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Let me start this week’s intro with a few quotes from John Nkengasong (Africa CDC), last weekend. When referring to the issue of a temporary Trips waiver proposal, he urged countries to get “on the right side of history”, stating: “As a continent, when this is all over, and it will be over, we are a resilient continent, we will remember not just the loud voices of those who did not support us but we will also remember the silence of our friends in this battle.” I’m sure many ‘friends’ have noticed.
“Global health starts at home”, they say, so how has the EU been doing in this respect? While arguably the EU got too much flak for its common vaccine policy & procurement for EU citizens (certainly given the fact that so called “frontrunners” like the UK, US and Israel weren’t exactly role models, grabbing & hoarding whatever they could get hold of), it’s also obvious that Team Europe didn’t receive enough criticism for its (rather “ambiguous”) role on global vaccine equity, in spite of the “Eurovision song-style” rhetoric since the start of the pandemic. In case you find that assessment too harsh, we suggest you read Politico’s “Europe prepares late entry in vaccine diplomacy race”. Even if the analysis is no doubt also a bit (Anglosaxon)- biased, it’s easily the depressing read of the week. At the very least, I’m not sure everybody shares Ursula von der Leyen’s assessment from last weekend that the EU is nowadays “the pharmacy of the world”. Ask John perhaps.
Anyway, after the pope had weighed in (shortly after the Gates foundation), backing a temporary Trips waiver while coming up with his own version of ‘variants of concern’ (HT Peter Singer), dominoes stopped falling, at least for now. It’s clear that the counter-offensive launched by lobby groups on both sides of the Atlantic and elsewhere to fight the TRIPS waiver proposal has the ear of quite a few (neo-) liberal European leaders. So let’s see how the WTO negotiations go in the coming months, they promise to be very tough, even if Ngozi hopes to “land” in November. At the very least, I hope Team Europe (and other Merkels & Macrons) won’t go into full-blown troika “smoke them out” mode (as in the “discussions” with the Greeks in the financial crisis). As for Covax, let’s hope the potential “Chinese gamechanger” indeed materializes, together with hopefully far more substantial sharing of doses by G7 countries. There was some encouraging news on ACT–A as well, with perhaps more to come next week. Meanwhile, however, the pandemic rages on in too many parts of the world, with untold horror. So let’s hurry up.
Against a dire overall backdrop, there are, however, always new global health meetings on the horizon that promise to bring at last some change and hope, with the G20 Global Health Summit (21 May) and the 74th World Health Assembly (24 May-1 June) as the first ones coming up, accompanied by the usual flurry of preparatory webinars, reports and side events. Let’s hope they indeed “deliver” transformative change, as argued for in one of these reports this week. Too many of these reports have been shelved in the past.
We leave you with a special mention of International Nurses Day (12 May) (do raise your hands if you want a caring, empathic, decently paid and preferably not overworked nurse at your bed in your final days instead of a ‘value for money’ health economist on the hunt for more ‘efficiencies’ 😊), and a trademark quote from Vladimir Putin, who boasted last week that “Russia’s homegrown coronavirus vaccine was as “reliable as a Kalashnikov assault rifle” “ Wish global health solidarity was like that too. Minus the bare chest and bear 😊.
Enjoy your reading.
Coverage of a G2H2 webinar on the issue. “The draft of a landmark resolution to establish a global “Pandemic Treaty” will be put to World Health Organization (WHO) member states this week in preparation for the World Health Assembly beginning 24 May, Jaouad Mahjour, WHO Assistant Director-General Emergency Preparedness, told a panel in Geneva Monday….”
“The concept has met with resistance in some quarters, as well – notably the United States has not yet signed onto the idea. And some civil society voices have said that absent of political will, a treaty would not necessarily have more clout than existing International Health Regulations governing emergencies. However, the countries now pushing for the treaty represent every region of the WHO, and range from superpowers to small island states, Mahjour told a panel convened by the Geneva Global Health Hub (G2H2), saying that the time for a treaty is ripe…”
Check out also what the other panelists said. Including Priti Patnaik (Geneva Health Files) (for her presentation on the pandemic treaty, see here )
· See also the recording of the webinar (scroll down): https://g2h2.org/posts/may2021/
· Meanwhile, via Geneva Health Files – the dash for a pandemic treaty
“A decision-text to kick start discussions towards a pandemic treaty is being considered by member states this week. Member states will consider establishing an intergovernmental meeting (IGM) to draft and negotiate a WHO framework convention on pandemic preparedness and response….”
“…At the recent event on the pandemic treaty, we discussed on what this haste in undertaking these critical negotiations mean for developing countries who are still fire-fighting the pandemic and have uneven, inadequate capacities. In addition, as we have found in our reporting, the discussions have been perceived to be top-down and driven by a small number of influential member states…”
« …Those in charge of drafting the treaty must begin with a clear look at the grave abuses that have characterized the covid-19 pandemic: authoritarian power grabs; continuing monopolies in diagnostics, therapeutics, and vaccines; failure to resource health systems; staggering setbacks for women; and an upsurge in violence, including covid-related hate crimes. States have all-too-easily sidelined the international human rights framework under cover of emergency responses. This cannot continue. Any treaty should address these key issues: … »
Cfr tweet Kent Buse: “Key #HumanRights elements for proposed International Pandemic Treaty : Sharing scientific progress ; Siracusa Principles; Workers rights ; Gender equality ; Digital rights ; Transparency ; Accountability ; Community voice.””
G Velazquez et al ; https://www.southcentre.int/policy-brief-93-may-2021/
“…. If WHO Member States decide that an international treaty to prepare and respond to pandemics is the way forward, it would be important to have clarity from the outset on the elements and areas that will be the subject of negotiation. The first step should be to identify the aspects of pandemic preparedness and response that the current crisis has revealed are not working, and how to build up on the existing instruments, notably the International Health Regulations (IHR). This paper discusses some of the critical issues that should be addressed in such a treaty if negotiations are launched, in view of the needs of countries at different levels of development and with disparate capacities to implement treaty obligations….”
Nithin Ramakrishnan, K M Gopakumar and Sangeeta Shashikant; https://www.twn.my/title2/health.info/2021/hi210507.htm
Their concluding paragraphs:
“Micheal Wood, a Member of the International Law Commission, opines that before starting any treaty-making process, one should always ask two basic questions: (1) Is a treaty really necessary to regulate the issue at hand, and (2) if so, what is the proper time to start negotiations? On both counts, the proposal for the new pandemic treaty and the draft decision to start negotiations fall short. The draft decision fails to provide a satisfactory reason why a treaty is necessary to better handle PHEIC. It has been proposed at a wrong time devoid of any “fairness and equity” considerations.”
And as a reminder, a link (Lancet Comment) - A global pandemic treaty should aim for deep prevention (by J Vinuales, S Moon et al). “…Deep prevention focuses on preventing the outbreak of the disease from occurring rather than focusing on local, national, or international spread.”
“The philanthropist had discussions with lawyers in October 2019 around when the Microsoft co-founder’s ties to Jeffrey Epstein became public.”
PS: my own view on this: there’s more than enough to criticize Bill Gates for in this pandemic and otherwise, no need to hint at his Epstein links (unless if he was implicated himself, which doesn’t seem the case so far).
Speaking of which – this is a hard-hitting must-read. Again, from Tim Schwab.
“The billionaire’s role in perpetuating vaccine apartheid in the name of protecting intellectual property rights has begun to draw criticism.”
“The announcement earlier this week of Bill and Melinda Gates’s divorce was a bombshell headline, but it shouldn’t distract us from an even more interesting development in the news media in recent weeks. Bill Gates, long heralded as a global hero in the pandemic response, is becoming an increasingly popular target of criticism for his role in the unfolding vaccine apartheid around the world….” Among others on the Curevac & Gates connections and the role of ‘global access agreements’.
“… But the larger questions raised by their business partnership concerns how Bill Gates, one of history’s most storied monopolists, has found himself so deeply involved in what may be one of the most potent monopoly markets ever devised: a vaccine that virtually everyone on earth needs. … It is increasingly urgent to ask if Gates’s multiple roles in the pandemic—as a charity, a business, an investor, and a lobbyist—are about philanthropy and giving away money, or about taking control and exercising power—monopoly power….”
“… The “global access agreements” that the Gates Foundation signs with its charitable recipients, like CureVac, have long been the linchpin of Gates’s expansive charitable work with the private sector—serving as both a response to critics who say the philanthropy is too closely aligned with Big Pharma and a justification the foundation can offer to the IRS to rationalize the tax benefits it gets from donating money to multinational companies—like the tens of millions of dollars it has given to GlaxoSmithKline. …Yet some see these access agreements as designed less to promote equity or “global access” and more focused on promoting the Gates Foundation’s access to intellectual property. Securing IP rights has long been a central, if rarely scrutinized, part of how the Gates Foundation does business…. … Given the tens of thousands of charitable grants and investments the foundation has made over the last two decades, the charity may have acquired access to or ownership of a stunning level of technology and intellectual property, which translates into the unprecedented level of influence Gates has not just over global health but also the pharmaceutical industry….”
PS: “… Another leading voice in the pandemic response, the Coalition for Epidemic Preparedness Innovation (CEPI)—which was cofounded by the Gates Foundation and whose general counsel, Richard Wilder, previously presided over intellectual property at Microsoft—appears to use similar access agreements when it gives away money, a tool it trumpets as promoting equity….”
Ahead of the WHA, some good points are being made in this piece (with the views of L Gostin & L McGoey and Chris Elias, among others.)
And to finish our section of ‘critical Gates reads’, a link:
The Disinformation Chronicle - I Never Trusted Bill Gates, Nor Should You “While leading a Senate investigation, I tracked a corrupt pharmaceutical executive right into the lobby of the much-vaunted Bill and Melinda Gates Foundation—Bill Gates did nothing.”
Analysis by Helen Branswell of the report of the Independent Panel for Pandemic Preparedness and Response (chaired by E Sirleaf & H Clark), released on Wednesday.
PS: This is one of three reports on the Covid-19 pandemic which have been published ahead of the WHA where they will influence the debates on a Pandemic Treaty and the resolution on strengthening WHO’s role in pandemic preparedness and response currently negotiated by WHO member states. This report, unlike the other two, got global (media) attention.
“The Covid-19 crisis should serve as a “Chernobyl moment” for global pandemic preparedness, triggering a series of actions to speed the end of this pandemic and to ensure it’s the last of its kind the world ever faces, according to a report from an international panel of experts. The report by the panel, which was established at the behest of member states of the World Health Organization, calls on wealthy countries with Covid vaccine to share their supplies in large volumes and quickly, with 1 billion doses donated by September and another 1 billion by the end of the year. The report calls for swift negotiations to lift intellectual property protections for Covid vaccines — and an automatic waiver if the negotiations fail to deliver within three months.
“It also recommends reform of the global architecture for pandemic preparedness and for significant changes to the way the WHO — which has led the global Covid response — is funded and functions, including limiting WHO directors-general to a single seven-year term to ensure their independence. … One of the report’s boldest recommendations is that the WHO should be given the authority to send teams to investigate outbreaks that appear to pose a pandemic threat without having to wait for approval from the country where the disease is spreading. … The report largely focused on changes needed going forward rather than a forensic recounting of the various missteps from early 2020. It did, though, note that the WHO could have declared the coronavirus outbreak a public health emergency of international concern — a PHEIC, in global health parlance — eight days earlier than it eventually did. (The PHEIC was declared on Jan. 30, 2020.) The panel acknowledged, however, that doing so did not appear to trigger any significant preparatory action, describing February as “a lost month” when many countries seemed to be hoping that what was unfolding would not hit them.”
“… It called on the G7 countries to immediately provide 60% of the $19 billion budget shortfall for the Access to COVID-19 Tools, or ACT Accelerator, an international partnership with a mission to spur development, production, and equitable access to Covid control tools like vaccines, drugs, and tests. The report also recommends that the ACT Accelerator become a permanent structure for developing and delivering global health goods. …. … As a means of improving global pandemic preparedness, it called for the creation of a Global Health Threats Council, to be headed by someone at the level of a head of state. High-level involvement is needed to keep pandemic preparedness work an all-of-government activity, rather than something left solely to health ministries, it argued. It also called for the creation of an international pandemic financing facility that could help low-income countries fund pandemic preparedness work, and could quickly disburse $50 billion to $100 billion, at short notice, in the event of a pandemic….”
Related links, coverage & analysis:
· The report - Covid-19: Make it the last pandemic (+ 16 background papers)
· Related Comment in the Lancet by chairs Ellen Sirleaf & Helen Clark - Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic
Quote Jeremy Farrar: “… After all, many of the suggestions in the report are not new, Farrar notes. In 2015, a panel led by Dame Barbara Stocking made similar points in a harsh report about WHO's handling of the West African Ebola epidemic. “You could have taken the Stocking report and crossed out Ebola and put it in COVID, and it would have said many of the same things,” Farrar says. “Unless there is political will and real financial support, then all of these reports are just going to be reports.””
“Scathing report criticises authorities in China, Europe and North America while recommending widescale reforms.”
