Plos Med (Editorial) – Plans and prospects for the 2020s: Beyond peak health?
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003075
Interesting editorial and an interesting concept, ‘
Peak Health’. Let’s hope we haven’t reached it yet.
The Plos Editors conclude, “
Despite the positive vision embodied by the SDGs, could “peak health” have already been reached? Although the analogy with peak oil may be debatable, there are signs that life expectancy in the United States and United Kingdom has reached a plateau, and may be declining. Health inequalities abound. It is anticipated that improved disease prevention and health provision in developing countries will continue to deliver improvements in life expectancy and reductions in life-years lost to disability and ill health but, in all countries, new health challenges will undoubtedly emerge. We must hope that progress in population health does not slip into reverse gear in the coming decades, driven by factors that could include the transition to non-communicable diseases, vaccine hesitancy, environmental stressors, and anticipated but unpredictable hazards such as antimicrobial resistance. … … Must we wait until the gains in health made over recent decades are lost?”
Lancet – Offline: The pretensions of global health elites
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30429-3/fulltext
Gloomy piece from Horton, related to a
meeting in Wilton Park in the UK earlier this month to discuss the idea of “
Healthy Societies for Healthy Populations”. Starting from the assessment that the global health emperors are starting to realize they have no clothes. Self-doubt is the beginning of all wisdom, though. Including for the global health elite, it is hoped. As somebody put it on Twitter, ‘may the decolonization conversation continue’.
Among others, Horton argues
global health has to be totally reconstructed. Will be easier said than done.
Covid-19 – “Pandemic Potential” (WHO) & shifting epicentre
It’s probably no coincidence that in the very week that
world markets began to panic, the same seemed true for
Donald Trump and his administration (as D Drezner put it in
The Washington Post ). But the Donald found a way around it,
putting his faith in his vice (Pence). In other words, it’s time to pray to God for the Americans, was the implicit message : )
You already hear talking about
“2008-level economic damage… “ - (Guardian)
Coronavirus 'could trigger damage on scale of 2008 financial crisis' .
Anyway. After drinking a hell of a lot of coffee before daring to start writing up this Covid-19 section, we organize this section more or less like last week: (
1) updates & key news from past week; (2) financing of the response; (3) vaccines, treatment news & science; (4) Analysis. (5) some other resources.
Not comprehensive. But extensive, yes – with a focus on IHP’s interests. You’ll have noticed that many mainstream media haven started
daily briefings on the Coronavirus, like for example, the
New York Times Coronavirus Briefing.
Updates past few days & key news from past week
Great daily updates also in
Stat News, Cidrap, HPW, Science, … We’re sure you get your fill every day. Some headlines from the last days & past week, not really in a particular order.
And of course, you might want to read the
daily media briefings from Tedros. See for example the one from
27 Feb -
WHO -Tedros media briefing 27 Feb.
Tweet: “ @
DrTedros “we are at a decisive point.” There is a positive signal (in China).. but outbreak can go in any direction based on how we handle it. Countries should be prepared for all scenarios: single cases, 1st cluster, 1st community transmission, sustained community transmission.”
See
HPW for coverage of this last briefing (from yesterday) -
Seven More Countries Report COVID-19 Infections: New Cases Abroad Exceed Those In China For Second Day Running
“…“
We are at a decisive point,” said Dr Tedros Adhanom Ghebreyesus in a daily WHO press briefing on the COVID-19 crisis. “My message to each one of these countries is: This is your window of opportunity. If you act aggressively now, you can contain this virus….” And (UN News)
- No country should make ‘fatal’ mistake of ignoring COVID-19: Tedros
Cidrap News (28 Feb) -
COVID-19 expands reach, fueled by trio of global hot spots
Current hotspots: Iran, Italy and South Korea.
Guardian – Coronavirus found in sub-Saharan Africa as WHO says spread could 'get out of control'
https://www.theguardian.com/world/2020/feb/28/coronavirus-found-in-sub-saharan-africa-as-who-says-spread-could-get-out-of-control
“
Coronavirus has spread to sub-Saharan Africa for the first time as stock market losses around the world deepened amid investor alarm over a potential global pandemic. Nigeria’s health minister, Osagie Ehanire, said the first case in the region was an Italian citizen who worked in Nigeria and had returned from Italy to Lagos on 25 February….”
HPW - Countries Pursue Aggressive Containment Measures As New Cases Outside China Grow
https://www.healthpolicy-watch.org/countries-pursue-aggressive-containment-measures-as-new-cases-outside-china-grow/
(26 Feb) “
Governments around the world are ramping up COVID-19 containment measures as new infections outside of China surged by 497 cases over the past 24 hours, outnumbering those inside the country for the first time ever during the epidemic. The increase abroad was largely linked to an acceleration of COVID-19 outbreaks in Italy, Iran, and South Korea, which also were spilling over into other countries, in Europe and the Middle East. Officials were aggressively restricting movement in areas with confirmed local transmission in an effort to curb person-to-person spread of the contagious virus….”
As for the question ‘
pandemic or not’, in the eyes of WHO:
“
Despite the escalation of cases in multiple countries, the WHO director-general emphasized that, for the moment, the COVID-19 emergency had not reached “pandemic status” as there was no “sustained and intensive community transmission” of the virus, nor was there “large-scale severe disease or death.” However, he underlined that all countries, whether they have cases or not, must prepare for a “potential pandemic”. …”
“…. Meanwhile, Algeria confirmed its first case of COVID-19 on Tuesday, just days after Dr Tedros met with African Ministers of Health at an emergency meeting on the coronavirus outbreak on 22 February. …”
Virology Down Under - Past Time to Tell the Public: “It Will Probably Go Pandemic, and We Should All Prepare Now”
J Lanard et al ;
https://virologydownunder.com/past-time-to-tell-the-public-it-will-probably-go-pandemic-and-we-should-all-prepare-now/
Great piece from last week, already then disagreeing with the WHO.
