessary to end Covid-19 because to have the vaccination coverage level that can break the transmission (at least 60%) may take many years. Establishing a monitoring system of the proper port of mask and social distancing in each public market is important. The management of the public market should be supported in terms of skills, systems, and technologies to be able to sensibilize and monitor wearing the mask and social distancing.

Testing of Covid-19

The public market is a cluster that embraces communities, families, and individuals from different local, neighbor countries, regional and global areas. It is a composite cluster. Testing the users in all of them including confirming the variants may be an important factor in ending the Covid-19. 

Vaccination of Covid-19

The public market is a potential site that may bring the Covid-19 vaccination to the communities. The public market is central in terms of community life. To end the Covid-19, the vaccination should be part of this community life for acceptability and access.

Conclusion

The public markets in developing worlds within the low-middle and high-income countries have potential high impact to implement almost all the diseases prevention strategies and interventions, including handwashing and sanitizing, wearing the mask and social distancing, and vaccination for Covid-19.  

Dr. Claude Sekabaraga

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Covid-19 (Coronavirus)- Universal Testing for Breaking Community Transmission

Introduction

The Covid-19 (Coronavirus) is spreading in communities both urban and rural in many countries in the world. The confinement is not a sustainable option. It can help in the short-term, but it is not affordable economically and socially.
Currently, three options are the ones that can contribute effectively to break the Covid-19 transmission:
(i) Universal vaccination: It may take a minimum of 5 years for the world.
(ii) Universal testing: It may take one year if included in the global health systems.
(iii) Universal barrier methods (mask, hand washing, and social distancing): It may take one month if there is political and community engagement.

Universal Screening
The PCR test with high sensitivity and specificity is the one largely utilized by the global health systems. The PCR is not technically accessible, and it is expensive. When the Covid-19 was with travelers and few contacts, it was the preferable test. Currently, Covid-19 is spreading globally in the communities.

Moving forward to the rapid tests and serology tests may increase the access technically and financially. There are rapid and serology combo tests (antigen and antibody) tests that can detect early and chronic infection or asymptomatic carrier. The positive cases should be confirmed by the PCR. There are rapid tests that can be used by the health professionals and the ones can be used at home (community health workers or self-testing).

Universal screening both by the health professionals, community testing, and self-testing for the detection of early and chronic or asymptomatic infections have high potential (high impact) to breaking the community transmission when the universal vaccination is not yet possible.

Access to the testing
The regulatory bodies of the health laboratories (Ministries of Health, Food and Drugs Authorities, etc.) should accredit the Covid-19 tests, the official representatives of the manufacturers (storage, transport, etc.), as well as the services providers (hospitals, clinics, pharmacies, etc.). This is to ensure the quality is maintained at all levels.

As much as many tests, many distributors, and many services will be accredited, the accessibility will increase towards universal access to testing. The access to the community and self-tests will make a big move towards the breaking of the transmission.

Incentives to the testing
There is an opportunity to establish a direct linkage between the economy and social activities to the prevention. All activities should be authorized on the conditions to have all the persons concerned to be tested and use the barrier methods (mask, hand washing or sanitizing, and social distance). The risky places like the dancing clubs, cinemas, etc. should need PCR tests. For others like the open markets, etc. should need the rapid and serology tests especially the combo tests that include the antigen and antibody testing. The regulatory bodies should provide the details of how each test should be used (what, why, and how).

With the decentralization of the Covid-19 tests at the community and households’ levels and linkages between the testing and the economic and social activities, universal testing can be reached and contribute highly to breaking the transmission.

Financing the testing
By moving towards universal testing, the economy of scale should be considered for the pricing. Regulatory bodies should assess the market and standardize the prices across the tests with the same nature and costs. The insurances (travel and health especially) should include the Covid-19 tests in the benefit packages. The subsidies to low-income populations should be planned for ensuring the test will not be a catastrophic health expenditure factor.

Conclusion
The Covid-19 universal testing can allow global businesses to resume as per the past normal conditions before the universal vaccination will be possible.