…The panel is scathing about the International Health Regulations, the only legally binding instrument on disease outbreaks. “As currently constructed [they] serve to constrain rather than facilitate rapid action,” the report says. “With respect to travel, it is hard to see that the IHR’s discouragement of restrictions is realistic for pandemics in our highly interconnected age.” “If travel restrictions had been imposed more quickly and more widely, that would have been a serious inhibition on the rapid transmission of the virus,” Clark told a press briefing ahead of the review’s publication. “We have to realise that we are living in the 21st century and not in medieval times.”…”
… But the strongest criticism was directed at the wealthy nations of Europe and North America for “wasting February 2020” through inaction — leading to “a lost month when many more countries could have taken steps to contain the spread of Sars-Cov-2 and forestall the global health, social and economic catastrophe that continues its grip”….”
“An intermediate level of alert for health emergencies would not solve the problem of countries’ inaction to the World Health Organization recommendations and advice, a review committee of the International Health Regulations has said. … Instead the report recommended instead that WHO be “more assertive” and open in sharing its rapid risk assessments either through its existing Disease Outbreak News or in a new alert notice that could be labeled as “World Alert and Response Notice” or WARN….”
And: “Declaring a PHEIC or PHEMIC?” “… it also recommended WHO and member states consider an alternative acronym for a public health emergency of international concern, currently pronounced as “fake,” given the proliferation of fake news. The committee said the PHEIC acronym is not part of the IHR text, and WHO and member states could consider the use of another acronym, such as PHEMIC.”
· L Gostin (O’Neill Institute) – Analysing the Covid-19: make it the last pandemic report
Neat analysis of the report as well. “While powerfully elaborating on these shortcomings and failures, the report does not single out any government, agency, or actor for their actions or inactions in impeding the response—hurting the ability of WHO to adapt for the future. In particular, despite marked delays in China’s reporting of a novel outbreak in Wuhan and its impeding WHO in finding the pandemic’s origins, the IPPR did not seek to hold the government accountable. The panel’s report presents numerous recommendations, covering both the immediate response to ending the COVID-19 pandemic, and ensuring that COVID-19 is “the last pandemic.” [on the latter, with 7 recommendations- the Panel’s Seven Point Plan for strengthening pandemic preparedness ] But if these recommendations were implemented, would it truly achieve those aims? For each of the many bold recommendations, the absence of enforcement and compliance measures will enable threats to persist….”
Titled ‘The world needs WHO more than ever’. “…the report presents WHO’s achievements in the past year against the Output scorecard, a unique reporting mechanism in the United Nations system that provides a detailed accounting of our achievements against each of the “triple billion” indicators agreed by Member States…”
And related tweet:
“@WHO is developing Health Systems for Health Security Framework #HSforHS. It is captured well in the mid-term report, and Evidence and Analytics for Health Security (#WHOEHS) is working on it with the support of many partners and technical teams.”
See also WHO “…A scoping review showed that health systems and health security are often treated as distinct fields, and this siloed approach presents challenges to health governance. WHO is developing a “health systems for health security” framework to identify the necessary capacities for health security, which will include surge resources during a health emergency while maintaining essential services.”
“ …A WHO staffer and three Ebola experts working in Congo during the outbreak separately told management about general sex abuse concerns around Boubacar Diallo, The Associated Press has learned. They said they were told not to take the matter further. WHO has been facing widespread public allegations of systemic abuse of women by unnamed staffers, to which Tedros declared outrage and emergencies director Dr. Michael Ryan said, “We have no more information than you have.” But an AP investigation has now found that despite its public denial of knowledge, senior WHO management was not only informed of alleged sexual misconduct in 2019 but was asked how to handle it.;..”
Related tweet Sophie Harman:
“The #WHO has failed the women of the DRC. The #WHO needs to act in a timely, serious & decisive way on sexual exploitation. The #WHO does not take gender equality seriously. The #WHO needs to get a handle on this NOW given COVID19 vaccine rollout”
“Italy is pushing for the Vatican – a steadfast opponent of reproductive and sexual rights – to have a permanent role at the World Health Organization (WHO), according to an investigation by openDemocracy. A handful of other European countries, including conservative Hungary and Poland, are understood to be co-sponsors of Italy’s draft resolution to the World Health Assembly (WHA), the governing body of the World Health Organization (WHO). …”
“U.S. government officials laid out the Biden administration’s global COVID-19 response framework at a congressional hearing Wednesday where lawmakers pressed for more clarity around plans for vaccine distribution, broader pandemic relief, and global health security efforts. Gayle Smith, the coordinator of the global COVID-19 response and health security at the State Department, outlined the U.S. framework and its five “planks” at a Senate Committee on Foreign Relations hearing….”.
“The first is increasing supply and access to vaccines globally — which was the focus of much of the hearing. The second is reducing mortality and transmission, including by supporting underlying health systems. The U.S. will work to address the acute shocks — economic and otherwise. It will also work to bolster economic systems that have struggled. Lastly, the U.S. will work to “build the international architecture for global health security that we will need in the future,” Smith said. That includes strengthening and modernizing existing institutions to ensure they are “fit for purpose”; pushing for new norms when necessary and ensuring compliance with existing ones; ensuring adequate and sustainable financing; and improving transparency, accountability, and oversight….”
Finally, Priti Patnaik ( Geneva Health Files) on the news from last week - WHO, Germany launch new global hub for pandemic and epidemic intelligence: WHO
“A key development, to be read along with the discussions on the pandemic treaty. It was made clear at the briefing where this announcement was made, that this is the way WHO is going to work now and in the future, dedicated engagements with select member states on specific issues….”
Press release after the Board meeting. Excerpts:
“The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria overwhelmingly praised the continued progress of the Global Fund in the past year despite the challenges of the COVID-19 pandemic. The Board discussed how the Global Fund partnership can continue to support countries to respond to COVID-19 and prepare for future pandemics, while at the same time mitigating the impact on HIV, TB and malaria programs and strengthen systems for health in order to reach the target of ending HIV, TB and malaria as epidemics by 2030….”
“… In his update to the Board, Peter Sands, Executive Director of the Global Fund, highlighted the key progress in the past year. In terms of grants signed and total funding approved, we are well ahead of where we were at the same point in the last cycle: As of end-April 2021, the Technical Review Panel has approved nearly US$11.7 billion of funding requests for grant-making out of a total country allocation of US$12.7 billion. … In addition to the core work fighting HIV, TB and malaria, more than US$1 billion has been approved to support countries’ responses to COVID-19 since March 2020. The first Fast-track funding requests to the COVID-19 Response Mechanism in 2021, including US$75 million for emergency oxygen for India, were approved within days of being received. More are in the pipeline. …. … A key point of discussion at the Board Meeting was the ongoing development of the new Global Fund Strategy, which will set the direction for the Global Fund post-2022. The Board is currently considering the role of the Global Fund in pandemic preparedness and response, in view of the impact COVID-19 has on the three diseases, the relevance of positioning the three diseases within the wider pandemic narrative (as three of the biggest unresolved pandemics), and the core strengths of the Global Fund’s model that can leveraged to build pandemic preparedness and responses….”
For more on the Global Fund Board meeting, see also Global Fund Observer:
“…Among others, Sands made a summary of the progress and challenges met by the organisation, highlighting six main Global fund Secretariat Priorities for 2021 which are: mitigate the impact of COVID-19, launch the next cycle of grants, drive efficiency and effectiveness, invest in people, finalize the next Strategy, and prepare for the Seventh Replenishment….”
More reads & analyses in this temporary TRIPS waiver debate & advocacy.
“A global spat over coronavirus vaccines is giving World Trade Organization Director-General Ngozi Okonjo-Iweala a rare opportunity to give her badly wounded organization a road back to relevance. And by the WTO's often glacial pace of working, she's giving herself an ultra tight deadline of November to oversee a deal on vaccine access and prove that the Geneva-based body is still a player in global trade….”
“Big Pharma needs to "move quickly instead of resisting" ramping up vaccine production in developing nations.”
“EU leaders have confronted the Biden administration over its calls for Covid-19 vaccine patent waivers and urged the US to export jabs directly if it wants to help poor countries in need. German Chancellor Angela Merkel said after a two-day EU leaders’ summit in Porto, Portugal, that suspending intellectual property rights was no solution to supply shortages and called for a focus on ramping up production instead. France’s President Emmanuel Macron and top EU officials echoed the German premier’s rhetoric as the union scrambled to respond to this week’s surprise US move. Both powers are attempting to fend off accusations they are hoarding vaccines as much of the world sees few or no shipments. … Charles Michel, president of the European Council, said earlier on Saturday that a vaccine patent waiver would not be a “magic bullet” for poorer countries but the bloc was willing to discuss “concrete” US proposals on intellectual property rights for vaccines… Mark Rutte, Dutch prime minister, said among leaders there was a “general hesitancy” to support the patent waiver. “There could be a paradox that by granting IP waivers, you could have issues around ramping up production,” he told journalists after the summit, warning that waivers could disrupt existing global supply chains for vaccines. …”
See also the Guardian - Macron voices concerns over Covid vaccines patent waiver
“French president says US and UK should start exporting doses around the world instead.”
“Speaking in Porto, Von der Leyen took a bullish approach, in a sign of the frustration felt at the US approach. She said: “We should be open to this discussion but when we lead this discussion there needs to be a 360 degree view on it as we need vaccines now for the world. In the short and the medium term the IP waiver will not solve the problem, will not bringing a single dose of vaccine in the short and medium term.” “… There is growing frustration in Brussels and European capitals that the US is seeking to take the high ground given that EU-based manufacturers have exported 200m of doses while the White House has put a block on vaccines leaving its shores….”
“India should walk the talk on TRIPS waiver. Or else the demand at the WTO is just international posturing.” Do read what this would entail.
“The Biden administration is examining ways to ensure that a waiver of COVID-19 vaccine patents to aid poor countries will not hand sensitive U.S. biopharmaceutical technology to China and Russia, responding to a chorus of concerns, U.S. and industry officials say. Many companies and now some U.S. officials fear the move would allow China to leapfrog years of research and erode the U.S. advantage in biopharmaceuticals….”
“A senior Biden administration official said that while the priority is saving lives, the United States "would want to examine the effect of a waiver on China and Russia before it went into effect to ensure that it's fit for purpose." A question and answer document produced by the administration and shared with industry representatives also acknowledges concerns that intellectual property sharing could damage the United States' competitive advantage over China, an industry source familiar with the discussions told Reuters. The contents of the document read to a Reuters reporter by an industry representative said the Biden administration believes it can address those concerns through the WTO negotiations, but did not specify how. The source added that some agencies in the Biden administration have conflicting views of how to address the concerns in negotiations that are expected to take months. … China's Fosun Pharma has struck a deal with BioNTech on COVID-19 vaccine product development, which would potentially give it access to some of the technology. China has high ambitions for its pharma industry and already is developing its own mRNA vaccine….”
“US president faced down pharma lobby and some in his administration.” Insightful article, among others discussing the key role of Katherine Tai (top trade envoy US), in the final decision.
“Civil society has been widely credited in diplomatic circles as “the catalyst" that tipped the balance and led the U.S. Administration of President Joe Biden to declare, on May 5, that it would engage in World Trade Organization negotiations over a waiver in intellectual property protections for COVID-19 vaccines….”
“The stars were better aligned for civil society this time around, with a new administration in Washington and a new Director-General (Okonjo-Iweala) in the WTO who was very proactive from day one in trying to secure an equitable distribution of vaccines and life-saving medicines, and unafraid to put people from all sides in a room together.” … … Another big plus for civil society, sources say, is that in the current campaign over the waiver, besides the WTO's Okonjo-Iweala, two other African nationals with close links to civil societies and first-hand knowledge of their role are currently at the helm of multilateral health agencies—Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, and Winnie Byanyima, UNAIDS Executive Director, and a former head of Oxfam International. Both have strongly and publicly voiced their support for the waiver initiative by India and South Africa as one of the tools needed to ramp up global vaccine production, and have also spoken out against the shocking imbalance in the global distribution of COVID-19 vaccines….”
“ Britain is seeking constructive engagement with the United States and other World Trade Organization members on the issue of IP waivers for COVID-19 vaccines, a government spokesman said after pressure from charities to back U.S. proposals…”
“… "We are engaging with the U.S. and other WTO members constructively on the TRIPS waiver issue, but we need to act now to expand production and distribution worldwide," the government spokesman said in an email to Reuters. "Any negotiations in the WTO on a waiver will require unanimous support, which could take a significant amount of time. So while we will constructively engage in the IP discussions, we must continue to push ahead with action now including voluntary licensing agreements for vaccines." Britain has promised to donate surplus vaccines to other countries when it is able to, but says it has no spare shots to give at the moment….”
“Success of a proposed intellectual property waiver to ramp up global manufacturing may still depend on whether pharmaceutical firms share technical know-how; Chinese companies, especially those using advanced technologies, may have concerns about their own IP and want to protect it.”
“By late last month, China had not expressed straightforward support for the initiative in WTO meetings on the matter, but was open to engage in text-based discussions, considered a next step towards consensus, according to a Geneva-based trade official. Experts say China is likely to bide its time rather than picking sides following the US move, especially as negotiations are expected to be long and other nations to resist, despite the US support for waiving IP protections….”
But – see Guardian yesterday: “ China’s commerce ministry spokesman, Gao Feng, has said Beijing supports a proposal by the World Trade Organization for an intellectual property protection waiver on Covid-19 vaccines to enter the consultation stage….”