It’s, yes, more likely than not, a pandemic. And if it isn’t yet, pretty soon it’ll be.
Reuters - WHO says no longer uses 'pandemic' category, but virus still emergency
https://www.cnbc.com/2020/02/24/reuters-america-update-1-who-says-no-longer-uses-pandemic-category-but-virus-still-emergency.html
“
The World Health Organization (WHO) no longer has a process for declaring a pandemic, but the COVID-19 coronavirus outbreak remains an international emergency, a spokesman said on Monday….”
Observers didn’t quite like that stance on Twitter.
As a reminder, see different stages (2009):
WHO phase of pandemic alert for Pandemic
Bloomberg (op-ed) - Why the WHO Won't Call the Coronavirus a Pandemic
Bloomberg;
Nice one. “
The question of whether to call Covid-19 a pandemic goes to the heart of the World Health Organization’s internal conflicts.”
Guardian - More new coronavirus cases outside China than inside, says WHO
https://www.theguardian.com/world/2020/feb/26/more-new-coronavirus-cases-outside-china-than-inside-says-who
Also one of WHO’s key messages of late. A
tipping point has been reached, it seems, as
there are now more coronavirus cases outside China than in the country. The positive side of this: Latest figures on new infections suggest
Beijing’s strict response to the crisis is paying off.
Having said that, at the same time there are
huge doubts about these Chinese figures.
Science (news) - The coronavirus seems unstoppable. What should the world do now?
https://www.sciencemag.org/news/2020/02/coronavirus-seems-unstoppable-what-should-world-do-now
One of the many ‘now what’ pieces. Great and informative read.
See also for example
the Telegraph -
As the virus spreads the world will move from containment to mitigation, say experts Will depend from country to country, clearly. “…
Mitigation follows containment in the public health response to major new outbreaks. While containment strategies aim to stop or hold back a disease, the goal of mitigation is to reduce its impact on society….”
HPW - World Needs Mindset Shift On COVID-19: Head Of WHO Delegation Issues Stirring Call For Action Upon Return From China
https://www.healthpolicy-watch.org/world-needs-mindset-shift-on-covid19-says-head-of-who-delegation-upon-return-from-china/
“COVID-19 can be beaten – but it will take a big mindset shift on the part of the global community to achieve what China has done – which is dramatically curb transmission of the new, mysterious and deadly coronavirus using traditional public health measures for diligent tracing of contacts, isolating those found to be ill; and providing intensive care, including advanced respiratory treatment, for the 20% of serious cases. That was a key message from Bruce Aylward, the head of a WHO-convened independent commission of experts that just returned from a 10-day trip to China studying the massive public health effort now underway there….”
See also
Helen Branswell (Stat News) -
WHO tells countries to prepare for coronavirus pandemic, but insists it’s too soon to make that call
Or in the words of
Mike Ryan, throughout the week:
“
It is time to prepare, not declare. Mike Ryan on the question re calling COVID-19 a pandemic. The epidemic differs in each country.” He probably nailed it.
PS: “…
the WHO-led international joint mission (led by B Aylward visited Beijing, plus Sichuan and Guangdong provinces, and also Wuhan. Tedros also announced six special WHO envoys who will provide advice to countries in different parts of the world…. “
Guardian - Coronavirus: US says Russia behind disinformation campaign
https://www.theguardian.com/world/2020/feb/22/coronavirus-russia-disinformation-campaign-us-officials?CMP=share_btn_tw
“
Thousands of Russian-linked social media accounts have launched a coordinated effort to spread misinformation and alarm about coronavirus, disrupting global efforts to fight the epidemic, US officials have said…. “ Doubt the Russians are the only ones, though.
Cidrap News - WHO chief warns Africa
http://www.cidrap.umn.edu/news-perspective/2020/02/korean-covid-19-cases-double-iran-linked-infections-climb
Tedros over the weekend:
“
In the wake of warning earlier this week that the window for containing COVID-19 has narrowed, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, met with African health ministers in an emergency meeting about preparedness, which was organized by the African Union and Africa Centres for Disease Control and Prevention….”
“
The WHO has voiced deep concern over the potential spread of the virus to countries with weak health systems, especially those in Africa….”
For an
African CDC statement (22 Feb), see
Statement by the Chairperson on preparedness and response to the coronavirus disease in Africa
“…
Africa CDC also established the Africa Task Force for Novel Coronavirus (AFCOR) to coordinate preparedness and response across the continent….”
PS: the
Middle East also seems increasingly worrying.
Stat - Once widely criticized, the Wuhan quarantine bought the world time to prepare for Covid-19
Stat News;
“
When the Chinese government blocked most travel into and out of the city at the center of the Covid-19 outbreak in late January, many public health experts took to social media and op-ed pages to decry the measure as not only draconian and a violation of individual rights but also as ineffective: This largest quarantine in history — the city, Wuhan, has a population of 11 million, and the lockdown has been expanded — would have little effect on the course of the epidemic, they argued. As the U.S. and other countries imposed travel restrictions, even the World Health Organization questioned whether they were a good idea. But early evidence is causing some disease fighters to reconsider….” PS:
Bruce Aylward was also a great fan (see his press conference earlier this week).
“
Scientists are still gathering data on the effect of travel restrictions and the historic quarantine — and, in particular, whether they reduced total cases and deaths or just postponed many of them without lowering the eventual cumulative toll. The answer will have broad consequences for future outbreaks, perhaps putting large-scale quarantines back on the list of health officials’ epidemic countermeasures, including in countries that value individual liberties more than China does….”
Some international organisations & Covid-19
Overview of mechanisms the WB uses to help with the outbreak response & preparedness (no mention here of the pandemic bonds, but see below for more on that).
Remarks by Georgieva after the G20 Finance Ministers and Central Bank Governors Meeting, last weekend in Ryadh, Saudi Arabia.