Dr. Claude Sekabaraga

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Equitable and Sustainable Financing of Covid-19 Vaccination of Developing Countries

I. Introduction

The vaccination, including the vaccine, logistics, and healthcare administration, may cost an average of US$75 per person. The government tax to gross domestic products (GDP) per capita is 10-15% as the economy is 70-90% informal sector (not filing and paying the government tax). Before Covid-19, the GDPs per capita of most developing countries were US$500-US$1,000. With Covid-19, the GDP may be mostly below US$500 per capita. The tax to GDP (regular government budget source) is then US$50-75. Meaning the government of the developing countries should need to use almost 100% of the budget to finance Covid-19 vaccination. How to ensure vaccine availability and avoid financial barriers to Covid-19 vaccination?

II. Financing options

1. Covid-19 Vaccines Global Access (Covax) led by GAVI, WHO, UNICEF and CEPI

It is a great initiative but currently mobilizes less than 10% of the budget. The sources of financing are governments essentially, foundations and companies. With the global economic health crisis, it may be impossible to have the Covax mechanism cover more than 50% of the three-year needs. Which options to increase and sustain the financial capacity of the Covax mechanism? A small percentage added to the international flight tickets may provide sustainable contributions.  Covax should engage as possible the international travel organizations like International Air Transport Association (IATA) and similar and regulators.

The countries should use the purchasing power of the Covax mechanism to acquire cost-effective vaccines. It requires Covax to establish grants and paid vaccines for developing countries.

 2. National Covid-19 Vaccination Financing by Developing Countries

The fiscal space to accommodate the cost of the vaccines and related services doesn't almost exist. A small percentage of the telecommunication fee (used by more than 80% of the population, with easy payment collection) should contribute to financing the vaccination in a realistic, sustainable, and socially acceptable manner).

The persons with more than US$15,000 income a year (5-25%) may contribute using voluntarily paid vaccination facilities. It can be an opportunity of having cross-social economic categories indirect solidarity. It may help the businesspersons benefit with less waiting time, and some comforts already are paying for other services (accommodation, leisure, etc.).

III. Conclusion

The universal Covid-19 vaccination may be reached if both the Covax and developing countries' governments design sustainable financing mechanisms beyond the current funding grant-based. As GAVI slogan: "No one is safe until everyone is safe."  

Dr. Claude Sekabaraga, MD, MPH

Quality & Equity Healthcare

 

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Covid-19 (Coronavirus): International Authority for Epidemics of the United Nations Security Council (UN-AIE)

 Introduction

The Covid-19 pandemic shows us that epidemics constitute a major threat to global security (the world is really a village). Scientific and medical advice from international organizations such as the World Health Organization is accepted or not according to national politics. Mandatory joint action against a common risk is essential. It is the Security Council of the United Nations that has the mandate to compel states to take action towards global security.

Why?

Political and health leaders have assessments based on political ideologies, economic interests, and even culture. The last epidemics of SARS, Ebola, and now Covid-19 show us how the world can be seriously threatened at a very high level and even see entire populations seriously affected directly (disease) and indirectly (economy). When Covid-19 started in late 2019, no one knew that we are facing a pandemic that will paralyze the world (confinement of populations at home with important consequences like a rapid increase in unemployment and poverty). The world needs authority in addition to scientific and medical advice from organizations like the World Health Organization. These organizations will continue their role as advisers for evidence-based decision making.

How?

The United Nations Security Council creates an Agency of the International Authority for Epidemics (UN-IEA) with the mission of deciding what joint actions States must take to protect the world from the threat of an epidemic that is beginning. The UN-IEA will establish offices where it deems necessary (national or subnational level) to collect information with a view to making decisions for action to control an epidemic that is beginning. Action to control the epidemic to be implemented by a subnational, national, or international entity (Provinces, Regions, Federated States, Countries, Transport Companies, Airports, International Air Transport Agency, etc.).

Conclusion

As it is difficult to know whether an epidemic will remain local or will reach the whole world as Covid-19 has done, countries will have to lose their autonomy in the control of the epidemics.

The Security Council should meet urgently by teleconference to take joint actions to control Covid-19. Countries and States actions are not coordinated enough to be effective at the international level.

Dr. Claude Sekabaraga, MD, MPH