P Patnaik; Geneva Health Files
Priti Patnaik’s assessment of last week’s turbulent WTO week. A few quotes:
“Irrespective of the outcome and the intent of the move by the USTR, this is quite clearly a watershed moment, going beyond mere political symbolism. … “That the US has opened the door to even discuss a proposal that seeks a blanket waiver on intellectual property protection, is unprecedented. This opens up possibilities to negotiate,” a trade official said. …. … The way this announcement was made reveals a new way of back-room diplomacy at WTO that caught even insiders off-guard, and it possibly underscores a win for the new DG Ngozi Okonjo-Iweala. …”
“It is hard to imagine that the WTO DG did not know well in advance that this announcement was coming,” one official said on the condition of anonymity. … “
“The co-sponsors of the proposal will share a revised text this month. The next TRIPS Council meeting is scheduled for June 8th-9th….”
“With the US support to the negotiations on the TRIPS Waiver, the World Trade Organization will become the nerve centre of the international response to the pandemic over the coming weeks and months….”
“The African Union’s health agency on Thursday welcomed U.S. President Joe Biden’s decision to waive intellectual property rights for COVID-19 vaccines but he counselled patience as the move would take time to translate into reality. … “It represents a very good step in the right direction (against the global pandemic). But the results will not be tomorrow,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention, told a briefing. “What we need now and urgently is vaccines that we can put in the arms of people while developing our own manufacturing capacity.”
… Nkengasong said there are countries on the continent like Senegal, South Africa, Tunisia, Morocco and Egypt with the platforms needed to producing vaccines but they needed support to do so. “With the right partnership, we can get there.” … … Nkengasong called on those nations sceptical of such a move to be on the right side of history….”
“As a continent, when this is all over, and it will be over, we are a resilient continent, we will remember not just the loud voices of those who did not support us but we will also remember the silence of our friends in this battle.”
“The Biden administration’s unexpected support for temporarily waiving Covid-19 vaccine patents won’t have an immediate financial impact on the companies making the shots, industry officials and analysts said. Yet the decision could mark a shift in Washington’s longstanding support of the industry’s valuable intellectual property, patent-law experts said. A waiver, if it does go into effect, may pose long-term risks to the vaccine makers, analysts said.
“… Moderna Inc., MRNA 1.65% Pfizer Inc. PFE 1.00% and other vaccine makers weren’t counting on sales from the developing countries that would gain access to the vaccine technology, analysts said. If patents and other crucial product information behind the technology is made available, it would take at least several months before shots were produced, industry officials said. Yet long-term Covid-19 sales could take a hit if other companies and countries gained access to the technologies and figured out how to use it. Western drugmakers could also confront competition sooner for other medicines they are hoping to make using the technologies. … A World Trade Organization waiver could also set a precedent for waiving patents for other medicines, a long-sought goal of some developing countries, patient groups and others to try to reduce the costs of prescription drugs. … Yet some industry officials and experts said the Biden administration’s support might be a one-time maneuver driven by an unusual pandemic and designed to encourage the companies to further collaborate with developing countries. … “It’s a way of signaling the U.S. government is open for matchmaking, not just domestically, which it’s already done, but matchmaking around the world,” said Arti Rai, faculty director of the Center for Innovation Policy at Duke Law.”
But must be accompanied by other measures.
“Over more than one year of the COVID-19 pandemic, the European Commission has held meetings primarily with representatives of Big Pharma or the Bill and Melinda Gates Foundation and associated organizations like ‘Global Citizen’. The Commission has listened almost exclusively to this echo chamber which pushes protecting Big Pharma patent rights, despite the way they are exacerbating global vaccine apartheid. Since March 2020, Big Pharma lobbyists met Commissioners 44 times – pharma associations 117 times and Gates-related organisations 41 times – whereas critical NGOs like Medecins Sans Frontières (MSF), Global Health Advocates (GHA), generic medicines producers and others have been completely or mostly denied access. “
Rachel Silverman ; https://www.cgdev.org/blog/ip-and-covid-19-vaccines-unpacking-fraught-debate
Recommended. « Activists see the waiver as essential to address unacceptable vaccine inequities and ensure lifesaving innovation is widely shared. But industry warns in apocalyptic terms about the end of medical innovation as we know it. The polarized debate reflects a fraught and painful history, where profits and incentives were too often used as an excuse to let the poor die preventable deaths, particularly during the HIV pandemic. In a recent presentation, Rachel Silverman tries to ”fairly (but slightly provocatively) characterize the arguments (and caricatures) on both sides of the debate; situate them within historical and broader context; and point out the strengths and weaknesses on both sides. » She concludes with her thoughts on a practical path forward that helps break out of the impasse and end the pandemic as quickly as possible.
One of a number of excellent reads who make the point, correctly, that a TRIPS waiver is only a first, though very important step. Excerpts:
“Support for the waiver, and the latest US Trade Representative report indicating that the US will respect the right to grant compulsory licenses consistent with the the TRIPS Agreement, may give all trading partners, not just developing countries, the confidence to boldly use those powers to improve the supply of COVID-19 vaccines without fear of trade retaliation. But aspects of the US announcement are more narrow in scope than the original proposal. The initial proposal would cover all technologies for the detection, prevention, treatment and response to COVID-19, while the US statement limits its support for waiving intellectual property rights in vaccines only. While vaccines are the centre of attention right now, the broader proposal would address the limited supply of therapeutics, like Baricitinib or Redemsivir, or diagnostics, like reagents for COVID test kits. Nevertheless, the US support could help bring the TRIPS waiver to the next stage of “text-based negotiations”. There is now hope that formal negotiations can start addressing outstanding issues, such as how long the waiver would last, and whether anything more than vaccines may be covered….”
“As the TRIPS waiver gained public attention, many have referred to the measure as a “patent waiver”. This has obscured other intellectual property rights which are included in the original proposed TRIPS waiver: copyright, trade secrets, and designs – not just patents. By covering multiple types of intellectual property in a global measure, the TRIPS waiver as originally proposed would provide more freedom to operate for manufacturers and suppliers and to do so in a speedy manner….”
“… To end the pandemic, we need a number of different strategies to share around the benefits of existing COVID vaccines, treatments and tests, as well as enable further innovation from multiple sites. …” “Wealthy countries need to reverse their over-ordering of doses, export restrictions should be lifted to increase production, and data from regulatory approval processes should be made accessible. Governments should oblige companies, paying them where necessary, to enter into voluntary transfers of their know-how, share trade secrets and other undisclosed information. The TRIPS waiver is a masthead for all of these things to happen simultaneously and urgently now.”
“An IP waiver alone will not solve the covid-19 vaccine access challenge, other steps will be needed, say Gregg Gonsalves and Gavin Yamey.”
Cfr tweet Els Torreele: “Excellent piece by @gregggonsalves and @GYamey on how to get more vaccine equity now: redistribute existing doses, IP-waiver, technology transfer to LMIC producers, and financial support to get them up and running .”
A few excerpts:
“… Even if COVAX succeeds in reaching its targets, only 20% of people in LICs and lower-middle income countries (LMICs) will be fully vaccinated by the end of 2021. When COVAX launched, it set the goal of procuring 2 billion doses for LICs and LMICs by the end of 2021, enough to vaccinate one billion people (assuming a two-dose regimen). While COVAX forecasts that it is still on target to reach this goal, it would still mean that just 20% of people in these less-wealthy nations would be fully vaccinated this year. The targets lacked ambition because they were based on a “scarcity mindset”—an acknowledgement that total global doses would be limited and rich nations would likely hoard the supply. …”
“…We call on Gavi, WHO, and CEPI (the three COVAX hosts) to join their close partner UNAIDS and become members of the People’s Vaccine Alliance, which is thinking bigger and more boldly….”
They list a number of crucial steps towards a people’s vaccine.
“Intellectual Property Is Just One Piece of an Elaborate Process.”
Including a 10-year plan: “…To lay the groundwork for the transfer of mRNA vaccine technology to low- and middle-income countries, vaccine producers in India, Brazil, and an African nation or one in the Middle East should start by establishing hubs of excellence for chemistry manufacturing and control. These hubs would then support mRNA vaccine research, development, and production in areas of the world currently lacking access. They would supply on-site training to professionals, who would also receive instruction from the technical operations teams at Pfizer-BioNTech and Moderna. The hubs should work with the WTO to ensure that vaccine ingredients and equipment flow freely through international supply lines. Manufacturing plants might have to produce equipment and materials for such hubs: bioreactor bags, for example, and specialized filters. Both the hubs and the vaccine producers in low- and middle-income countries will need public support and sustainable funding from the United States and other G-7 nations, together with the World Bank Group, possibly through innovative financial instruments such as capital subsidies or purchasing contracts.” Let’s hope it won’t take that long.
Short summary by the author: “There aren't vaccine supply chain shortages INSTEAD of problems with IP and monopolies. Those shortages are BECAUSE of problems with IP and monopolies.”
“One of the main arguments from the pharmaceutical industry against waiving certain intellectual property rights in the pandemic is that supply chain shortages, not patents, are the limiting factor in vaccine production. … it’s important to recognize these industry commenters are certainly correct when they identify supply chain shortages as a significant barrier limiting production. But these libertarians and pharmaceutical industry defenders don’t attempt to explain why these shortages are so pervasive. Vaccine manufacturing supplies, including single use bioreactor bags, are not only in short supply because of exceptionally high pandemic demand, but also because there’s been a classic monopoly rollup of the bioprocess supplies industry in recent years. That consolidation is fortified by extensive intellectual property barriers that prevent new entrants from manufacturing these now crucial bioreactor bags and filters….”
“There are now four dominant firms in the space, as permitted by the Federal Trade Commission and the European Union competition authorities. … There are four dominant players: Merck, Danaher, Sartorius, and Thermo Fisher. The current industry structure is a result of a systemic roll-up in the industry, largely so conglomerates could have a full integrated suite of products to offer to pharmaceutical buyers, as well as the pricing power in doing so, in addition to extensive intellectual property thickets. …”
“Global collaboration is essential, writes Spanish prime minister.”
“…. This is why Spain is proposing a comprehensive initiative to facilitate the transmission of the necessary technology and expertise, lift all barriers to ramping up production and accelerate vaccine distribution. First, until agreement is reached at the World Trade Organization, we need to deploy all available mechanisms to incentivise pharma companies to enter into voluntary licensing agreements, as well as the pooling of all forms of knowledge related to the virus, including through the WHO’s Covid-19 Technology Access Pool. The upcoming G20 global health summit and the World Health Assembly should be used to encourage the industry to transfer the necessary knowhow. Second, it is critical to make full use of existing manufacturing capacities while removing trade obstacles and ensuring the proper functioning of supply chains. … Third, the transportation, distribution and delivery of vaccines needs to be accelerated, both between countries and within them. Covax must be given the financial and non-financial support it needs to meet the goal of delivering at least 2bn doses by the end of the year. Likewise, the “health systems connector” pillar of the WHO’s global collaborative framework should be buttressed to build the necessary processing, storage, distribution and delivery capacity….”
See also Politico Pro: Spain calls for new working group to change global IP rules (gated)
"Spain also calls for a joint commitment to be made to the COVID-19 Technology Access Pool at the upcoming World Health Assembly, to put pressure on industry to work with the pool. At present, no pharmaceutical company has signed up."
“A preliminary network analysis highlights the complex intellectual property landscape behind mRNA-based COVID-19 vaccines.”
Cfr Tweet Els Torreele: “Very cool and informative map of patents on mRNA vaccines and their interlinks by @burcuno . All of them must be waived to clear the way for other producers to help solve covid-19 vaccine inequity.”
And a link:
“WHO scientist Soumya Swaminathan on Monday supported India and South Africa's proposal of waiving TRIPS to Covid-19 Vaccines….”
Coverage of Wednesday’s meeting of the ACT-Accelerator’s Facilitation Council,
“In a rush to jumpstart more global vaccine manufacturing capacity, the global COVAX vaccine facility is now stepping into the fray. A new COVAX Supply Chain and Manufacturing Task Force have laid out a three-stage plan to enhance existing vaccine production capacity, as well setting up a new “vaccine manufacturing group” – to further expand production long-term. The plan aims to address immediate manufacturing bottlenecks, expanding existing capacity and workforce capacity limitations as fast as possible, through: Identifying and matching “fill and finish” manufacturers with producers of active ingredient; Accelerating approvals of export permits/customs clearances; Facilitating partnerships for the supply of vital vaccine inputs. …”
“… According to Seth Berkley’s vision, over the next few months, COVAX will be focused on ensuring there aren’t shortages in products or delays at existing manufacturing facilities. Over the medium-term, through end- 2022, a manufacturing workforce will be developed to maximize even more production using existing systems. The long-term goals of COVAX, meanwhile, include expanding production capacity in low- and middle-income countries, and particularly in Africa, through efforts such as a new mRNA vaccine technology hub, led by WHO. …. … As a longer-term thrust, a new WHO vaccine mRNA manufacturing training facility aims to train and develop more vaccine manufacturing professionals – who could help kickstart new vaccine facilities in LMICs. … The hub and training center are expected to launch by 2022 …
“… In yet another thrust, a COVAX Task Force Coordination Office will also be created to map the vaccine manufacturing ecosystem, including shortages in key vaccine raw ingredients, identifying supply gaps for the Task Force address. … Dr Ngozi Okonjo-Iweala, Director General of the World Trade Organization (WTO), announced that WTO would join the COVAX Supply Chain and Manufacturing Task Force at the Facilitation Council meeting on Wednesday. … … Meanwhile, as part of a longer-term initiative – a “COVID-19 Vaccine Manufacturing Working Group”, was announced Wednesday by the ACT Accelerator Initiative. That high-level effort, co-chaired by Germany and South Africa, aims to address more fundamental shortages in raw materials, and opportunities for technology transfer by vaccine manufacturers – to increase the long-term stability of doses to the global vaccine facility, COVAX, and ensure the equitable distribution of vaccines …”
“… In order to deliver on the promises of the ACT-Accelerator, US$18.5 billion is needed to fill the financing gap. Some US$6 billion was mobilized in 2020 and an additional US$8.5 billion was mobilized so far in 2021, however, more is needed urgently. “
You might want to check out some documents, like the Access to COVID-19 tools funding commitment tracker (with funding situation on 11 May)
“As of 11 May 2021… commitments of USD 14.6 billion. The ACT Accelerator Commitment Tracker provides details of this funding. These pledges, together with cost adjustments since September 2020, bring the remaining funding gap for 2021 to USD 18.5 billion.”