Some more (news) links
Other reads related to the US (political) situation re the coronavirus:
Coronavirus triggers swift bipartisan backlash against Trump (Politico); Daniel Drezner in the Washington Post -
Is this the week that Trump panics about covid-19? On Wednesday, The Donald sounded strangely re-assuring. No doubt, trying to assure voters that all will be fine (so that he can be re-elected in November). So far, his message didn’t convince stock markets. Nor the public.
The
Washington Post on the mess-up from late last week, with
Americans flown back from the now notorious cruise ship (both coronavirus-infected ones and not infected ones on the same plane). What happened between the State Dept, CDC & other stakeholders?
PS: Yesterday
, Pence appointed US Global AIDS Coordinator, Debbie Birx, as White House Coronavirus Response Coordinator. That sounded more reassuring.
- WHO has criticized China for failing to share data on coronavirus infections among health care workers (see Washington Post).
Financing of the response
As you know, late last week
Tedros called (again) for more funding in the coronavirus fight. So far, mainly European countries (France, Germany, Sweden, …) (and the EU ) seem to have responded. At least, to support WHO in its fight.
Tweet: “
Germany is making an additional 50 million euros available to WHO, earmarked specifically for acute measures to fight the coronavirus. WHO had requested an additional 670 million euros in the short term to stabilise the situation in the less developed countries.”
“
To boost global preparedness, prevention and containment of the virus the Commission announces today a new aid package worth €232 million. Part of these funds will be allocated immediately to different sectors, while the rest will be released in the next months. … … Out of the €232 million aid package: - €114 million will support the World Health Organization (WHO), in particular the global preparedness and response global plan. This intends to boost public health emergency preparedness and response work in countries with weak health systems and limited resilience. Part of this funding is subject to the agreement of the EU budgetary authorities.
- €15 million are planned to be allocated in Africa, including to the Institute Pasteur Dakar, Senegal to support measures such as rapid diagnosis and epidemiological surveillance. - €100 million will go to urgently needed research related to diagnostics, therapeutics and prevention, including €90 million through the Innovative Medicines Initiative, a partnership between the EU and the pharmaceutical industry. …”
PS: the outbreak will also top the agenda when
European and African officials gather this week in Ethiopia.
AP - White House unveils $2.5B emergency coronavirus plan
“
The White House on Monday sent lawmakers an urgent $2.5 billion plan to address the deadly coronavirus outbreak, whose rapid spread and threat to the global economy rocked financial markets. … … The administration is requesting $1.25 billion in new funding and wants to transfer $535 million more in funding from an Ebola preparedness account that’s been a top priority of Democrats. It anticipates shifting money from other HHS accounts and other agencies to complete the $2.5 billion response plan….”
Later during the week, Trump said, however, that whatever funds are needed for corona, they’ll be found. At least
for the situation in the US, of course… See
BMJ News - “
Trump said he had asked Congress for $2.5bn to fight the virus (from the Ebola response budget), but Congressional Republicans had suggested $4bn and Democrats had pushed for $8.5bn. He indicated he would accept whatever Congress decided….”
Not much US support yet for WHO or other global institutions, as far as I can see.
“
Investors are betting that a special pandemic bond issued by the World Bank will pay out relief funds to countries affected by the coronavirus, as the death toll from the outbreak continues to mount.”
For more analysis of these pandemic bonds, see CBC -
Pandemic bonds were supposed to fund the cost of fighting the coronavirus — so why aren't they paying off?
And for an insightful analysis (14 Feb) -
An inside look at the debate around pandemic bonds, which have $425 million hinging on how deadly the coronavirus ends up being (Markets insider)
See this tweet from Devi Sridhar: “
If you're waiting for World Bank pandemic bonds to pay-out, don't hold your breath. Even if they do on 23rd March, would only be $196 million for 76 countries affected. China has spent $10 billion on coronavirus already. “
PEF = too little, too late to make any difference.”
For the latest update on these
pandemic bonds (and debate around them), see
the Guardian (28 Feb) -
World Bank's $500m coronavirus push 'too late' for poor countries, experts say
“… A flagship $500m World Bank scheme to help the poorest countries deal with a health emergency is “too little too late” for the coronavirus outbreak, say health experts. The first pandemic emergency financing (PEF) bonds were launched in 2017 by Jim Yong Kim, the bank’s president at the time, after the Ebola outbreak in west Africa. Designed to potentially “save millions of lives and entire economies” by speedily funnelling money to nations facing pandemics. But critics say the “insanely complicated” terms of the high-interest bonds are heavily skewed towards investors, while for the victims any payouts may come too late, if at all. One economist described the bonds, payouts from which depend on how deadly the outbreak is, as “obscene”….”
(27 Feb) - “
The COVID-19 outbreak is not just a public health crisis, it’s rapidly becoming a global crisis – of health, economics and politics.”
“…I believe our greatest weapon against uncertainty and panic is trust, which in much of the world is at a historic low. To regain it, our global powers, including the World Bank, International Monetary Fund (IMF), and leaders of the G7 and G20, must make decisions that demonstrate they see this as a global crisis, and continue the current containment approach while also preparing for the worst. … … Anything less than an urgent initial commitment of $10 billion from the World Bank leaves us at risk of much greater costs later and long-term catastrophe. … … The investment should be used to bolster the public health response in the most vulnerable countries, coordinated through the World Health Organization, and to develop diagnostics, treatments and vaccines. If COVID-19 burns out, then the hours and money spent on our response will not have been wasted but will represent a crucial investment in global health. Likewise, the IMF needs to ensure it allocates appropriate capital to support central banks across the world. …”
Vaccines, treatments & science
The consensus seems to be that
treatments will be there quicker than a vaccine. Anyway, some reads (in steno style):
(by
Tedros & Soumya Swaminathan) – on last week’s scientific forum in Geneva.
