Hazar Imam stressed that the most urgent priority was to ensure the safety and well-being of the Jamat and the global AKDN workforce, and also, where possible, that of the broader constituencies served. This would involve rapid response measures both to delay the spread of the virus and to prepare AKDN and public health-care institutions for dramatically higher volumes of patients.
As infections soared, the Global Task Force appointed two committees to advise the institutions’ response, one for testing, another for vaccines and therapeutics.
“We had to put in place testing capacity; we wanted to keep an eye on all the vaccines being developed; we needed to know what to do when patients’ symptoms worsened; and on top of this the enormous inflow of information as well as disinformation about Covid-19 had become quite disturbing,” said Dr Gijs Walraven, AKDN’s Director for Health and General Manager of the Aga Khan Health Services (AKHS), and one of four members of the Steering Committee overseeing the global Covid response. “These technical committees have been providing important advice to the AKDN health agencies and Jamati leadership everywhere, but especially for the geographies where we need it most.”
These geographies include Central Asia, South Asia, Syria, and East Africa. Like many of the world’s richest nations, AKDN’s 22 hospitals and almost 800 health centres in these regions had very limited testing capacity or personal protective equipment (PPE – gloves, medical face masks, gowns) when the virus reached their shores. While high-income countries mobilised to secure the necessary equipment and supplies, low- and middle-income countries faced additional challenges including fragile health systems especially in rural and remote areas, limited capacity in high-dependency and intensive care beds for severe and critical patients, and shortages not only in equipment and supplies, but also in human and financial resources. In coming months, there may also be inequity in access to safe and effective Covid-19 vaccines, with the poorest likely to be the last in line to receive the vaccine.
Testing
In April 2020, Professor Elnasir Lalani, Founding Director of the Aga Khan University (AKU) Centre for Regenerative Medicine and Stem Cell Research, Professor of Stem Cell Biology and Translational Medicine, and Professor of Molecular and Cellular Pathology, prepared a report for the Global Task Force on the types of Covid-19 tests available and approved under Emergency Use Authorisation by the US Food and Drug Administration (FDA), testing options, specialised equipment and facilities required, and recommendations on how to move forward.
The Global Task Force created the Testing Subcommittee in May 2020 and appointed members from across three continents with Professor Lalani as its Chair. The subcommittee began assessing the status of laboratories, trained personnel and testing across AKU hospitals and AKHS sites in order to develop essential testing capacity which the Jamat and surrounding communities could access.
"The only place with testing capacity was the AKU hospital in Karachi," said Professor Lalani. "In May 2020, AKUH Nairobi and AKHS Dar-es-Salaam began to order Covid-19 test kits and equipment, so they acted as pilot projects on building testing capacities such as trained personnel, laboratory infrastructure, and validation of tests in different countries. Based on those projects, we decided to set up a hub-and-spoke model for each country, whereby testing samples from the major cities are sent to the hub for processing."
Laboratory facilities are now being developed at hub sites to administer RT-PCR testing, the Gold-Standard of tests. Now, 14 are operational, and all countries with AKU and AKHS presence have fully functional and equipped labs to undertake Covid-19 RT-PCR Testing.
"As a committee, we have been engaging during most of 2020 remotely most days of the week with highly dedicated and knowledgeable colleagues on the ground, on designing and equipping an internationally accredited molecular pathology laboratory; identifying appropriate FDA approved Covid-19 testing kits; training of laboratory personal; supply chain and other related matters,” said Professor Lalani. “This has been a mutually rewarding exercise. The hospitals will utilise these laboratories for many other diagnostic tests, they are the way forward in terms of diagnostics.”
Vaccines and therapeutics
Dr Mirza Kajani leads the Vaccines and Therapeutics Subcommittee. He was previously chairman of the National Health Board in the USA, and before that, president of the Ismaili Health Professionals Association, which AKHS and AKU have called on for the past decade or more to recruit teams to areas in which they need expertise around the world.
The Vaccines and Therapeutics Subcommittee was established in June 2020 with 12 members. Most are academics, but the group also includes clinical, pharmaceutical, NGO, and AKDN purchasing committee representatives. The subcommittee has grown to 20 people as the scope has expanded, from being a vaccine and therapeutics evaluation team to a vaccine access team and vaccine trial capacity-building team. The efforts extend through all four drug research and development phases (i – small safety trials early on in a drug's development; ii – medium-sized trials for both safety and efficacy; iii – large trials; iv – large, post-marketing trials, typically for safety reasons). The subcommittee has focused its review and recommendations based on peer reviewed published literature in an effort to provide evidence-based recommendations.
“You need enough expertise all the way through to the last mile and beyond,” said Dr Kajani. “Vaccine developers do not always share their data, so how do we understand their efficacy and safety? If a vaccine isn’t effective for our context, how will we monitor this? If a country is forced to accept a vaccine, what do you do? The new Corona or SARS-Cov 2 virus is not going away and with the circulation of new strains it is likely that booster vaccines may be required annually, and this will need continuing assessments ” Dr Kajani said.
The subcommittee is working hard to bring Phase 3 trials of vaccine candidates to AKDN institutions for evaluation.
“Whenever you bring a vaccine candidate for research to a country, you are better able to evaluate its safety and efficacy in the indigenous population. You also raise your institution to a certain level, as participation in vaccine trials can serve as a springboard for basic, clinical and population research in future.”
Marathon at the speed of a sprint
The Global Task Force subcommittees are made up of Ismaili and non-Ismaili health professionals whose expertise is directly linked to AKDN and Jamati health structures. Their meetings regularly include additional invitees including industry experts, scientists and policy makers, connecting high-level global talent to AKDN and in turn providing a platform for these experts that understands their mission, fulfils their desire to contribute, and offers an opportunity for professional growth. The committees will remain intact as long as needed, likely for a few years, until a substantial majority of the global population has been vaccinated. Testing will also be needed for a long time, because finding out who has the virus is a cornerstone for guiding the measures that can help to suppress the pandemic.
“AKDN’s response to the pandemic started off as a sprint, and it has become a marathon at the speed of a sprint,” Dr Walraven said. “For all of us, life has changed dramatically. Also on a personal level, in spite of all the measures we have taken to protect our people, we have inevitably had some deaths, so it has come very close. Covid-19 has taken over.”