“The Government of Japan yesterday announced that it will host the virtual Gavi COVAX Advance Market Commitment (AMC) Summit on June 2nd 2021. The event, co-hosted by Japanese Prime Minister H.E. Yoshihide Suga and José Manuel Barroso, Chair of the Gavi Board, will aim to secure at least US $8.3 billion for 2020-21 in order to accelerate access to 1.8 billion COVID-19 vaccine doses for lower-income economies via the Gavi COVAX Advance Market Commitment by raising an additional US$ 2 billion from donors and the private sector in addition to US$ 6.3 billion raised before the campaign was launched at the “One World Protected” event on April 15th….”
“Securing 1.8 billion doses would enable the AMC to protect nearly 30% of the population in all AMC countries, or roughly half the entire adult population. Currently, the AMC has funds in place to protect approximately 20% of populations, equivalent to all health and social care workers, elderly and those with underlying health conditions. The additional funds are also urgently needed to diversify the portfolio in times of supply uncertainty; secure access to doses for delivery in 2021 and early 2022; and plan the scenarios and strategy for public health needs for 2022 and beyond….”
Coverage of an emergency meeting of African health ministers last weekend.
“The COVAX Facility is 150 million COVID-19 vaccine doses behind schedule because of export restrictions in India — and that number will reach 190 million doses next month, said Dr. Seth Berkley, CEO at Gavi, the Vaccine Alliance, during an emergency meeting of African health ministers on Saturday. … … The facility has delivered 54 million doses to 121 countries, according to Berkley. … At the meeting, African health ministers said they are not sure what they should do with the doses they have, and worry that if they use up all of their supply on first doses, they won’t have vaccines to provide people with their second doses given the delay in shipments. … This is a “big worry” shared by many African nations, said World Health Organization Africa Regional Director Dr. Matshidiso Moeti. She advised countries to not hold back doses and to vaccinate as many people as possible, expressing concern about the expiration of the doses already delivered. … Moeti said that there is a lot of work happening to ensure that additional supplies are secured so that countries have the doses before the 12 to 16 week period where those who had their first dose would need a second dose. She called upon countries to use their relationships with wealthier countries who have stockpiled vaccines, to encourage them to share doses — particularly of AstraZeneca. … Berkely said that COVAX is working to diversify its portfolio — it now has eight vaccines included in the program. COVAX deals with Novavax and Moderna were signed last week. “We'll be announcing some more, plus larger quantities of the existing vaccines. And we plan to get up to 10 or 12 different vaccines in the portfolio,” Berkley said. The facility will publish new projections on timing of allocations in the coming days, he said….”
“… A concert event that aired on May 8 called Vax Live, organized by the international advocacy group Global Citizen, raised more than $60 million and other support for COVAX, Gavi, the Vaccine Alliance, announced today. The event featured performances from musical stars and messages from heads of state, including US President Joe Biden, and other well-known leaders, such as Pope Francis. The United Arab Emirates (UAE) announced that it will donate 1 million COVID vaccine doses and will help distribute 25 million doses through its supply chain. Other countries announcing donations included Croatia, which pledged to share doses with its neighbors, and Canada, which announced more support for the WHO's ACT Accelerator, designed to speed the development and equal distribution of vaccines, drugs, and diagnostic tests. Several corporations also announced new support, including a $25 million pledge from Mastercard and $5 million from Cisco and Procter & Gamble….”
See also GAVI
Berkley: “… COVAX needs $1.6 billion by June to be fully financed for 2021.”
From late last week. “The Chinese-made Sinopharm vaccine became the latest COVID-19 vaccine to receive an Emergency Use Listing from the World Health Organization (WHO) on Friday; experts said the vaccine showed an overall efficacy rate of 79% in preventing symptomatic and serious disease. The WHO approval positions Sinopharm to become a major player in the COVAX global facility. … It remains to be seen, what kind of deal the Beijing-based pharma company might negotiate with COVAX. … At a press briefing on Friday, it was clear that WHO officials are keen to call on Sinopharm’s participation….”
· And via the Guardian:
“Sinopharm said in March that at least 100m of doses of its two vaccines have been supplied across the world, while over 80m doses of the two vaccines were administered. Experts said today’s decision by the world’s top public health authority could be a gamechanger, especially for developing countries. “If there is a green light, these vaccines could boost the thin stream of supplies that has been channelled through Covax to date,” Suerie Moon, co-director of the Global Health Programme at Geneva’s Graduate Institute, told the Associated Press news agency….”
“… It is the first vaccine of any kind made in China to receive emergency use authorisation from the WHO. The approval is a signal to countries that the Sinopharm vaccine is safe to use and means that the jab will be added to the WHO’s vaccine procurement programme Covax….”
“WHO today listed the Sinopharm COVID-19 vaccine for emergency use, giving the green light for this vaccine to be rolled out globally. The Sinopharm vaccine is produced by Beijing Bio-Institute of Biological Products Co Ltd, subsidiary of China National Biotec Group (CNBG). …”
Not very good news for Covax.
“Novavax, one of the first players in the race to vaccinate the world against Covid, delivered disheartening news on Monday, saying that its highly protective vaccine would not be authorized in the United States or Britain until at least July, and that it would not reach peak production until the end of the year. … … the company has struggled to demonstrate that it can deliver on its promise to supply the world with 2 billion doses this year. Novavax has never brought a vaccine to market in its 34-year history.”
“… But it is likely to have significant repercussions for the rest of the world, given that just last week, Novavax finalized a deal with Gavi, a public-private global vaccine partnership, to supply 1.1 billion doses of its shot to low- and middle-income countries. Novavax has struck other deals with countries like South Korea, Japan and Australia, and has set up agreements with eight production plants around the world. … One of its major manufacturing partners, the Serum Institute in India, has faced its own production and geopolitical challenges. … … Serum is the backbone of vaccine supply to the world,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center, which is tracking global vaccine deals. “I think particularly for countries in South and Southeast Asia, as well as countries in Africa, it is hard to overstate the impact that this is having.” “
With some key trends & WHO messages.
“The WHO said in its situation report that global cases dropped slightly last week and that India made up 50% of the world's cases, with worrying trends seen in some neighboring countries. Though overall cases declined in Europe and the Middle East, some countries saw double-digit increases last week, including Nepal (79%), South Africa (41%), and Malaysia (19%). At a briefing today from the WHO's Pan American Health Organization (PAHO), its director Carissa Etienne, MBBS, MSc, said a number of Americas countries are still experiencing surges, putting pressure on health systems and oxygen supplies. For example, intensive care unit beds in Chile and Peru are at 95% capacity, and some parts of Brazil have waiting lists. She also warned that cases are surging in some border areas, such as parts of Guyana and Bolivia that border Brazil. Also, Colombia's cases have steadily risen over several weeks, which could worsen following a week of protests….”
See also HPW on the situation in Latin America - Pandemic ‘Far From Over’ in the Americas; Vaccination Prompting a ‘False Sense of Security’ in the Region
“Coronavirus cases are exploding in Asia and the Pacific with over 5.9 million new confirmed infections in the past two weeks, more than in all other regions combined, the International Federation of the Red Cross said Wednesday. It warned that the surge is pushing hospitals and health systems to the brink of collapse. Seven out of 10 countries globally that are doubling their infection numbers the fastest are in Asia and the Pacific, it said….”
Via Cidrap News:
“Though Africa's overall cases and deaths have decreased for the third week in a row, 11 countries are reporting increased cases, with South Africa and Uganda reporting the biggest rises, the WHO's African regional office said yesterday in its weekly outbreaks and health emergencies report. "The overwhelming increase in cases and deaths in India, and increases in other regions of the world, are clear signs that the pandemic is not yet over in African countries," the group said….”
“ Limitations in testing capacity and surveillance—as well as uneven demand for testing—are likely masking the true severity of COVID-19 on the African continent, fueling the dangerous myth that much of Africa has been unscathed by COVID-19. Test positivity rates were above 10% across many African Union (AU) member states during the second wave—substantially higher than the 5% maximum warning level suggested by the WHO and suggesting that many cases have gone undetected – says new research from the Partnership for Evidence-Based Response to COVID-19 (PERC)….”
“World Health Organization chief Tedros Adhanom Ghebreyesus said on Monday he was focusing on fighting the current pandemic, when asked if he would stand for a second term as head of the agency. "So I think it's time to still focus on this pandemic. It's very unprecedented. I'm currently focused on fighting this pandemic with my colleagues working day and night," Tedros told a briefing….”
“The World Health Organization (WHO) has decided to classify the B1.617 variant first identified in India as a “variant of concern”, according to Maria Van Kerkhove, WHO lead on COVID-19….”
“WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that global COVID-19 cases have started to “plateau” – but at an “unacceptably high” rate with more than 5.4 million new cases and almost 90,000 deaths in the past week. “ There are declines in most regions including the Americas and Europe, but …. Cases and deaths are still increasing rapidly in WHO’s South East Asia region and there are countries in every region with increasing trends,” added Tedros. “The spread of variants, increased social mixing, the relaxation of public health and social measures and inequitable vaccination, are all driving transmission,” he added….”
PS: Tedros also said that the WHO Foundation was launching a "Together for India" appeal to raise funds to purchase oxygen, medicines and protective equipment for health workers.
“Although the outlook for global growth has improved, the ongoing impacts of the COVID-19 pandemic, as well as inadequate progress on vaccination in poorer countries, are putting recovery at risk, according to the latest UN economic forecast, published on Tuesday. The World Economic Situation and Prospects (WESP) mid-year report warned widening inequality is threatening global growth, projected at 5.4 per cent this year. …”
Ariel Karlinsky; https://akarlinsky.github.io/_pages/IHME-critique.html
Karlinsky is from the World Mortality Database. His thoughts on IHME’s updated estimates of global and national mortality (see last week).
“The main result of IHME’s analysis is that global excess deaths are 2-2.5 times higher than reported COVID deaths is probably true, though this might a lower bound as well. What worries me is the details that they have shared, which show that their excess estimates are wildly out of bounds of anything we know, even though data should be identical, and that they have very little actual data to work with….”
“ COVID-19 vaccine developers are making ever bolder assertions that the world will need yearly booster shots, or new vaccines to tackle concerning coronavirus variants, but some scientists question when, or whether, such shots will be needed. In interviews with Reuters, more than a dozen influential infectious disease and vaccine development experts said there is growing evidence that a first round of global vaccinations may offer enduring protection against the coronavirus and its most worrisome variants discovered to date. Some of these scientists expressed concern that public expectations around COVID-19 boosters are being set by pharmaceutical executives rather than health specialists, although many agreed that preparing for such a need as a precaution was prudent. They fear a push by wealthy nations for repeat vaccination as early as this year will deepen the divide with poorer countries that are struggling to buy vaccines and may take years to inoculate their citizens even once. We don't see the data yet that would inform a decision about whether or not booster doses are needed," said Kate O'Brien, director of the Department of Immunization, Vaccines and Biologicals at the World Health Organization (WHO). O'Brien said the WHO is forming a panel of experts to assess all variant and vaccine efficacy data and recommend changes to vaccination programs as needed….”
“World Health Organization will test whether three existing drugs can save lives of hospitalized people. … A landmark programme to test potential COVID-19 therapies in dozens of countries is restarting with a fresh roster of treatments — this time aimed at tempering the raging immune responses that can worsen severe disease. The clinical trial, named Solidarity and coordinated by the World Health Organization (WHO), will test three drugs that dampen inflammation, an approach that has already shown promise in people hospitalized with COVID-19….”
“Variants including B.1.617 have been linked to India’s surge in infections. Researchers are hurrying to determine how much of a threat they pose.”
“The question about how Covid-19 vaccines stand up to coronavirus variants often gets distilled to: Do they work? The simplest answer is yes. People who’ve received one of the highly powerful vaccines don’t need to be too worried about the variants for now, experts say. But the complete answer is more complicated….”
“Below, STAT outlines the latest on some of the vaccines’ performance against the variants, what’s known about the variant of concern in India, and how the continued emergence of variants will shape the future of Covid-19….”
“Modelling suggests countries struggling to immunise populations could adopt UK strategy”.
“ Multiple travellers carried a new coronavirus variant from central Africa to Europe, where it has now spread to at least a dozen countries, according to genomic data. The variant, named B.1.620, hosts a suite of mutations that have been linked to increased transmissibility and the ability to escape the immune response. The findings suggest that the variant is circulating widely in central Africa but has been undetected because of limited sequencing, highlighting the risk posed by regional inequities in genomic surveillance.”