“
In what appears to be a first, disease trackers in Singapore have used an experimental antibody test for COVID-19 to confirm that a suspected patient was infected with the coronavirus. The patient was one of two people who together formed a missing link between two clusters of cases that each occurred in a Singaporean church. Researchers around the world are racing to develop antibody tests, also called serological tests, that can confirm whether someone was infected even after their immune system has cleared the virus that causes COVID-19. The group that developed the test, at Duke-NUS Medical School in Singapore, is among the front-runners, although its assay has to be validated before it is taken into production and deployed widely….”
Fortune -
The first US trial for a coronavirus treatment has started
Cfr a tweet: “The race for treatment is on --> all eyes on remdesivir (antiviral drug). First US trial already launched by the NIH.”
See also Time -
COVID-19 Vaccine Shipped, and Drug Trials Start “
Moderna Therapeutics, a biotech company based in Cambridge, Mass., has shipped the first batches of its COVID-19 vaccine. The vaccine was created just 42 days after the genetic sequence of the COVID_19 virus, called SARS-CoV-2, was released by Chinese researchers in mid-January. The first vials were sent to the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) in Bethesda, MD, which will ready the vaccine for human testing as early as April….”
So far, the sounds made by Azar in this respect are not very reassuring…
“
One of the most perplexing questions regarding the current COVID-19 coronavirus epidemic is the discrepancy between the severity of cases observed in the Hubei province of China and those occurring elsewhere in the world. One possible answer is antibody dependent enhancement (ADE) of SARS-CoV-2 due to prior exposure to other coronaviruses…”
“International teams worked at speed to make
tests for the virus available in record time.”
Early April, first tests would start. In other vaccine news, see Stat -
A Chinese biotech partners with GSK to boost its coronavirus vaccine development.
Analysis
Overview of the situation there, what countries are doing, and how WHO, African CDC, Gates Foundation and others are helping.
Quote: “
Dowell says the Gates Foundation… … estimates there were as many as four undetected outbreaks in Africa by mid-February.”
“
Many Africans don’t trust the health system. That complicates the response.”
“
Success against coronavirus will require national leadership, engaged local responders, and strong cooperation with NGOs.” (by C Holmes, R Katz et al)
Must-read by the
African CDC director.
“”…
To help develop a common strategy that will allow for effective coordination, collaboration, and communication, the African Union Commission, Africa Centres for Disease Control and Prevention (Africa CDC), and WHO, in partnership with African countries, have established the Africa Taskforce for Coronavirus Preparedness and Response (AFTCOR). The partnership has six work streams: laboratory diagnosis and subtyping; surveillance, including screening at points of entry and cross-border activities; infection prevention and control in health-care facilities; clinical management of people with severe COVID-19; risk communication; and supply-chain management and stockpiles.”
He
lists 4 important things. Including: “…
any effective preparedness and response strategy for COVID-19 requires a committed political will; as such, the African Union Commission, Africa CDC, and WHO convened, on Feb 22, 2020, in Addis Ababa, Ethiopia, an emergency meeting of all ministers of health of 55 member states to commit to acting fast and collectively to develop and implement a coordinated continent-wide strategy. AFTCOR taskforce was formed, and a continent-wide strategy was endorsed at the end of the emergency meeting, with a call for strong coordination of efforts….”
“…
the COVID-19 outbreak is transforming how scientists communicate about fast-moving health crises. A torrent of data is being released daily by preprint servers that didn’t even exist a decade ago, then dissected on platforms such as Slack and Twitter, and in the media, before formal peer review begins. Journal staffers are working overtime to get manuscripts reviewed, edited, and published at record speeds….”
“…
Early this week, more than 283 papers had already appeared on preprint repositories, compared with 261 published in journals. Two of the largest biomedical preprint servers, bioRxiv and medRxiv, “are currently getting around 10 papers each day on some aspect of the novel coronavirus…”
“If COVID-19, the novel coronavirus, becomes a global pandemic, it will raise new questions about how to rapidly scale up vaccination efforts in low- and middle-income countries, according to the head of Gavi, the Global Vaccine Alliance. … … Global health experts now face the potential challenge of having to figure out how to develop and deliver to LMICs a vaccine that is also in broad global demand. That could raise some difficult questions about how to ensure equitable vaccine distribution, according to Seth Berkley, CEO at Gavi….”
By
B Hanage & M Lipsitch. Great read (and advice), for both media & scientists.
“…
To help in this effort, we think reporting should distinguish between at least three levels of information: (A) what we know is true; (B) what we think is true—fact-based assessments that also depend on inference, extrapolation or educated interpretation of facts that reflect an individual’s view of what is most likely to be going on; and (C) opinions and speculation….”
“
Panic is a word that’s been widely used during this outbreak, yet Robert Peckham argues that this social phenomenon is little understood.”
“
The ongoing covid-19 outbreak has underlined the need for more research on the nature of panic and its drivers. The strategies we have for communicating about risk and engaging with communities are insufficient. We need to better understand the links between panic, rumour, fear, and anxiety. To what extent is panic universal or are panics in fact culturally specific? How precisely is panic linked to issues of trust—whether that is trust in the government, media, or experts? … … Panic is still too little studied and far too little understood. It is easily dismissed as a distraction to the main task at hand of containing an epidemic. And yet the management of panic is likely to be key to managing infectious diseases in an ever more connected world.”
Interesting analysis (including also with some lessons). “…
As for COVID-19 in China, this combination of an outbreak-control closure period for social distancing and a range of accompanying epidemic control measures [including extension of Chinese new year
] seems to have prevented new infections, especially in provinces other than Hubei, where new infections have been declining for more than 2 weeks…”
“
Experts can't stop restrictions, but they can mitigate them.” Recommended and nuanced analysis, with also an eye for politicians’ incentives.
Poignant letter on the situation on the ground in Wuhan. Was widely picked up in international media.
However, the Lancet Global Health now says
the paper is retracted: “On
Feb 26, 2020, we were informed by the authors of this Correspondence that the account described therein was not a first-hand account, as the authors had claimed, and that they wished to withdraw the piece. We have therefore taken the decision to retract this Correspondence.”
