Nadia Sam-Agudu

Global experience with COVID-19 and mpox demonstrate challenges and opportunities that pandemics bring to the management of people living with and vulnerable to HIV. This session presents lessons learned--challenges and successes--from the COVID-19 and mpox pandemics, from innovative research approaches to national pandemic responses and global frontline personnel collaborations.

Dr. Gail Matthews from Australia starts off by describing “adaptive platform” trials and advantages over traditional RCTs, e.g. allows multiple research questions, maximizes patient contribution to research, and can include women and children. She notes how COVID-19 spurred an explosion of platform trials (e.g., RECOVERY trial). Pitfalls include operational complexity and difficulties with ethical review. Dr. Glenda Gray speaks about COVID-19 in South Africa, with one of the highest case fatality rates globally. She stresses the critical role of data and how South Africa’s Medical Research Council uses death registries to calculate excess deaths from COVID-19. She highlights the geospatial impact of COVID-19 (e.g., due to racial and economic inequity). PLHIV were ~2x more likely to die from COVID-19 especially if undiagnosed, untreated or unsuppressed. Dr. Gray describes TB and HIV as “slow-burner” pandemics that were impacted by COVID-19. Dr. Chloe Orkin (UK) shares lessons learned from global mpox case series. She highlights significant sexual behavioral changes in high-risk populations and the severe clinical manifestations of mpox in immunocompromised persons such as those living with HIV. She recommends consideration of frontline data and conditions in outbreak responses and heeding early warnings (e.g., Nigerian reporting on genital mpox transmission).

The session informs us that pandemic preparedness should include resilient health systems, vital registries and data science, diagnostic capability, hospital/genomics surveillance, including “slow burning” epidemics, therapeutics manufacturing capability, medical devices and PPE, and social science. Key messages include doing outreach work to increase vaccine equity, and not forgetting healthcare workers and activists in pandemic responses across the globe. The session features researchers and frontline clinicians using innovative research and multidisciplinary collaborative approaches to facilitate rapid pandemic responses. Experiences from an mpox-endemic African country, or an Asian country significantly affected by COVID-19 would have provided additional value from a different perspective.

Ryan Williams

Reviewing clinical, healthcare-system and community-based strategies employed in the response to the mpox and COVID pandemics is a vital part of establishing effective and evidence-based practice for the future. This symposium explored both the data as well as the strengths and challenges of numerous response strategies to mpox and COVID.

Gail Matthews outlined how the need for rapid, multifaceted and international responses to pandemics like mpox and COVID was well suited to the benefits of platform trials, as these are able to evaluate multiple treatments simultaneously in an accelerated timeframe. Additionally, platform trials have enhanced statistical power, improve patient safety and maximise patient contribution to research. Challenges include the need for complex governance and harmonised data collection. Glenda Gray highlighted the need for (health) data to be collected during pandemics; current and future responses cannot be implemented and pre-empted without an accurate picture of what is happening at the coalface. Data during during COVID showed decreases in testing and treatment for HIV and TB, disparities between socioeconomic, racial and geospatial status as well as key community attitudes affecting vaccination hesitancy and fatigue. Chloe Orkin elucidated many of the successes achieved in the response to mpox. Comprehensive knowledge was gathered regarding mpox phylogenetics, clinical features including asymptomatology, epidemiology, vaccine safety & efficacy and the vital role of community engagement. Lessons to be learned include the failure to predict this pandemic, the disparate way in which vaccinations and health care reached marginalised populations and the slow pace at which international guidelines changed.

The fact that many infectious diseases can be asymptomatic (at least initially) and can pose challenges for individuals, communities and healthcare providers, is an important consideration. The need to combat stigma associated with this was also affirmed. Overall, this session emphasized the critical role of collecting and analysing biopsychoscial data during any pandemic, as these will provide invaluable tools when facing the next pandemic - whenever and whatever this may be. As more platform trials are conducted, it is hoped that they will become more streamlined and better able to empower healthcare providers.