Some more reads on Covid-vaccine access, inequity… (including geopolitics & vaccine diplomacy around it) and other bottlenecks.
“Over the past few weeks, leaders of some of the globe’s most populous nations have sought more shots from China despite concerns about their effectiveness. Demand is expected to rise even further now that the World Health Organization has authorized a vaccine from China’s Sinopharm Group Co. Ltd. and is expected to soon do the same for Sinovac Biotech Ltd.’s. That will allow developing countries in Asia, Africa and Latin America to access them through Covax, the global vaccination effort. “China has become not just the largest exporter,” said Yanzhong Huang, a China specialist and senior fellow for global health at the Council on Foreign Relations. “In many countries it has become the only option.” “… In the meantime, countries from Uruguay to Senegal to Indonesia have few places to turn apart from Beijing -- and China is making the most of it. The country has already shipped out about 240 million doses, more than all other nations combined, and has committed to providing another 500 million, according to Airfinity Ltd., a science information and analytics company. …”
“… Some experts, though, are worried about the potential public-health impact of widely deploying Chinese vaccines that have demonstrated lower efficacy rates than those made by Pfizer and Moderna. …”
Very depressing read. See also a tweet by Els Torreele: “This (well-written) article is disturbing in so many ways - from an ugly nationalistic scramble to hoard vaccines to a scramble to make "strategic donations" for political opportunist reasons?? Where is equity, ethics, health rights, access, and...decency?”
A few excerpts:
“Europe is about to have more doses than it needs. Now the bloc is deciding how to get the most political punch out of its excess vaccines. …. Within a matter of months, supply of vaccines around the EU is set to outstrip demand. It’s a sudden reversal from the halting vaccinations and uneven delivery schedules of the past few months. … …. So now, European capitals are eyeing ways to maximize their vaccine diplomacy by sending doses to strategically important places. Some are still open to working with COVAX, just as long as the global distribution initiative works with them to help the EU fulfill its geopolitical goals while giving unneeded doses to countries in need….”
Others: “… “You can clearly see that the COVAX Facility did not turn out as appreciated as intended,” said one EU health attaché, urging the Commission to develop its own mechanism for sharing doses. “
“With vaccines to spare, the looming question for EU capitals is whether to channel them through COVAX, ideally maximizing the impact and ensuring equity, or go their own way on donations in hopes of getting more credit for their largesse.
“… geopolitical competition is proving irresistible. In a letter dated May 6 — just days after Sweden’s COVAX donation — Prime Minister Stefan Löfven joined other top COVAX supporters Macron and Sánchez, along with the prime ministers of Belgium and Denmark, to call for urgent approval of a European dose-sharing mechanism “to complement and support COVAX’s leading role.”…”
“Critics say the administration has taken a piecemeal approach to the worsening international crisis.”
“… Even some administration officials concede that Biden’s recent decision to support the developing world’s petition for a vaccine-patent waiver, which drove a wedge with drug companies that sped hundreds of millions of doses to inoculate America and is unlikely to boost supply this year, shows the risk of dribbling out tactics, rather than setting out a comprehensive strategy to help vaccinate the world. … inside the Biden administration, there is confusion over which agency is leading the effort to craft the country’s global vaccination strategy, which has led to a fragmented rather than strategic approach. While Jeff Zients, the covid-19 coordinator at the White House, has been the person in charge of setting and executing the domestic fight against the virus, five administration officials say there are too many players addressing the worldwide challenge, with not enough direction. The actors involved in the global response include officials from the White House’s coronavirus response team, the National Security Council, the Office of the U.S. Trade Representative, the State Department, the U.S. Agency for International Development and HHS. Several of those officials conceded that the United States does not appear to have an overarching strategy but rather is taking a piecemeal approach. Speaking on the condition of anonymity because they were not authorized to discuss the issue publicly, some framed the government’s recent actions, including sharing 4 million AstraZeneca doses with Canada and Mexico, pledging an additional 60 million doses later this year, and supporting the patent waiver, as incremental steps….”
“While the African Union has secured up to 400 million doses of Johnson & Johnson’s COVID-19 vaccine for countries to purchase, very few have finalized orders — and time is running out.”
“… Only Botswana, Cameroon, Tunisia, Togo, and Mauritius have completed orders and submitted a 15% deposit as a down payment for the doses, said Benedict Oramah, president of the African Export-Import Bank, or Afreximbank, during an emergency summit of health ministers on Saturday.
Another 13 have signed commitment letters, but not given deposits, and another 17 have expressed interests in pre-orders but not taken further action. Twenty-one countries have not taken any action toward securing these doses. The AU expects to close its order book in the coming weeks in order to move forward with finalizing the delivery, which will start in the third quarter of this year.”
… The AU is taking an “All of Africa” approach to securing doses, through a pooled procurement rather than countries negotiating independently with manufacturers, which helps countries to access lower prices, Oramah said. … The World Bank is expected to provide financing to countries, which would include grants and concessional loans, for the purchase of vaccines and the funding from Afreximbank serves as bridge financing in the interim before this funding is accessible, Oramah said. … … “We've worked very hard to secure those as the African Vaccine Acquisition Task Team. It is up to countries now to show the leadership and what I call the 'fierce urgency of now,' to protect their people and protect their economies by securing those vaccines,” Nkengasong said.
“Forty-eight SSA governments are expected to require at least $12.5 billion to vaccinate 70% of their population, defined globally as the minimum coverage to achieve herd immunity.”
“Estimating the costs of COVID-19 vaccine deployment enables countries to plan and budget for its distribution. African countries are seeking vaccines through different channels, including the COVID-19 Vaccines Global Access (COVAX) Program, the WBG’s US$12 billion financing package, the African Union (AU), bilateral negotiations, and donations. …. … As part of the Inter-Agency COVAX Costing Group, the World Bank is helping countries to estimate the cost requirements of their COVID-19 vaccination programs. With Bank guidance, the costing exercise also facilitates a conversation around a sustainable COVID-19 program and health system. The information below provides preliminary estimates for countries that need tools to prioritize and advocate for the expansion of health financing for vaccines. …” (with costing for various SSA countries)
“… To understand what this means for African countries, these average vaccination costs per capita add up to approximately 150%, or 1.5 times, the annual total government health expenditure (THE-G) per capita of African governments, although figures vary greatly among countries. These estimates also show, however, that achieving herd immunity in African countries would cost just over 1% of the potential $9.2 trillion loss to the world economy if developing countries cannot vaccinate their population. …. Figure 3 shows that fiscal burdens are highest in the Democratic Republic of Congo (vaccination cost per capita is 5.13 times higher than THE-G per capita), South Sudan (4.96 times higher), and Cameroon (4.43 times higher), while in the Seychelles (0.04 times), Botswana (0.07 times), and South Africa (0.09 times), vaccination makes up the lowest share of total health expenditure. …”
“The UK should commit to giving 20% of its vaccines to other countries that are in urgent need of them as early as June, according to Unicef, which says the UK will still have enough to vaccinate every adult by the end of July. The children’s charity estimates the UK will have enough spare doses this year to fully vaccinate a further 50 million people around the world, and urges the government to set an example to the G7 by starting to share them next month. Vaccinating the populations of other countries is the only way to ensure new coronavirus variants do not spread, it says. Unicef made its call before the G7 summit in the UK next month and as France announced it would donate up to 5% of its vaccine stocks to Covax, the UN-backed initiative to get vaccines to lower-income countries. ….… Unicef says the UK should lead by example and called on other G7 countries also to donate 20% of their vaccine stocks to Covax….”
Plus an interesting quote Bruce Aylward: “In sub-Saharan Africa the number of people who are vulnerable is 3-4% of the population. And an even smaller percentage of health care workers.”
“Tens of millions of asylum seekers, migrants, refugees and internally displaced people around the world have been excluded from national Covid-19 vaccination programmes, according to World Health Organization research seen by the Guardian. The gaps mean that a scattered group numbering at least 46 million people, about the size of the population of Spain, may struggle to get vaccinated even if a global shortage of doses eases. Among the excluded are 5.6 million people internally displaced by six decades of civil war in Colombia, hundreds of thousands of refugees in Kenya and Syria and nearly 5 million migrants in Ukraine….”
In related news, see also HPW - Excluding Refugees, Migrants & Other ‘Uprooted People’ From COVID Vaccine Campaigns Undermines Global Health & Safety
“ Overcrowding in refugee camps, mistrust of authorities including vaccination registration processes, and lack of access to vaccines are some of the most pressing problems preventing migrants, refugees and other “uprooted people” from getting COVID-19 vaccines, panelists said in a Geneva Global Health Hub (G2H2) panel on Tuesday….”
“Humanitarian organisation Médecins Sans Frontières (MSF) has called on US diagnostics corporation Cepheid, which produces the GeneXpert testing machines that run COVID-19 tests, to immediately reduce the prices for the tests to allow for more people to be diagnosed as the pandemic continues to ravage parts of the world. MSF’s plea comes after Cepheid on Thursday announced that it will reduce the price of its new 10-color IV-4 GeneXpert machines from US$19,000 to $15,800, and additionally offer countries buying those machines ‘100 COVID-19 tests for free’. Similar bundled price reductions for the larger XVI GeneXpert machines and COVID-19 and TB tests have also been announced. … … Cepheid has set the price for each COVID-19 test at $19.80, which is at least 400% more than it costs the corporation to produce the test, based on MSF’s analysis of the cost of manufacturing Cepheid’s similar TB and HIV tests. …”
“The Biden administration’s decision to stop opposing a proposed COVID-19 waiver of certain intellectual-property rights under World Trade Organization rules is a welcome move. But ending the pandemic also requires scaling up knowledge and technology transfer, as well as public production of vaccine supplies.”
“The World Bank has pledged $12 billion to help poor countries purchase and distribute COVID-19 vaccines, tests, and treatments. But its pledge lacks critical information, raising the risk that this urgently needed financing will be wasted….”
André Bourla started a PR offensive after the Biden decision. “’s chief executive said that low- and middle-income countries had opted not to order the company’s Covid-19 shot, in a letter posted online after the Biden administration said it supported waiving patents to expand global access to vaccines. “We reached out to all nations asking them to place orders so we could allocate doses for them,” Chief Executive Officer Albert Bourla said in . “In reality, the high-income countries reserved most of the doses. I became personally concerned with that and I reached out to many heads of middle/low-income countries by letter, phone and even text to urge them to reserve doses because the supply was limited.” … Most low-and middle-income countries he contacted decided to place orders with other vaccine makers either because the underlying technology used in Pfizer’s shot was still untested, or there were local production options available, Bourla wrote.
… In a letter responding to the public debate over the proposal, Bourla said that Pfizer and BioNTech use a tiered pricing model for their vaccine. Middle-income countries are asked to pay half what the highest-income nations do, while low-income countries are offered the shot at cost. “
“… Pfizer and BioNtech are on track to deliver 3 billion doses this year to more than 116 countries, Bourla said, and that the 450 million doses delivered to date have been heavily weighted toward higher-income countries that pay the most…. Bourla expects 40% of doses, or more than 1 billion, will go to middle- and low-income countries this year. “We expect the supply balance to weigh in their favor in the second half of 2021,” he said, “and to have virtually enough supply for all in 2022.”
“The Fosun unit will contribute up to US$100 million of assets including cash and a manufacturing facility, while BioNTech will chip in the licence and know-how; Fosun is BioNTech’s exclusive partner for the vaccine in mainland China, Hong Kong, Taiwan and Macau.”
“BioNTech said on Monday it plans to set up a regional headquarters and build a new manufacturing site for its vaccines based on messenger RNA technology (mRNA) in Singapore, in the latest move to expand its production network. The biotech company said the Singapore production facility will have an estimated annual capacity of several hundred million doses of mRNA-based vaccines depending on the specific type, once it is operational in 2023. BioNTech said its expansion plans were supported by the Singapore Economic Development Board and would increase the global supply of mRNA-based vaccines and establish a production facility in south east Asia to respond rapidly to future pandemics. … …. BioNTech plans to open the Singapore office in 2021 and expects the manufacturing site to be operational by 2023, creating up to 80 jobs in Singapore….”
Laurie Garrett’s take: “Loosening property rules over coronavirus vaccines is likely to accelerate—not stifle—the pharmaceutical industry’s creativity.”
Still, “…Although waiving TRIPS requirements on COVID-19 vaccines is a spectacular, historic gesture, would-be generic makers worldwide will soon discover their efforts are stymied not by patents but for want of Avanti Polar Lipids’ liposome ingredients, Flexsafe RM special bags to hold liquid vaccines in bulk, phosphate-buffered saline solution, Distearoylphosphatidylcholine for liposome-making, 5’ cap for mRNA made by TriLink BioTechnologies, RNA polymerases—the list goes on, and on, and on. As the number of would-be vaccine makers grows, so will demand for thousands of such items, putting pressure on companies that are, in many cases, mom-and-pop operations. Worse, pressure on supplies critical for COVID-19 vaccine making is already resulting in a production loss of vital medicines for other diseases. …Scaling up vaccine production to produce enough doses to fully immunize more than 7.8 billion people will require a level of international coordination and cooperation never previously seen. Knocking down patent barriers on the final vaccine formulations is a start, but that’s all that it is.”
“Adar Poonawalla and Serum Institute have come under withering criticism as Covid ravages India.”
Brilliant analysis. “The COVID-19 Global Access (COVAX) initiative is being touted as a key step toward vaccine equality. But many of COVAX’s donors and architects are deeply enmeshed in the global intellectual property regime at the heart of vaccine apartheid.”