“
Thousands of health care workers, largely in China, have been infected amid the ongoing coronavirus outbreak, a sign of the immensely difficult working conditions for medical staffers, who should be among those best protected against infection. The infections, along with the deaths of several doctors in China, underscore the deeply challenging, chaotic environment that health care workers confront when toiling on the front lines of a major outbreak. They face long hours, changing protocols, potential medical supply shortages, and risks to their own personal health and that of their loved ones….”
“It mixes
demand and supply effects” From last week’s Economist issue.
The coronavirus outbreak looks set to become a further element in the ongoing de-globalization.
Recommended ‘big picture’ read. “A pandemic longer than a year may lead to business failures, mass unemployment, and a world thrown into global recession”.
Tom Frieden lists 8 things. Recommended read. “…
we must do eight things -- some immediately and some in the coming months -- as we shift from the initiation phase of the pandemic to the acceleration stage…”
Comparing Wuhan with other provinces in China. “…in
-depth analysis of these data show clear disparities in mortality rates between Wuhan (>3%), different regions of Hubei (about 2·9% on average), and across the other provinces of China (about 0·7% on average). We postulate that this is likely to be related to the rapid escalation in the number of infections around the epicentre of the outbreak, which has resulted in an insufficiency of health-care resources, thereby negatively affecting patient outcomes in Hubei, while this has not yet been the situation for the other parts of China…”
“
A global group is needed to gather outbreak data and stress test public health authorities”.
Excerpt: “…
To address this issue, the world should consider establishing a global surveillance facility, modelled after the hugely successful Gavi, the vaccine alliance. Such a facility, based in the World Health Organization but with independent accountability, would provide countries with funding and technical assistance during outbreaks. It would help to build resilient systems before epidemics strike. If the world’s largest economies collectively contributed $2bn a year, that would allow us not just to build the fire station and pay firefighters but also to prevent fires.
… … Public health systems can learn lessons from the global financial sector, which has appropriated epidemiological terms such as contagion or surveillance. In the 1960s, the IMF made its lending contingent on national income accounts. It invested heavily in helping countries improve their data allowing it to track financial flows. Bank regulators now stress test banks, and a new epidemics body could use the IHR to test whether countries can provide complete, quick and transparent reporting….”
A view from Mohammed Bin Rashid School of Government professors on the situation in the UAE – and the importance of
agile government.
Rapid review.
“
In early 2020, a new type of coronavirus epidemic (COVID-19) emerged suddenly and spread steadily from China’s Wuhan City, Hubei Province, disrupting China’s social order. The epicenter of the epidemic, Hubei Province lacked medical personnel and epidemic prevention supplies; assistance was urgently needed. This note identifies the Chinese government’s “counterpart aid” strategy in response to the epidemic and explores the strategy’s utility, drawing on earlier experiences with disaster response. Our analysis is based on an earlier research paper examining Wenchuan earthquake relief….”
“ WHO's newly launched platform aims to combat misinformation around COVID-19. John Zarocostas reports from Geneva. … … Immediately after COVID-19 was declared a Public Health Emergency of International Concern, WHO's risk communication team launched a new information platform called WHO Information Network for Epidemics (EPI-WIN), with the aim of using a series of amplifiers to share tailored information with specific target groups….”
Some other Covid-19 related resources
“…
This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published….” (all free access)
Ebola DRC
WHO – Situation report (20 Feb)
WHO;
“
During the past week, the incidence of new Ebola virus disease (EVD) cases has remained low. From 12 to 18 February, one new confirmed case was reported. …”
“To maintain operations and prevent re-emergence of the outbreak, WHO is requesting funding. Under the Strategic Response Plan (SRP 4.1), WHO’s financial need for the Ebola Response from January to June 2020 is US $83 million. Thanks to the generosity of many donors during 2019, WHO has some carry-over funding, which has been applied to maintain operations through February 2020. USD $40 million is currently needed to ensure continuity of response and preparedness activities to bring the case incidence to zero, and continue building strong, resilient health systems...”
Or in the words of
Tedros himself (tweet): “
Even though new #Ebola cases in #DRC have thankfully declined, we remain in full response mode. But there is a lack of funding for @WHO activities beyond February. We still need support from the international community to end this outbreak for good.”
Coverage for example in VOA -
WHO Warns It is Running Out of Money to Tackle Ebola Epidemic in DRC
For some reason, Jeff Bezos & Bill Gates never run out of money.
The Brussels Times - No new Ebola cases reported in the DRC for a week
https://www.brusselstimes.com/all-news/97249/no-new-ebola-cases-in-the-drc-for-a-week-democratic-republic-congo-world-health-organisation-who/
(26 Feb) And the latest update: “
The WHO said on Wednesday via Twitter that no new cases had been confirmed or reported for the past seven days, nor had any deaths been confirmed. The epidemic is now reduced to a single sanitary zone, Beni, in the east of the country, WHO added….”
Healio - West African Ebola epidemic cost $53 billion, according to new estimate
Healio;
Based on a paper from 2018, but good to keep in mind as Covid-18 is wreaking havoc around the globe, including economically. “
The Ebola virus epidemic in West Africa was the largest of its kind, resulting in more cases and deaths than all previous outbreaks combined. According to newly published study findings, the economic value of those who died is the most significant component of a new “more comprehensive” assessment of the epidemic that devastated to Guinea, Liberia and Sierra Leone, which found that it cost approximately $53.19 billion dollars….”
Malaria
BMJ Feature - WHO’s malaria vaccine study represents a “serious breach of international ethical standards”
https://www.bmj.com/content/368/bmj.m734
“
Experts are troubled by the apparent lack of informed consent in a large, cluster randomised study of the malaria vaccine. Peter Doshi reports.”
