Five Questions With…Professor Charlotte Watts

As COVID-19 continues to spread across borders, what are you most concerned about in terms of its development in LMICs, and what is the most helpful way that we can help the poorest countries deal with COVID-19?

I am extremely concerned. The impacts will be multiple, with the potential to reverse many of the development gains made in the last 10 years. In terms of health, we are still trying to assess how large the COVID-19 outbreak may be in different low and middle income countries. We do know that health systems could be quickly overwhelmed, and that COVID-19 infection fatality rates are likely to be higher than in richer countries, due to weaker health systems.

Alongside the direct impacts of COVID-19, I am concerned about the indirect health impacts. We are already seeing rates of childhood immunisation dropping, which could lead to the resurgence of vaccine-preventable diseases, and disruptions to critical prevention programmes, such as bed-net distribution and sexual and reproductive health services. Fear of COVID-19 infection is an important part of this, with attendance at health centres and clinics dropping if people think that they are unsafe. The impacts will not solely be due to infection and health systems. The global economic shock will have multiple knock-on impacts for developing countries.

It’s important to add that there are many unknowns about how COVID-19 may play out in different countries. Several factors, such as closer societal mixing and weak health systems are likely to increase the risk of transmission and reduce the ability of the population to adhere to control measures. On the other hand, LMICs often have a much larger proportion of younger people, and lower (but growing) rates of some non-communicable disease such as cardiovascular disease and diabetes. This may reduce the likelihood of more severe illness and death.

How will the responses in other countries/regions impact the UK?

Infectious diseases such as COVID-19 know no borders, and for the world to be safe from the pandemic, people in the most vulnerable countries also need to be safe. So it is in everyone’s interest that all countries can effectively tackle the virus.

UK aid has an important role to play. Firstly, in using its resources and expertise to support the most vulnerable countries and key agencies such as the World Health Organization. And secondly, in investing in the development of vaccines, diagnostics and therapeutics through organisations such as the Coalition for Epidemic Preparedness Innovation (CEPI), the Foundation for Innovations in New Diagnostics (FIND), and Gavi, the Vaccine Alliance, that aim to develop and support the distribution of new technologies to poor countries.

The UK is making substantial contributions to these organisations – including £250 million of UK aid support to CEPI for vaccine development, the biggest donation of any country.

Do you think COVID-19 will present similar or distinct challenges in LMICs?

There are some common challenges that all countries face, including how to control an infectious disease where many people are asymptomatic but can be infectious, how to control infection through social distancing and lockdown without destroying economies and livelihoods, and how to juggle the need to prioritise COVID-19 with other important issues.

There are also clear differences in the capability of health systems to respond and in the ability of countries to mitigate the secondary and economic impacts to their populations. The ability of populations to enact prevention – for example, when they may live in over-crowded communities, need to go out daily to earn a living, and have difficulty accessing even basic commodities that are critical for prevention – such as clean water, soap and disinfectant. That is why, alongside our investment in vaccines, diagnostics and therapeutics, we are also supporting UNHCR and other NGOs to install new hand-washing stations and isolation and treatment centres in refugee camps.

What can the UK learn from the successes of African countries? Which innovations stand out as examples that could be applied here?

All countries can learn from each other, and there are many lessons which can be shared from countries across the world.

In South Africa for example, due to their widespread use of Gene Expert as part of their tuberculosis response, early in the outbreak they were able to pivot this testing towards COVID-19, and conduct widespread community testing. This helped them understand where infections were occurring, and then draw upon their network of community healthcare workers to conduct contact tracing. This is similar in many ways to the track and trace model in the UK, which will expand access to testing and use a large cadre of workers to follow up on contacts.

I have also recently been learning about the approaches used in Ghana to conduct pooled testing, and am interested in whether there are lessons that can be learnt for future surveillance approaches in the UK and internationally.

Are there any recent developments in the course of the virus that can give us cause for optimism?

At times it is hard to be optimistic when the impact of the pandemic is so significant. But there are things that do give me hope: the ways in which communities around the world have mobilised in solidarity to combat the virus and support key workers and those who are most vulnerable, and the huge global mobilisation of R&D to develop a vaccine, diagnostics and treatments.

The development of any vaccine is a complicated and challenging endeavour, and we can’t guarantee a COVID-19 vaccine in the near future. However, there’s a lot of work and effort going on around the world to accelerate the process and to maximise our chances.

I am also interested in the “building back better” narrative that is emerging. COVID-19, like other infectious diseases, impacts on the most vulnerable. We saw profound social change as a result of HIV/AIDS. Similarly, I hope that we will emerge from COVID-19 with a strengthened commitment to the importance of tackling poverty and inequality, and of supporting a greener and more sustainable approach to development.