“German group plans to invest proceeds in bid to become a leading force in cancer therapies.”
“BioNTech beat expectations in its first-quarter earnings, swinging to a €1.6bn profit and pledging to invest proceeds from its Covid-19 vaccine in becoming a “powerhouse” in cancer therapies. The German biotech, which has developed its vaccine with Pfizer, forecasts current 2020 contracts to supply 1.8bn doses are worth about €12.4bn. But this could rise further as BioNTech expects to have manufacturing capacity for up to 3bn doses this year. The company has already signed contracts for 2022 with Canada and Israel, and is in talks with other governments eager to prepare for waning immunity or new variants by buying up booster shots. Ugur Sahin, BioNTech’s chief executive, said the world would have “more than enough” vaccines in just nine months as it rapidly expands manufacturing. … … … Sahin said the company’s goal was to build a “21st century immunotherapy powerhouse”, using the messengerRNA technology behind the vaccine for drugs that harness the immune system to fight cancer….”
“A Canadian pharmaceutical company, Biolyse, has agreed to provide Bolivia with 15 million doses of the Johnson & Johnson COVID-19 vaccine – as long as the Canadian government gives it a compulsory license to do so. In March, Johnson & Johnson rejected an application by Biolyse for a voluntary license to make a generic version of its vaccine. Biolyse is now seeking a compulsory license in terms of Canada’s Access to Medicines Regime (CAMR) to supply vaccines to Bolivia, which has only managed to vaccinate around 5% of its population. But for this to succeed, the COVID-19 vaccine will have to be listed in Schedule 1 of the Canadian Patent Act as only medical products listed there are eligible for compulsory licenses in terms of CAMR….”
Cfr tweet Jocalyn Clark: “ "offers an alternative to a full waiver of patents.... a rare step to open up avenues for expanded vaccine production with fewer patent restrictions at a time of severe shortages in lower-income countries." Bolivia is calling @WTO bluff, Canadian connection. #CovidVaccine.”
“A provision in Brazil's intellectual property law that allows for unlimited patent term extensions has been declared unconstitutional by the Brazilian Supreme Court, in a decision that could enhance the availability of affordable medicines to patients in need….”
And some links:
“ Vietnam is seeking the transfer of mRNA technology to domestically manufacture COVID-19 vaccines, state media reported on Tuesday, as officials warned of supply issues until the end of the year….” “"Given the currently limited supply to Vietnam, especially as the COVID-19 situation is showing complicated developments, the health ministry has met with a World Health Organization representative to facilitate the negotiations on transferring of mRNA technology," the Vietnam News Agency reported….”
“Chinese jabs are dominating vaccination campaigns in Latin America, the region worst hit by coronavirus, in a win for Beijing that builds on its “mask diplomacy” supplies of ventilators and protective equipment last year. As Latin America struggles against a deadly third wave of the pandemic, China has shipped more than half of the 143.5m doses of vaccines delivered to the region’s 10 most populous nations, according to a Financial Times analysis of data provided by governments. …”
Geneva Health Files - Understanding the Oxygen crisis: Q&A: Robert Matiru, Unitaid
Interview & must-read.
“ A number of countries have faced difficulties in accessing medical oxygen to cope with COVID-19, including in South Asia where many deaths have resulted from a lack of access to oxygen supplies. In February 2021, before the Indian oxygen crisis plunged cities like New Delhi into chaos, WHO had said, that COVID-19 oxygen emergency was impacting more than half a million people in low- and middle-income countries every day, as demand surged. It had assessed needs for US$90 million in immediate funding to meet the demand in 20 low- and middle-income countries (LMICs). A COVID-19 Oxygen Emergency Taskforce was set up under the ACT-Accelerator Therapeutics pillar “to measure oxygen demand, work with financing partners, and secure oxygen supplies and technical support for worst-affected countries.” (Also see COVID-19 Oxygen Needs Tracker.) The Indian crisis laid bare the difficulties in scaling and ensuring access to oxygen supplies. … . This surely has lessons for other countries. Geneva Health Files spoke to Robert Matiru, Director of Programmes at Unitaid, who also advises the ACT Accelerator on therapeutics…”
Among others, on the differences between India & other LMICs (where difficulties are more systemic & long term), on the 6 companies dominating the market, what the international community is doing…
“Medical oxygen’s role has been highlighted during the pandemic. Higher income countries have solved their supply problems but the situation elsewhere remains dire, Jane Feinmann reports.”
“In a briefing paper released today, titled Gasping For Air, Médecins Sans Frontières (MSF) highlights the importance of having medical oxygen supplies at the heart of the COVID-19 response. … Governments must invest in stable oxygen supply chains, including providing more concentrators, and regulating the price of oxygen…. “
“…To try to put numbers on how much of an underestimate it is—and thus on how great the true burden has been—The Economist has attempted to model the level of excess mortality over the course of the pandemic in countries that do not report it. This work gives a 95% probability that the death toll to date is between 7.1m and 12.7m, with a central estimate of 10.2m. The official numbers represent, at best, a bit less than half the true toll, and at worst only about a quarter of it.”
“…Unsurprisingly, most of the deaths caused by covid-19 but not attributed to it are found in low- and middle-income countries. Our figures give a death rate for the mostly rich countries which belong to the oecd of 1.17 times the official number. The estimated death rate for sub-Saharan Africa is 14 times the official number. … We estimate that, by May 10th, there was a 95% probability that the pandemic had brought about between 2.4m and 7.1m excess deaths in Asia (official covid-19 deaths: 0.6m), 1.5m-1.8m deaths in Latin America and the Caribbean (v 0.6m), 0-2.1m deaths in Africa (v 0.1m), 1.5m-1.6m deaths in Europe (v 1.0m) and 0.6m-0.7m deaths in America and Canada (v 0.6m). …”
A Kebede, H Larson et al; https://www.researchsquare.com/article/rs-444605/v3
“This study aims to identify the behavioural determinants of COVID-19 vaccine acceptance and provide recommendations to design actionable interventions to increase the uptake of the COVID-19 vaccine in six lower-and-middle income countries….”
Results: “The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk of getting COVID-19, perceived severity of COVID-19, trust in COVID-19 vaccines, perceived safety of COVID-19 vaccines, and expected access to COVID-19 vaccines had the highest association with COVID-19 vaccine acceptance in Bangladesh, Kenya, Tanzania, and DRC. Additional behavioural determinants found to be significant in both Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. The study also identified important perceptions and beliefs around COVID-19 and its severity, advantages and disadvantages of being vaccinated, and action efficacy of the vaccine to control the spread of the virus.”
“African countries are struggling to bolster genomic sequencing as SARS-CoV-2 variants spread on the continent, reports Abdullahi Tsanni.”
Coverage of a Graduate Global Health Institute webinar from last week. “The COVID-19 pandemic has highlighted how crucial journalism is to counter the rapid spread of inaccurate information and to hold governments accountable, a diverse panel of leading journalists noted on Thursday, a few days after World Press Freedom Day….”
“Vaccine hesitancy threatens the pandemic response.”
“… hesitation is common around the world, according to a new poll by Gallup. In a survey of 300,000 people across 117 countries, the pollster found that only 68% of adults would agree to be vaccinated if a free jab were available to them; 29% said they would refuse. Gallup found that people in richer countries tend to be slightly warier of covid-19 vaccines than those in poorer parts of the world….”
“Wastewater tracking was used before the pandemic to monitor for polio and illicit drug use, but interest in the field and its applications has now ballooned.”
See also NYT - From the Wastewater Drain, Solid Pandemic Data
“The coronavirus could turn sewage surveillance into a mainstream public health practice. …. Health experts anticipate a new age of wastewater epidemiology, with the ability to track not just the coronavirus but other outbreaks and diseases…”
J Nachega et al ; https://www.ajtmh.org/view/journals/tpmd/104/4/article-p1179.xml
“…In this article, we discuss contact tracing experiences, challenges, and lessons learned from four African countries (Nigeria, Rwanda, South Africa, and Uganda) and highlight the need for shared best practices across Africa during subsequent COVID-19 waves and for future pandemics. The information presented draws from a Webinar hosted by the African Forum for Research and Education in Health and Fogarty International Center, NIH….”
“The Lancet COVID-19 Commission Task Force for Public Health Measures to Suppress the Pandemic was launched to identify critical points for consideration by governments on public health interventions to control coronavirus disease 2019 (COVID-19). Drawing on our review of published studies of data analytics and modelling, evidence synthesis and contextualisation, and behavioural science evidence and theory on public health interventions from a range of sources, we outline evidence for a range of institutional measures and behaviour-change measures. We cite examples of measures adopted by a range of countries, but especially jurisdictions that have, thus far, achieved low numbers of COVID-19 deaths and limited community transmission of severe acute respiratory syndrome coronavirus. Finally, we highlight gaps in knowledge where research should be undertaken…”
(by IHME authors). “It's surprisingly hard to answer how many lives we've lost to COVID-19.”
“…On average, in high-income countries, we estimate that around one out of three deaths from COVID-19 may be missing from official tallies. As a whole, the percentage of unreported COVID-19 deaths is higher in low-and middle-income countries than it is in high-income countries. For example, our research indicates that around two out of three deaths may be missing from government statistics in sub-Saharan Africa and South Asia. …”
Clare Wenham et al; https://www.kcl.ac.uk/news/individual-women-leaders-covid#.YJz3IpwhkEg.twitter
“There needs to be more nuance in discussions around gender and leadership.”
“…We think that there’s greater nuance to this story: rather than successful Covid-19 responses being the function of individual women executive leaders, countries which have a better social contract between population and government (the extent to which individuals are willing to sacrifice certain freedoms and bestow power to a political authority, and in return expect to be protected by that authority for the common good) are more likely to elect women, more likely to prioritise public services like healthcare, and more likely to respond better to the pandemic. Importantly, for effective public health interventions, the population has to trust the government and be willing, and able, to adjust their behaviour accordingly….”
“…instead of thinking about individual women leaders, we need to focus on the societies in which these women come to power…”
“Discussions on gender (in)equality during crises requires more than just equality for individual heads of state and should include a holistic approach to improving policies which affect the lives of women and other marginalised communities….”
E Mathieu, M Roser et al ; https://www.nature.com/articles/s41562-021-01122-8
“…We present the Our World in Data COVID-19 vaccination dataset, a global public dataset that tracks the scale and rate of the vaccine rollout across the world. This dataset is updated regularly and includes data on the total number of vaccinations administered, first and second doses administered, daily vaccination rates and population-adjusted coverage for all countries for which data are available (169 countries as of 7 April 2021). It will be maintained as the global vaccination campaign continues to progress. This resource aids policymakers and researchers in understanding the rate of current and potential vaccine rollout; the interactions with non-vaccination policy responses; the potential impact of vaccinations on pandemic outcomes such as transmission, morbidity and mortality; and global inequalities in vaccine access.”
Continues to have very informative data visualizations. This one is on ‘daily deaths by region: top 50’. Showing among others that COVID-19 in India is now claiming twice as many lives every day as in Brazil.
E V Yeika, M van de Sande et al; https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13600
Systematic review. Conclusions: “The prevalence of SMA is high in Africa and varies across sub‐regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex: comprising of socio‐economic factors and insufficient access to healthcare coupled with poorly implemented policies regulating antibiotic sales.”
“…the road to 26 million people receiving ART around the world in 2020 has been a long one. What can the rollout of ART teach us as parts of the world are in the grip of second and third waves of the COVID-19 pandemic? Many researchers have reflected on this in the past year. …”
“… Clearly a waiver on intellectual property alone is not the solution to ensuring equitable access to COVID-19 vaccines, but it does highlight an important lesson from the history of ART that remains to be learned. In a Viewpoint recently published online in The Lancet Global Health, Agnes Binagwaho and colleagues state “We need to examine our moral principles when it comes to vulnerable groups, keeping pharmaceutical companies, normative agencies, and political leaders in check and continuously advocating for initiatives that first and foremost promote ethical and equitable solutions.” More than 30 years after the approval of AZT, the challenges of massive global rollout programmes remain. As science and geopolitics continue to collide, the COVID-19 pandemic gives us an opportunity to reimagine new ethics-based systems for the future.”
“… This WHO Global Database on Prevalence of Violence against Women is a comprehensive database on the prevalence of the two most common forms of violence against women globally: Intimate partner violence and sexual violence by someone other than a partner, referred to as non-partner sexual violence. This interactive data visualization platform presents the first global, regional and country/area estimates on intimate partner violence and global and regional estimates on non-partner sexual violence in the UN SDG era (2015-2030). These Violence against Women, 2018 estimates draw on population-based, nationally or sub-nationally representative surveys/studies conducted between 2000-2018 from 161 countries and areas…”
“A decade after the launch of the Istanbul convention, the landmark human rights treaty to stop gender-based violence, women are facing a global assault on their rights and safety, according to campaigners. This week marked 10 yearssince the to the convention, seen as a turning point in efforts to address violence against women. Yet despite 46 countries signing the treaty, the world has become gripped by a pandemic of violence against women, exacerbated and exposed by Covid-19, according to a UN envoy. “The Covid pandemic revealed what was happening before,” said Dubravka Šimonović, UN special rapporteur on violence against women. She said across the world there had been a stark increase in calls to domestic violence helplines, reports of women missing or killed, and a lack of safe places for those fleeing abuse….”