“A large scale malaria vaccine study led by the World Health Organization has been criticised by a leading bioethicist for committing a “serious breach” of international ethical standards. The cluster randomised study in Africa is already under way in Malawi, Ghana, and Kenya, where 720 000 children will receive the RTS,S vaccine, known as Mosquirix, over the next two years….”
Rare Diseases day (29 Feb)
Lancet Editorial - Rare diseases need sustainable options
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30457-8/fulltext
“Feb 29 marks Rare Disease Day, an opportunity to reflect on the lives of the estimated 400 million people globally who are affected by one of 6000–8000 rare diseases, most of them genetic. These diseases were long neglected, but large international initiatives such as EURORDIS and Rare As One have been set up to represent patients’ voices, highlight the disease burden (including psychological aspects) on patients and their families, share data and knowledge, promote collaboration, and fund research into the causes of rare diseases and novel therapeutics. As yet, targeted drugs are available for only a few hundred of these disorders, leaving millions of patients without any specific treatment options….”
UHC
BMC Health Services (Editorial) - Rehabilitation Is a Global Health Priority
A W Heinemann et al ;
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4962-8
“
The World Health Organization (WHO) launched an initiative in 2017 to promote universal access to rehabilitation when it hosted “Rehabilitation 2030: A Call for Action” . Attended by more than 200 rehabilitation experts from 46 countries, this meeting highlighted the unmet need for rehabilitation services and called for coordinated action and joint commitments by all stakeholders to raise the profile of rehabilitation…”
Critical work is being undertaken by the WHO to enhance access to rehabilitation, particularly in low- and middle-income countries. … … “It is evident to us that rehabilitation must be integrated fully into a nation’s health system and be strengthened specifically at the primary care level in order to increase access and achieve its full potential. As the WHO highlighted, we agree that health systems must be strengthened to assure that everyone who needs rehabilitation receives it. … … As editors-in-chief of rehabilitation journals, we unanimously accepted the invitation to participate in WHO’s Rehabilitation 2030 meetings and we embrace the concept of function as WHO’s third health indicator along with mortality and morbidity. We recognize the increasing importance of health policy planning in improving access to rehabilitation services.”
NCDs
NCD Alliance - NCDA and WHO formalise a decade-long collaboration
https://ncdalliance.org/news-events/news/ncda-and-who-formalise-a-decade-long-collaboration
“The NCD Alliance (NCDA) is pleased to announce the signing of a Memorandum of Understanding with the World Health Organization to formalise over ten years of existing close collaboration on the prevention and control of noncommunicable diseases (NCDs). The MoU was signed on Friday, 21 February, 2020, by Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization, and Katie Dain, CEO of NCD Alliance (NCDA), at the World Health Organization Headquarters, Geneva, Switzerland….”
Other NCD Alliance news:
New partnership to improve care for people living with NCDs in LMICs
“…
the NCD Alliance and The Leona M. and Harry B. Helmsley Charitable Trust announced a new multi-year partnership that seeks to advance UHC and improve care for people living with chronic noncommunicable diseases (NCDs), including type 1 diabetes, in LMICs….”
HP&P - The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a ‘policy cube’ approach
Kent Buse et al;
https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz175/5753899?searchresult=1
“
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization ‘Best Buys’ guidelines for the prevention and control of non-communicable diseases (NCDs). … … We captured findings in a ‘policy cube’ incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.”
Road safety
WB – Guide for road safety opportunities and challenges in LMICs: Country profiles
http://documents.worldbank.org/curated/en/447031581489115544/pdf/Guide-for-Road-Safety-Opportunities-and-Challenges-Low-and-Middle-Income-Country-Profiles.pdf?cid=tai_tt_transport_en_ext
It is the first data report to cover all 125 LMICs with comprehensive road safety country profiles.
Planetary health
Lancet Planetary Health – February issue is out
https://www.thelancet.com/journals/lanplh/issue/vol4no2/PIIS2542-5196(20)X0003-9
Do start with
the Editorial -
Weighing the risks. The last paragraph is the key one:
“…
we appear to be firmly ensconced in an era of post-truth debate and increasing personal and political populism. This polarisation, combined with the fundamental challenge that living within planetary boundaries poses to the sociopolitical and economic status quo make the process of turning knowledge into real change more challenging even than generating that knowledge in the first place. Much as we need to continue to refine our understanding of key sustainability challenges and map out viable solutions, it is insight into the theoretical and practical means to achieve acceptance and implement change that will most determine planetary health in the coming decades…”
Noteworthy are also, among others:
Climate change and gender-based health disparities (by Kim van Daalen et al).
Carbon-neutral medical conferences should be the norm.
Guardian - JP Morgan economists warn climate crisis is threat to human race
https://www.theguardian.com/environment/2020/feb/21/jp-morgan-economists-warn-climate-crisis-threat-human-race
Every day is a day for ‘innocent cynics’, nowadays : )
Guardian - G20 sounds alarm over climate emergency despite US objections
https://www.theguardian.com/world/2020/feb/23/g20-sounds-alarm-over-climate-emergency
“
Group’s first ever reference to global heating signals growing economic concerns over climate change.” So, before you get too carried away, the G20 concern is mainly economic, for now. Still, progress.
Deutsche Welle – Climate change leads to more violence against women, girls
DW;
“Rape, domestic violence, forced marriages:
A new study shows the effects of climate change are leading to an increase in violence against girls and women in many corners of the world.”
For the study, see IUCN -
Gender-based violence and environment linkages
Global Health Governance & updates Global Health Initiatives
Policy processes sans frontières: interactions in transnational governance of global health
Catherine Jones et al ;
https://link.springer.com/article/10.1007%2Fs11077-020-09375-2
“
National policy on global health (NPGH) arenas are multisectoral governing arrangements for cooperation between health, development, and foreign affairs sectors in government policy for global health governance. To explore the relationship between national and global processes for governing global health, this paper asks: in what forms of interaction between NPGH arenas and global health governance are learning and networking processes present? In a multiple case study of Norwegian and Swiss NPGH arenas, we collected data on intersectoral policy processes from semi-structured interviews with 33 informants in 2014-2015. Adapting Real-Dato’s framework, we analyzed each case separately, producing monographs for comparing NPGH arenas. Analyzing both NPGH arenas for relational structures linking external resources to internal policy arena processes, we found five zones of interactions - including institutions, transgovernmental clubs, and connective forms. These interactions circulate ideas and soften arenas’ boundaries. We argue that NPGH is characteristic of transnational governance of global health.”
