DNDi Aims for Equity in COVID-19 Treatment Research


MILWAUKEE, Wisconsin — As of August 13, 2021, there have been 205,338,159 confirmed cases of COVID-19 worldwide and more than four million deaths. But, with nearly 4.5 billion vaccine doses administered across the globe already, a reason for hope remains. Furthermore, important research continues. While vaccines act as a huge step forward, they are not the only solution to defeating the pandemic. COVID-19 treatment research, especially research that acknowledges the different challenges to health equity the virus poses, is pivotal to supporting the health of people everywhere.

The Need for Every Tool

Despite the efforts by collaborations like COVAX to ensure equitable vaccine distribution, drastic differences in vaccination rates persist from country to country and continent to continent. August 31, 2021 data shows that North America has been able to administer 94.13 vaccine doses per 100 people. Africa, on the other hand, has only administered 7.53 doses per 100 people, largely due to lack of access.

Other barriers to vaccination among low-income countries include medical resource scarcity and lack of healthcare workers, both to administer vaccines and to take care of sick patients. In February 2021, as Western nations aimed for complete vaccine coverage by the middle or end of the year, African leaders hoped to vaccinate 35% of their populations in the same time frame.

As significant global attention turns to the prevention of COVID-19 by way of immunization, it is important to remember vital and ongoing work that seeks to identify ways to treat the disease. The value of COVID-19 treatment research diminishes in wealthy countries as they vaccinate greater portions of their people. The same cannot be said for countries that have only been able to administer relatively few doses. Perhaps even more importantly, no vaccine confers complete immunity, not every person eligible for vaccination can or will be vaccinated and the protection offered by vaccines does not continue indefinitely.

With these considerations in mind, The Borgen Project recently spoke with Rachel Cohen about ANTICOV, a large-scale medical trial coordinated by the Drugs for Neglected Diseases Initiative (DNDi). Cohen has held numerous roles advocating for global health and health equity and has served as the Regional Executive Director of DNDi North America for the last 10 years.

About the Drugs for Neglected Diseases Initiative

DNDi exists as a research and development organization that works to ensure sustainability. It intends to develop 25 treatments by 2028 to specifically help neglected patients. It has already developed nine such treatments targeting six of the world’s neglected diseases since its inception in 2003. DNDi is a formidable force in global health equity and advocates for policy that reflects the prioritization of health equity.

DNDi’s most recent and promising effort is the ANTICOV trial, which began in November of 2020. In recognition of the need to consider varied drug effectiveness across communities and to avoid giving exclusive research attention to vaccines, this trial investigates drug treatments specifically for mild-to-moderate cases of COVID-19.

The trial’s work spans 13 African countries, 19 sites and includes 26 research and development organizations. Research efforts hope to identify as many safe and efficacious drug candidates as possible to prevent severe illness. At the same time, ANTICOV prioritizes affordability and feasibility in order to successfully distribute to low-income communities.

As Cohen put it, “It was our instinct right away to […] help form a coalition […] with a number of research institutions […] to push for the acceleration of research and development in low-and-middle-income countries broadly and to push for sharing of research knowledge and data as well as advocacy for equity and access to health technologies.”

The ANTICOV Approach

Taking into account the factors influencing treatment utilization in low-income communities, ANTICOV operates based on Target Product Profiles. This method allows researchers to lay out their ideal specifications for each treatment being studied, including the cost, method of administration, tolerable side effects and so on. DNDi uses these profiles to reduce the risk of finding an efficacious treatment that cannot realistically be provided due to limited resources or other factors at play in low-income regions.

“[The idea behind Target Product Profiles] is totally ingrained in the logic of our organization as a whole […] There is no point in a sort of medical innovation if it doesn’t ultimately change medical practice […] and they change medical practice if there’s equitable access to that technology or that tool,” Cohen shared.

Furthermore, by researching drugs effective in treating mild-to-moderate cases and preventing progression to severe infection, the ANTICOV trial also has the potential to address other factors regarding healthcare infrastructure. This could include the practitioner shortages and limited intensive care capacities often prevalent in low-income areas.

Despite the many organizations and communities involved in ANTICOV, the importance of community engagement remains a priority. Each of the 19 research sites operates its own engagement plan through collaboration with community leaders, civil society organizations and more. This is in addition to consultation with global experts, like those at WHO, and larger regional community engagement efforts.

Looking Ahead

Cohen’s sentiment to work for the sake of all, regardless of economic or social situation, echoes that of many other experts and organizations worldwide. It is also accompanied by hope for additional support from other global actors, including the United States government, USAID and the National Institutes of Health. United, concentrated efforts on such a scale could significantly benefit COVID-19 treatment research. “We’re trying to make sure that we’re coordinating very well with all the different players on the research side, first of all, to reduce duplication, but also to speed […] the entire process of research,” Cohen said.

As access to COVID-19 vaccines remains a challenge in the months and years ahead, efforts such as the ANTICOV trial will be pivotal in providing safe, effective and affordable care to people across the globe.

Amy Perkins
Photo: Flickr


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