Some papers & UHC policy news below. More papers (especially on PBF, in a number of countries) in the extra UHC section.
K Diaconu, Sophie Witter et al ; https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007899.pub3/full#.YJjzgQmMzjc.twitter
Review assessing the effects of paying for performance on the provision of health care and health outcomes in low‐ and middle‐income countries.
Conclusion: “The evidence base on the impacts of P4P schemes has grown considerably, with study quality gradually increasing. P4P schemes may have mixed effects on outcomes of interest, and there is high heterogeneity in the types of schemes implemented and evaluations conducted. P4P is not a uniform intervention, but rather a range of approaches. Its effects depend on the interaction of several variables, including the design of the intervention (e.g., who receives payments ), the amount of additional funding, ancillary components (such as technical support) and contextual factors (including organizational context).”
Tedros at the first session of the WHO Council on the Economics of Health for All (chaired by M Mazzucato):
“… universal health coverage is WHO’s top priority. But globally, we are going in the wrong direction. Around the world, more households are spending an increasing proportion of their income on health. And more people are being exposed to poverty as a result of out-of-pocket health spending….”
“We have a unique moment to mobilize investments for healthier, more resilient, more productive and more sustainable societies. That’s where this council can make such an important contribution. We need a new narrative that makes health for all the central goal of public policies on innovation, industry, employment, environment and more. We need a new approach to shaping the global economy, with the objective of building societies that are healthy, inclusive, equitable and sustainable. We need to identify best practices from countries and communities around the world, as the basis for actionable recommendations. And we need ideas that are both bold and practical….”
“There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. …”
“This paper is particularly focused on digital technologies that significantly change “business as usual” – i.e. technologies that substantially transform the way in which health-financing tasks are undertaken by stewards, purchasers, providers, users and citizens in general. These technologies include mobile telephone applications, webpage interaction platforms, blockchain, big data analytics, and artificial intelligence including machine learning. A key premise of this paper is that digital technologies for health financing should contribute to UHC. …”
“… This paper outlines potential benefits and seeks to anticipate and explore possible risks and challenges on the basis of a scoping literature review, including published and grey literature, with a focus on LMICs. It provides initial conclusions and reflections on how to reap the benefits, and mitigate the risks and challenges, in relation to health financing.”
“The repository of health budgets has now been updated and contains links to health budget documents and finance laws from over 120 countries and covers the period from 2017 to 2021….”
“The WHO has launched a new framework for investment and research in Health Systems for Health Security. The event co-hosted by the University of Leeds and WHO - on May 20 - will launch the framework and discuss how to move it forward. Registration can be found at: https://nomadit.co.uk/hsforhs/ …”
S Merriman, S Hawkes et al; https://gh.bmj.com/content/6/5/e005672
Results & conclusion: “Five of the fourteen journals explicitly encourage sex/gender analysis in their author instructions, but this did not lead to increased sex/gender reporting beyond the gender of study participants (OR=3.69; p=0.000 (CI 1.79 to 7.60)). Just over half of research articles presented some level of sex/gender analysis, while 40% mentioned sex/gender in their discussion. Articles with women first and last authors were 2.4 times more likely to discuss sex/gender than articles with men in those positions (p=0.035 (CI 1.062 to 5.348)). First and last authors from high-income countries (HICs) were 19 times as prevalent as authors from low-income countries; and women from low-income and middle-income countries were at a disadvantage in terms of the impact factor of the journals they published in. Conclusion Global health and medical research fails to consistently apply a sex/gender lens and remains largely the preserve of authors in HIC. Collaborative partnerships and funding support are needed to promote gender-sensitive research and dismantle historical power dynamics in authorship.”
And, telling: “Articles with men from HICs as 1st & last authors were published in journals with impact factors nearly *20* points higher than articles with men or women authors from LMICs.”
“The present report contains a brief account of the activities undertaken by the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Tlaleng Mofokeng, since she assumed the functions of the role on 1 August 2020, and identifies the priority themes for her work in the coming years. The main approach of the Special Rapporteur will be to examine the understanding of coloniality and racism, their impact on the right to health and how to move forward to substantive equality. In the report, she argues that substantive equality as a goal allows for the addressing of structural and indirect discrimination and for the identification and elimination of the power dynamics that have perpetuated the systems and patterns of privilege and disadvantage that outlived formal colonialism. To achieve substantive equality in the realization of the right to health, laws and policies should address the intersectional nature of discrimination, namely the lived experiences of those who experience discrimination on multiple grounds. In particular, the Special Rapporteur plans to look into the interrelated and entrenched obstacles operating at different levels that stand between individuals and their enjoyment of sexual and reproductive health rights. The present report includes seven priority themes that will be elaborated throughout the tenure of the mandate holder and also contains two additional issues that will be examined further….”
Showing how systemic racism persists in the global development, humanitarian & peace-building spheres — and exploring what a decolonized aid system might look like. The report draws on global consultations with more than 150 activists, decision-makers, academics, journalists and practitioners.
“Despite the commitments to address the inequities in the system, most notably announced at the World Humanitarian Summit in Istanbul in 2016, little progress has been made in many key areas, including in the funding for local organisations and the way that decisions, power and control is still held by a relatively small number of donors and INGOs….”
Check out the findings as well as the recommendations.
And a few links:
· Matahari Global Solutions and AIDS and Rights Alliance of Southern Africa (ARASA) - Inception report: racial diversity in global health - From rhetoric to tangible change
Inception report based on a roundtable on 25 February. A research report with recommendations will follow before the end of 2021.
“… In this new initiative, ARASA and Matahari Global Solutions are focusing on the effects of racism and white supremacy culture in global health. It is important that we recognize that white supremacy does not exclusively refer to nationalist right-wing extremists and anti-Black violence. Rather, that “in white-centred societies and communities, [white supremacy] is the dominant paradigm that forms the foundations from which norms, rules, and laws are created.” White supremacy, therefore, exists through structures that have been moulded by white people, who, courtesy of these structures, maintain the power to set guidelines that impact the lives of many people. These structures and their power dynamics reinforce conscious and unconscious racial biases….”
· Scidev.net - Open access ‘excludes’ developing world scientists
“Rival UN effort targeting tech companies risks leading to a stand-off with OECD.”
“… US president Joe Biden’s plan to reform global corporate taxation will do little to help the countries most in need of more tax revenues, say developing economies which are lobbying for greater power over multinationals. Washington’s ambitious proposal would tax 100 of the world’s largest companies on profits made in countries where they have little or no physical presence but derive substantial revenues and would introduce a global minimum tax rate, in a bid to end what it dubbed a “race to the bottom” where businesses channel profits through low-tax jurisdictions. But companies would pay most of their taxes in the country where they are headquartered, even if their profits — and in many cases the labour and raw materials used — are sourced from developing countries, senior diplomats and lobby groups told the Financial Times. They are also concerned that many developing countries are not participating in the negotiations over the proposal at the OECD and fear the eventual agreement is unlikely to reflect their interests….”
“… Several large developing economies are involved in a rival effort at the UN to develop an international tax regime, which would specifically target digital services companies. The move is driven by acrimony over the small amounts of tax paid by US tech giants in many countries where they make big profits. The plan would grant countries the right to tax digital companies’ revenues based on where revenues are generated, rather than only where the company is resident. Argentina, India, Kenya and Nigeria have all recently introduced digital taxes and a number of other African countries are considering it, according to the ATAF. The UN proposal, which has been championed by India and Argentina, was narrowly approved by the UN’s tax committee last month. Other developing countries including Ecuador, Ghana, Liberia, Nigeria, Vietnam and Zambia have backed it….” “… “There seems to be an odd competition between the UN and OECD going on,” said Tove Maria Ryding, policy and advocacy manager at the European Network on Debt and Development. “The UN is looking at developing digital services taxes and the OECD is trying to get rid of them” in favour of a regime that would apply to all industries….”
Link: Guardian - OECD calls for higher inheritance tax after Covid pandemic
“Wealth inequality will rise over the next decade unless death duties also increase, says thinktank.”
“WHO’s Special Initiative for Action on Social Determinants of Health for advancing Equity is the first of its kind to rally global, regional, national and local actors to come together around a common approach to dealing with the social determinants of health to advance health equity….”
“The world’s renewable energy industry grew at its fastest pace since 1999 last year, despite the disruption caused by the Covid-19 pandemic, and may have established a standard for growth in the future, according to the International Energy Agency (IEA). The global energy watchdog revealed that the delivery of renewable energy projects, including windfarms and solar power projects, grew by 45% last year in a step change for the global industry….”
Have a hunch I’ll have to develop a keen interest in this one.
“Prostate cancer is the second most frequent cancer in men, and there were about 1·4 million new cases around the world in 2020. Prostate cancer accounts for an estimated 15% of all cancer cases in men worldwide and is the most common form of cancer in men in in 112 countries (figure). Globally, there are many hundreds of thousands of premature deaths from prostate cancer annually, and a huge toll in morbidity, particularly bone metastases leading to pain, fracture, and disability. Curative treatment itself can also cause adverse effects on urinary and sexual function. There is a growing tension between the need to diagnose advanced disease early while not overdiagnosing lower risk disease that probably does not need treatment. … Health systems and providers in low-income and middle-income countries (LMICs) are confronted with the challenges of disease burden, late diagnosis, and reduced access to specialist services and treatment. …”
“… The Lancet Commission on Prostate Cancer will seek to assess these diagnostic and treatment developments, determine what is likely to constitute the best approach in different health-care settings, and make policy and clinical practice recommendations. The Commission will follow four broad themes in prostate cancer: improving the evidence base in LMICs; reducing the risk of overdiagnosis while increasing detection of clinically curable disease; better treatment selection; and optimising treatment for advanced disease….”
“As a new global resolution on “Diabetes prevention and management, including access to insulin,” undergoes negotiations this week ahead of the World Health Assembly, Médecins Sans Frontières/Doctors Without Borders (MSF) today welcomed the discussions on the resolution, and called on all countries to strongly support this critical opportunity to boost access to treatment for people living with diabetes everywhere. MSF urged governments and health leaders to set global targets for diabetes reflecting the 90-90-90 goals used in the global HIV response, to facilitate access to diagnosis, treatment, and ensure control of the disease; and ensure transparency of pricing of all types of insulin and the bundle of medical supplies required to inject and monitor this lifesaving treatment. The negotiations on the resolution, proposed by Russia, are ongoing and expected to end by 14 May, followed by a formal presentation of this resolution at the World Health Assembly, 24 May to 1 June….”
As already reported a few weeks ago, but here with all the detail you need:
“The United Nations General Assembly passed its first-ever during the seventy-fifth session on 28 April 2021. The resolution was proposed by Bangladesh and Ireland, and co-sponsored by more than 79 nations, including Australia. … The resolution describes drowning as a serious and neglected health threat, causing more than 2.5 million preventable deaths in the past decade. More than 90% of deaths occur in low- and middle-income countries, with Asia carrying the highest number of drowning deaths. … …The resolution calls on member states to: develop national drowning prevention plans; implement recommended interventions, including barriers, supervision, swim skills, rescue and resuscitation training, and boating regulation; and introduce water safety, swimming and first aid lessons as part of school curricula. These interventions are outlined in the that was released by World Health Organization (WHO) in 2014….”
“In a far-reaching statement, WHO and the International Coalition of Medicines Regulatory Authorities (ICMRA) called on the pharma industry to provide much wider access to clinical data for all new medicines and vaccines approved, or under review, and even those that had been rejected. “Clinical trial reports should be published without redaction of confidential information for reasons of overriding public health interest,” WHO said in the joint statement on Friday….”
Hosted by TDR. First episode was on “Research in the time of COVID-19”. “The first episode of Global Health Matters takes us on a journey to Somalia, India and Benin to explore how researchers have adapted to one of the greatest challenges we have ever faced — the COVID-19 pandemic. “
M A Parsons et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1924821
« Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors – Afghan and internationals – expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation.”
Working paper. “This working paper sets out a conceptual framework for a shock-responsive health system for the Maintaining Essential Services After Natural Disasters (Maintains) programme…”
« …Many aspects of LGBTQI health and their determinants are woefully understudied. Key priorities for advancing LGBTQI health research include filling gaps in knowledge by region, health condition, sexual orientation and gender identity group, theoretical frameworks, and methods. Importantly, researchers must collect and use data to advance the wellbeing of LGBTQI individuals, communities, and populations (panel). Simply identifying disparities by sexual orientation, gender identity, or intersex status is not enough and could exacerbate stigma against LGBTQI people in some settings. Researchers must also frame health disparities within the sociopolitical conditions that create them, clearly document the connection between these conditions and LGBTQI health, and conduct analyses that can lead to effective interventions….”
J Stiglitz reviews Mazzucato’s new book, ‘Mission Economy: a Moonshot guide to change capitalism’.
Great review. Quotes: “That it is so hard to make quick progress on what should be a relatively uncomplicated problem (i.e. global vaccine equity) underscores that changing capitalism is far more difficult than putting someone on the moon. … What the world needs is a pragmatic agenda for how to bring these changes about, including in the laws that govern the economy and a rebalancing of the roles played by the market, the state, and the other societal institutions; and a political strategy to make it happen…. A new economic system wouldn't be the capitalism we've become accustomed to—with banks engaged in predatory lending, pharmaceutical companies pursuing profits, food and beverage companies pushing products that can lead to childhood diabetes, and coal and oil companies destroying the environment. It would entail a broader set of institutional arrangements, with cooperatives and not-for-profits working alongside private firms of every size and governments at every level.”