Think Global Health - Diagnostic Gaps in Global Health
C Boehme & M Pai;
https://www.thinkglobalhealth.org/article/diagnostic-gaps-global-health
«
Lack of diagnostic capacity in primary care impacts patient outcomes, damages health systems, and lowers health security. »
“…The diagnostic capacity of a health care system is therefore a critical factor in the achievement of universal health coverage (UHC), which relies upon the detection of large numbers of people with treatable conditions. Despite this, diagnosis is now the weakest link in the cascade of care….”
The authors also offer some suggestions for doing something about it.
Global Fund Observer – new issue
https://www.aidspan.org/gfo_article/global-fund-board-approves-1357m-and-%E2%82%AC257m-portfolio-optimization-awards-23-countries
Do read, among others:
CSIS (Brief) - Sustaining U.S. Support for Gavi: A Critical Global Health Security and Development Partner
K Bliss;
https://www.csis.org/analysis/sustaining-us-support-gavi-critical-global-health-security-and-development-partner
“…
The United States has recently announced a commitment of $1.16 billion to Gavi over four years, essentially sustaining the annual commitments of $290 million through FY 2023. This sends a strong message to other donors, as well as eligible countries, that the United States remains confident in Gavi’s ability to deliver results. To reinforce its support, the United States should also: (1) encourage other donor countries to sustain or even increase their support for Gavi over a multi-year period; (2) identify opportunities to strengthen bilateral engagement on immunization programs, advocacy activities, and the mobilization of domestic resources for vaccines in priority countries; and (3) continue to support Gavi as it navigates the challenges to immunization programs posed by demographic change, urbanization, conflict, and migration over the 2021-2025 period and beyond….”
WHO Academy - France pledges US$100 million (€90 million) for WHO Academy
https://www.who.int/news-room/detail/24-02-2020-france-pledges-us100-million-for-who-academy
For some reason, I always have to think of ‘Star Academy’ when hearing about the WHO Academy. Even more as it’s going to be based in Lyon 😊.
“
Geneva: France’s Minister for Europe and Foreign Affairs, Mr Jean-Yves Le Drian, and Dr Tedros Adhanom Ghebreyesus, Director-General of WHO today met at the Permanent Mission of France to the United Nations in Geneva to discuss the WHO Academy, which will be the world’s largest and most innovative lifelong learning platform in global health. The WHO Academy aims to reach millions of people worldwide, offering high-tech learning environments at a “hub” in Lyon with “spokes” in the six WHO regions. The Academy will provide learning opportunities for leaders, educators, researchers, health workers, WHO staff and the broader public, and will deliver high quality, multilingual learning, both online and in-person, alongside a cutting-edge simulation centre for health emergencies. The discussion today follows a Declaration of Intent signed by Emmanuel Macron, President of the French Republic and Dr Tedros on 11 June 2019, and a pledge by France in the amount of US$ 100 million (€ 90 million) to WHO to support the creation of the WHO Academy, which will be established as an internal division within WHO. … By propelling and strengthening digital innovations and lifelong learning opportunities around the world, the WHO Academy will play an instrumental role towards achieving WHO’s triple billion goal by 2023 and the health Sustainable Development Goals: 1 billion more people will benefit from universal health coverage; 1 billion more will be better protected in health emergencies, and 1 billion more will enjoy improved health and wellbeing.”
The Lancet–SIGHT Commission on peaceful societies through health and gender equality
P Friberg et al ;
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30158-6/fulltext
“…
Improved health and gender equality could help to increase social stability, reduce inequities, and prevent or mitigate conflict, but there is insufficient evidence on these relations and the mechanisms for change. To address this gap, The Lancet and the Swedish Institute for Global Health Transformation (SIGHT) have convened a Commission to examine how improved health and gender equality can contribute to more peaceful societies. Chaired by Tarja Halonen, the former and first female president of Finland, this Commission is an independent, international, and multidisciplinary group of experts from research, development, and multilateral organisations. The Secretariat at SIGHT will draw on Sweden's university network and history of political neutrality, peace, and civil society advocacy. The Commission, which had its inaugural meeting in May, 2019, in Stockholm, Sweden, is examining the interlinkages between SDG3 on health, SDG5 on gender equality, and SDG16 on peace, justice, and strong institutions. …”
HPV
LSHTM - HPV vaccination found to prevent more cases and deaths than previous estimates
LSHTM;
“HPV vaccination has higher health benefits and is more cost-effective than previously estimated, according to a new study published in The Lancet Global Health. The research, led by the London School of Hygiene & Tropical Medicine, updated a mathematical model with new methods and data about population growth, ageing, and the number of women who get cervical cancer in different countries. The study team estimate that HPV vaccination will now prevent 26% more cases and 51% more deaths of cervical cancer when nine year old girls are vaccinated compared to previous estimates at the global level. … … The researchers urge for more African countries to introduce and scale-up HPV vaccination.”
A few papers and reports of the week
BMJ Global Health (Editorial) - Paradigms, policies and people: the future of primary health care
Susan B Rifkin;
https://gh.bmj.com/content/5/2/e002254
“…
Achieving health in line with its WHO definition is only possible when there is a shift in paradigm … … In applying this concept to health policy and health provision in the case of PHC, the shift in paradigm needs to move from viewing health as a result of a linear, predictive set of biomedical interventions to viewing it as a dynamic, iterative process that include social, political and economic factors. Taking actions to achieve health as defined by WHO requires a change in the conceptualisation of its goals and objectives including …. “
… The future of achieving PHC as envisioned by the Alma Ata Declaration requires a paradigm shift that depends on policies and people. It depends on eliminating the continuing confusion between PHC and primary care, creating institutional structures and committed financing to address health improvements in the context of social, political and economic realities and the most important issues of the day such as climate change, and embedding specific mechanisms to include lay people and communities in decisions about healthcare that reflect the context and social determinants of their specific environment….”