“…Paid childcare has been largely ignored by academia, government policy makers and donors in and beyond Africa. The World Health Organisation recently published its first ever guideline for early childhood development. Although this document includes a lot of valuable information, it – and the research is it based on – largely focuses on improving parental care. This overlooks the fact that more and more families seem to be using paid childcare in Africa. Through paying insufficient attention to non-parental care providers in general, and paid childcare specifically, early childhood development strategies are missing an intervention opportunity in sub-Saharan Africa….”
“In our paper, one of a set of inter-disciplinary publications looking at the care of children around the world, we explore how and why childcare is often ignored. And how the issue can be brought in from the shadows….”
With focus on the EU debate & political economy, and how experts should go about this, when writing op-eds or going to tv studios.
“BioNTech cannot unilaterally say it will increase COVID-19 vaccine production for most of the world. Pfizer decides.” (based on contractual agreements)
(re an interview with Pfizer’s CEO)
“If we are being candid, this is the language of a monopolist and fear-monger. It’s essentially saying how dare you allow any competitors to make our vaccines and only Pfizer should be allowed to control the raw materials market.”
“The G7 promised to share vaccines globally and fairly. Instead they bought most of the doses that will be made this year – so many that they’ll have over 1.2 billion left after fully vaccinating their populations. They know they won't use them, so they need to share them ASAP.”
“Come work with us to help @WHO build a fairer, healthier, and greener world by acting on the social determinants of health #sdoh #equity. Key initial task will be supporting development of a new World Report. Apply by May 31.”
Re this Reuters article - U.S. wants COVID vaccine patent waiver to benefit world, not boost China biotech
“Even if it had been a good idea to control the share of mRNA tech w Chinese companies (prob not), this reexam too late bc Germany already authorized a voluntary partnership btwn BioNTech and Fosun in China to produce the vaccine, in reaction to the US IP waiver announcement.”
“#Covid19 showed clearly the value of an R&D treaty/convention The world -rich & poor- need a structural solution not just plaster on the huge abscess of unequal access to medicines/medical technologies.”
“Rich country problems: - Vaccinate kids or not? - Take Astra-Zeneca or not? - Continue to mask or not? - Travel again or not? Rest of the world: - Will we survive or not? - When will we see any vaccines? - Do our own leaders care? - Does the world care?”
“To celebrate the 74th session of the World Health Assembly, the Global Health Centre and partners are organising a series of virtual discussions on critical global health issues from 20-28 May 2021. Hosted by the International Geneva Global Health Platform, these online events will focus on gender inequalities, the International Health Regulations, violence against health facilities, and the role of digital infrastructures as digital determinants of health….”
All preparatory documents so far: https://apps.who.int/gb/e/e_wha74.html
And that’s an understatement.
“More grant money for traditional issues such as health and education is also aimed at countering Beijing's influence in Africa.”
N Chatterjee et al ; https://www.tandfonline.com/doi/full/10.1080/08039410.2021.1918238
Written before the second wave in India took off.
“…. Vaccine nationalism is harmful to the global effort in the fight against the pandemic. India in contrast has been quite generous to its neighbours in sharing vaccines pursuing its own form of vaccine nationalism. The strategy pursued by India can be read as an effort to gloss over the failures in initial pandemic management, to improve diplomatic leverage and reinforce an idiom of nationalism. Such an effort however has potentially harmful effects undermining trust in the vaccine as well as in the government. The politicization of vaccine also has counterproductive outcomes for democratic practices within the country.”
Good overview of last week’s WTO General Council.
“The TRIPS waiver proposal, together with a separate submission from the “Ottawa Group” of WTO members on tackling goods-related issues such as supply chain transparency, reduction in applied tariffs, and trade facilitation in the area of vaccines, were both “hot-button topics” during the week’s meetings….”
Takes over from Kalypso Chalkidou.
“…Javier is uniquely positioned to build on the legacy of his predecessor, Kalipso Chalkidou, who advanced CGD’s efforts to strengthen value-for-money and priority setting in global health. Based in our Washington D.C. office, Javier will lead the global health policy team and steer an extensive portfolio of research aimed at informing decisions to allocate scarce health resources via CGD’s work as part of the International Decision Support Initiative (iDSI), advancing the agenda on equitable distribution of COVID-19 vaccines, and ensuring strong health systems to preempt and prepare for future pandemics….”
“In early 2020, as the COVID-19 pandemic began to ravage the world, the European Union (EU) sprang into action with its member states and financial institutions to deliver a collective global response, laying the foundations of more unified European approach to international development that has been termed “Team Europe.””
“The institutionalisation of the Team Europe approach is becoming a reality. Following proof of concept at the start of the COVID-19 crisis, EU delegations around the globe have successfully managed to build on this momentum to find ways for the EU and its partners to enhance cooperation and collaboration. However, we are none the wiser as to how this will work in practice. Clearly, the EU is attempting to align its domestic and external policies with the focus on transporting the EU Green Deal beyond its borders. However, this appears to be at the expense of human capital—a remarkable choice, in light of the pandemic. The main heavyweights in the driving seat are France and Germany together with the EIB. They are setting both the geographic and sectoral focus of the TEIs based on their own priorities….”
And a link:
International Affairs - Threat not solution: gender, global health security and COVID-19 (by Sophie Harman) See also a previous IHP newsletter.
Some links, among others on papers re Uganda, Cameroon & Zimbabwe:
· Global Health Action - Fitting Health Financing Reforms to Context: Examining the Evolution of Results-Based Financing Models and the Slow National Scale-Up in Uganda (2003-2015) (by Ssennyonjo Aloysius et al)
· Health Systems & Reform - Strategic Health Purchasing Progress Mapping in Cameroon: A Scoping Review (by Isidore Sieleunou et al)
· HP&P - Looking into the performance-based financing black box: evidence from an impact evaluation in the health sector in Cameroon(By Damien de Walque et al)
· SS&M - Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe (by E Fichera et al)
· International Journal for Equity in Health - Assessing healthcare access using the Levesque’s conceptual framework– a scoping review (by A Cu, V Ridde et al)
Cities are facing problems with flooding, overheating, water shortages, and damage to their infrastructure from extreme weather, which is growing more frequent as the climate changes. A found that last year about 43% of them, representing a combined population of 400 million people, did not have a plan to adapt to the climate crisis….”
“The fifth session of the Ministerial on Climate Action, the Leaders Summit on Climate, and the 12th Petersberg Climate Dialogue convened over the course of the past three months, seeking to set the stage for the Glasgow Climate Change Conference. The next stepping stone towards COP 26 is the 2021 P4G Seoul Summit, which will focus on the theme, ‘Inclusive Green Recovery Towards Carbon Neutrality’. COP 26 is currently scheduled to take place from 1-12 November 2021, in Glasgow, UK.”
From the Petersberg Climate Dialogue.
“The head of the United Nations is calling on international lending agencies to stop financing major fossil fuel projects, which he said are no longer economic investments. UN Secretary General Antonio Guterres, in a speech Thursday, also said the Group of Seven nations should make “substantial” climate financing pledges, with some doubling prior commitments. … The event was part of the runup to the UN’s annual climate conference in November, and his comments reflect the increasing push to motivate world leaders to increase their efforts to curb carbon emissions. Restricting financial support for fossil fuels has emerged as a key strategy …at a time when the world “stands at the edge of the abyss,” he said.”
This new research report, ‘Beyond the gap: Placing biodiversity finance in the global economy’, calls for an urgent and profound re-organisation of the global post-pandemic economy to prevent further planetary harm. The report is published by the Third World Network and the University of British Columbia.
“The study, conducted by researchers from Lancaster University, the University of British Columbia and Duke University, focuses on explaining failed commitments towards the Convention on Biological Diversity (CBD), a major multilateral treaty with aims to conserve and sustainably use biodiversity, and share its benefits equitably. Researchers find that the global approach to setting biodiversity policy is skewed – with discussions revolving around how to bring nature into the existing rules of the economic game, rather than examining how the rules are creating the problem in the first place. The report also highlights that investments into nature-enhancing projects are doing little to stem the worsening biodiversity crisis – because underlying economic drivers are being ignored…”
“There is no substitute for aggressive cuts in greenhouse-gas emissions. But the risks and benefits of technologies that could mitigate global warming need to be evaluated.”
“Of the 100 cities worldwide most vulnerable to environmental hazards all but one are in Asia, and 80% are in India or China, according to a risk assessment. More than 400 large cities with a total population of 1.5 billion are at “high” or “extreme” risk because of a mix of life-shortening pollution, dwindling water supplies, deadly heatwaves, natural disasters and the climate emergency, the report found. Jakarta, the capital of Indonesia, plagued by pollution, flooding and heatwaves, topped the ranking….”
“This scoping review maps documented system influences on TB-IPC implementation in health facilities of low/middle-income countries (LMICs)….”
Comment linked to new study in the Lancet GH - An investment case for the prevention and management of rheumatic heart disease in the African Union 2021–30: a modelling study
The authors present an investment case for interventions to prevent and manage RHD in the African Union (AU).
· BMJ Global Health - Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments
Analysis by Y M Keller et al.
“China announced a new disease prevention and control agency under the aegis of its top health body, in what is its biggest move yet to address gaps that caused critical delays in sounding the alarm about Covid-19 when it first emerged in Wuhan in late 2019. The new National Disease Prevention and Control Bureau will draft policies regarding infectious disease control and provide guidance on the surveillance of epidemics, among other public health mandates, state news agency Xinhua reported on Thursday….”
With the view of Tom Wenseleers, evolutionary biologist in Leuven, Belgium.
F H Guleid, E Barasa et al ; https://gh.bmj.com/content/6/5/e005690
The authors carried out a bibliometric analysis to describe the COVID-19 research output in Africa in terms of setting, study design, research themes and author affiliation.
Results: “A total of 1296 articles were retrieved. 46.6% were primary research articles, 48.6% were editorial-type articles while 4.6% were secondary research articles. 20.3% articles used the entire continent of Africa as their study setting while South Africa (15.4%) was the most common country-focused setting. The most common research topics include ‘country preparedness and response’ (24.9%) and ‘the direct and indirect health impacts of the pandemic’ (21.6%). However, only 1.0% of articles focus on therapeutics and vaccines. 90.3% of the articles had at least one African researcher as author, 78.5% had an African researcher as first author, while 63.5% had an African researcher as last author. The University of Cape Town leads with the greatest number of first and last authors. 13% of the articles were published in medRxiv and of the studies that declared funding, the Wellcome Trust was the top funding body.”
“Non-hospitalised COVID-19 patients have a low risk of serious long-term effects, but they report more visits to general practitioners following infection, according to a study published in The Lancet Infectious Diseases journal.”
Guy Standing’s view: “In short, we should actively support the campaign for a waiver, precisely because it would be a prospective thin end of the wedge for dismantling the IP system that is rigged in favour of huge rentier incomes gained by monopolistic corporations in general. While some defenders of the system think that a waiver would be a ‘dangerous precedent’, we should look at it as a ‘liberating precedent’, opening up the prospect of eroding an unethical system. Probably, the waiver in itself would not have nearly as much positive effect as its leading advocates claim. But the symbolism would be substantial….”
“Researchers developed a computer model of the spread of COVID-19 through the United States and simulated the impact of vaccinating different proportions of the population at varying rates with different types of COVID-19 vaccines. They then analysed the effects of these different simulations on hospitalisations, deaths and costs from healthcare and productivity loss. The research, carried out by scientists from Public Health Informatics, Computational, and Operations Research, at City University of New York (CUNY) Graduate School of Public Health & Health Policy, the National School of Tropical Medicine at Baylor College of Medicine, and Johns Hopkins Center for Health Security published their paper in the Journal of Infectious Diseases.”
“The researchers found that the gains in protection really start once 20% of the population has been vaccinated. Going from 50% to 70% coverage could prevent 9.5 million cases and save US$ 10.8 billion in direct medical costs and productivity losses. But they found significant savings in lives and costs from relatively small increases in vaccination coverage and ensuring higher vaccination coverage levels sooner. Their model found that achieving a 50% coverage in 180 days (e.g., by early summer) with a vaccine that is 70% efficacious resulted in a decrease of 20.9 million cases and 91,660 deaths. And every 1% increase in coverage between 40% and 50% coverage resulted in 2.1 million fewer cases, 9,160 fewer deaths, and saved more than US$ 960 million in direct medical costs and US$ 1.9 billion in productivity losses….”
And some links:
“Brazil's Health Ministry on Tuesday announced it had signed a deal for Pfizer (PFE.N) to deliver an additional 100 million doses of its COVID-19 vaccine, doubling the number of shots from the company.”
“A new review published in the medical journal The Lancet suggests that the COVID-19 virus has a unique infectious profile, which might explain why it can be so hard to treat and cause people with 'long COVID' issues after infection. Research suggests COVID-19 infects both the upper and lower respiratory tracts. The virus can also cause multi-organ impacts, blood clots and can prompt an unusual immune-inflammatory response – resulting in challenges in treating the disease. … "Based on growing evidence we propose that COVID-19 should be perceived as a new entity with a previously unknown infectious profile. It has its own characteristics and distinct pathophysiology and we need to be aware of this when treating people."”
“A South African report into excess deaths over the past year suggests more than 133,000 people in the country have died from COVID-19, far more than the official tally of nearly 55,000.”