BMJ Global Health - Addressing power imbalances in global health: Pre-Publication Support Services (PREPSS) for authors in low-income and middle-income countries
C Busse et al;
https://gh.bmj.com/content/5/2/e002323
“
The contextual knowledge and local expertise that researchers from low-income and middle-income countries (LMICs) contribute to studies in these settings enrich the research process and subsequent publications. However, health researchers from LMICs are under-represented in the scientific literature. Distally, power imbalances between LMICs and high-income countries, which provide funding and set priorities for research in LMICs, create structural inequities that inhibit these authors from publishing. More proximally, researchers from LMICs often lack formal training in research project management and in publishing peer-reviewed research. Though academic journals may value research from LMICs conducted by local researchers, they have limited time and financial resources to support writing, causing them to reject manuscripts with promising results if they lack development. Pre-Publication Support Service (PREPSS) is a non-profit, non-governmental organisation that works to meet this need. PREPSS provides onsite training, peer-review and copy editing services to researchers in LMICs who wish to publish their health research in peer-reviewed journals. Authors are not charged for these services. After receiving PREPSS services, authors submit their manuscript to a peer-reviewed journal. The PREPSS model is one of many interventions necessary to restructure global health research to better support health researchers in LMICs and reduce current power imbalances.”
WHO resource - WHO Symposium on Health Financing for UHC
https://www.who.int/news-room/events/detail/2019/11/12/default-calendar/collaborative-agenda-on-fiscal-space-pfm-and-health-financing-2019
Includes the
meeting report from the symposium (which took place in November last year): featuring
A closer look at fiscal space and public financial management issues in health.
Cfr a
tweet by A Soucat: “
New @WHO ! Latest knowledge on Public Finance issues for health! @WHO Montreux meeting report. A collaborative effort on PFM for health with @WBG_Health @OECD @OpenBudgets @CGDev @results4dev @UNICEF @GlobalFund @GAVI and many others!”
WB (Working paper) - Toward Successful Development Policies : Insights from Research in Development Economics
A Erhan et al ;
https://openknowledge.worldbank.org/handle/10986/33289
«
What major insights have emerged from development economics in the past decade, and how do they matter for the World Bank? This challenging question was recently posed by World Bank Group President David Malpass to the staff of the Development Research Group. This paper assembles a set of 13 short, nontechnical briefing notes prepared in response to this request, summarizing a selection of major insights in development economics in the past decade. The notes synthesize evidence from recent research on how policies should be designed, implemented, and evaluated, and provide illustrations of what works and what does not in selected policy areas. »
NEJM (Perspective) - Transforming Global Health with AI
M Mehta, A Jha et al ;
https://www.nejm.org/doi/full/10.1056/NEJMp1912079?query=featured_secondary
“
Artificial intelligence could revolutionize health and health care in low- and middle-income countries by addressing the large knowledge and judgment gaps that make care delivery poor. But for AI to fulfill this promise, some key challenges will need to be addressed….” Three, in fact.
FIAN (report) – When the SUN casts a shadow
https://www.fian.org/en/press-release/article/when-the-sun-casts-a-shadow-2282
“
A new research study sheds light on the human rights risks of the multi-stakeholder partnership Scaling up Nutrition (SUN)”.
“…SUN encourages companies to join the struggle against malnutrition as a ‘smart investment’. The 23 transnational members of the SUN Business Network include companies such as Mars, PepsiCo, DSM, Ajinomoto, Kellogg’s, and Cargill, many of which are leading manufacturers of ultra-processed foods and snacks….”
Some blogs & mainstream news articles of the week
Duke (News) - "We must ask uncomfortable questions": Notes from Decolonizing Global Health 2020
https://globalhealth.duke.edu/media/news/we-must-ask-uncomfortable-questions-notes-decolonizing-global-health-2020
Short report (with some key quotes) of the
Duke Decolonizing Global Health 2020 conference (from end of January).
Devex - Why blended finance hasn't taken off
https://www.devex.com/news/why-blended-finance-hasn-t-taken-off-96612
Because it just sucks, I guess.
“
Blended finance has been the hot topic in development finance circles for a number of years, but despite the excitement around it, the practice hasn’t taken off….”
Some tweets of the week
- M Pai (on global health & decoloniality)
“
My head is buzzing after a 4 hr flight with @DreJoanneLiu. ! Stuff we discussed: 1. Global health is an aristocracy 2. World needs more people who can raise hell 3. Humanitarian work cannot about 'security' - it should be about our common humanity To be cont. over lunch next week..”
“Right now, global health programs & degrees in high-income countries heavily emphasize health inequities in low-income countries. This recapitulates colonialism. What if they focused on health inequities & disparities, anywhere they occur (local, national & international)?”
- A Guterres (on not funding WHO )
“If there is something that is completely stupid to do in today's world, it is not to fully fund @WHO WHO appeals. Because WHO appeals are vital to support Member States & avoid this tragic disease to become a global nightmare - @antonioguterres on #COVID19”
- David Heymann (on using the term ‘pandemic’)
“@CHGlobalHealth states the word "Pandemic" is a distraction - countries must do whatever they can to contain the outbreak, whatever the word we use to describe of the current public health emergency #COVID19 #coronavirus”
- Charles Kenny (on WB & cancelling conferences )
“World Bank is cancelling conferences *in DC* because of Coronavirus (the Fragility Forum, no less), but it still isn’t paying out on pandemic bonds yet. Sometimes what is needed isn’t financial engineering solutions, sometimes we just need finance.”