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Dear Colleagues,
Lately I’ve been watching the cheesiest series *ever* in my life on Netflix, and as my wife and I already got to the end of season 4, I’m afraid this short intro will be more ‘glass half full’ than usual, having considerably mellowed with every episode 😊.
Sure, there are many discouraging signals & frightening trends in the world, and “doom and gloom” is being predicted by experts all around, mostly for very good reason (eg Peter “I know a window of opportunity when I see one” Piot on an upcoming “Age of pandemics”). And yes, the first Trump-Biden debate was truly “exceptional” ☹ ( let’s just say UN SG Guterres’ advice, that we need to “listen more to older people’s ‘suggestions and ideas”, doesn’t pertain to every elderly person). The world also passed a sad and agonizing milestone this week, with 1 million official Covid-19 deaths. Still, as dr. Tedros rightly argues, “It’s never too late to fight back”! That goes for many of the wicked 21st century challenges we face. Even The Donald will, for once, heed dr. Tedros’ advice.
Ahead of the IMF/WB annual meetings, both IMF and the World Bank made some rather encouraging sounds this week. It seems their leaders understand these are pivotal times indeed (or at least they give the impression). Let’s hope action will follow suit. An all-out #FeministBailout, “based on care, respect for eco-systems, and solidarity”, is probably too much to ask for.
Moving to the ACT-Accelerator then. Its updated investment case unfortunately still puts way too much focus on ‘restarting’ a destructive 20st century economy (airlines, mass tourism, …). ‘Building back better’ wasn’t much of a concern, clearly, and this in the very week that saw the launch of the Doughnut Action Lab. While I understand some of the rationale behind it (given how many millions of people are struggling to make ends meet), it’s still a missed opportunity with a view on the Global Sufficiency economy we desperately need in the 21st century. To put it bluntly: “Vaccines for All” so that we can all hop on planes again, and visit Dubrovnik, Barcelona and Venice in droves, isn’t exactly going to lead to ‘Health for All’ on this planet. On a more positive note, funding for the ACT-Accelerator got a boost at a High-Level UNGA event, especially funding for its vaccine pillar ( if suggested WB funding will be approved by the WB Board, that is). The diagnostics pillar also had some encouraging news this week, making available 120 million affordable, quality COVID-19 rapid tests for LMICs. Still, a big funding gap remains, overall. Fundraising needs to, ahum, “accelerate”.
For the framers and spin doctors among you, I hear more and more that COVAX is the “the biggest multilateral effort since the Paris climate agreement .“ (true, by Seth Berkley, among others 😊). While I quite concur, I also hope the People’s Vaccine, as demanded (forcefully) by Covid-19 survivors and many others, will continue to gain momentum, with far more support for C-TAP than has been seen so far. Whether José Manuel Barroso, the new GAVI Board chair, currently “non-executive Chairman of Goldman Sachs International”, will ensure a breakthrough in this matter, is doubtful though.
I leave you with a spot-on quote from Jeremy Farrar, now that many countries see rising Covid figures again, certainly in this part of the world: “With epidemics you must always act faster and go further than at first seems necessary or you feel comfortable with. That has been the case in every epidemic I have worked through – SARS, HIV, bird flu, Ebola. Covid-19 is no exception.”
Enjoy your reading.
Kristof Decoster
On this week’s UN biodiversity summit, and more.
“Before the coronavirus pandemic disrupted talks, Wednesday’s summit was meant to be the moment international leaders gave their input before negotiators headed to Kunming to thrash out a final agreement. While there is a danger that governments might ignore the environmental targets while grappling to rescue economies and save lives, there is cautious optimism that the opposite has happened. Repeated warnings linking Covid-19 and zoonotic diseases to the destruction of nature have focused minds. … … Despite the optimism, the ambition of the “Paris agreement for nature” will be reflected in the detail of measurable, targeted actions. As things stand, the draft Kunming agreement has headline targets of protecting 30% of the world’s land and sea by 2030, introducing controls on invasive species and reducing pollution from plastic waste and excess nutrients. Ahead of Wednesday’s summit, 64 leaders and the EU published an ambitious 10-point pledge [ see also below ] that many privately hope will bounce other countries into being more ambitious. Watch out for how that translates into statements by countries such as Australia, China and India that did not sign the pledge….”
For a short report of the summit, see IISD - UN Biodiversity Summit Supports 2030 Agenda-aligned Post-2020 Framework “The first UN Biodiversity Summit highlighted the urgency of action at the highest levels in support of a post-2020 global biodiversity framework that contributes to the 2030 Agenda for Sustainable Development and places the global community on a path towards “living in harmony with nature” – the 2050 Vision for Biodiversity.”
“…NGA President Volkan Bozkir called on Member States to use the Summit to build political momentum towards a post‑2020 global biodiversity framework to be adopted at the 15th meeting of the Conference of the Parties (COP 15) to the CBD to be held in Kunming, China in 2021. “Kunming must do for biodiversity what Paris did for climate change,” said Bozkir, by placing the biodiversity discourse firmly on the political agenda.”
“World leaders have pledged to clamp down on pollution, embrace sustainable economic systems and eliminate the dumping of plastic waste in oceans by the middle of the century as part of “meaningful action” to halt the destruction of nature on Earth. Emmanuel Macron, Angela Merkel, Justin Trudeau, Jacinda Ardern and Boris Johnson are among 64 leaders from five continents warning that humanity is in a state of planetary emergency due to the climate crisis and the rampant destruction of life-sustaining ecosystems. To restore the balance with nature, governments and the European Union have made a 10-point pledge to counteract the damage to systems that underpin human health and wellbeing….”
“… All signatories to the Leaders’ Pledge for Nature, launched virtually in New York on Monday, have committed to putting wildlife and the climate at the heart of post-pandemic economic recovery plans, promising to address the climate crisis, deforestation, ecosystem degradation and pollution….”
“Scientists at the environmental research organisation Resolve have drawn up a blueprint for a planetary “safety net” of protected areas they say could help halt catastrophic biodiversity loss...”
These areas need additional conservation to stem biodiversity and climate crises.
For more, see the paper in Science Advances. “Global strategies to halt the dual crises of biodiversity loss and climate change are often formulated separately, even though they are interdependent and risk failure if pursued in isolation. The Global Safety Net maps how expanded nature conservation addresses both overarching threats….”
H Frumkin & S Myers; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32038-9/fulltext
“Elections impact health through changes in both health-care delivery and upstream social and environmental policies. The upcoming US election presents stark contrasts in environmental policies that will affect health in the USA and globally. Here we examine these contrasts through the lens of planetary health….”
S Kadandale, R Marten et al; https://www.who.int/bulletin/online_first/BLT.20.252882.pdf?ua=1
“The health community recognizes the climate crisis as an existential threat to humanity and human health, requiring immediate and effective action across all sectors. However, global-level policy guidance reveals a disconnect between primary health care and climate; most political declarations, reports and resolutions for primary health care make only cursory references to the climate crisis, mentioning its implications for health but not linking them. Given that primary health care should be the entry point for the population’s interaction with the health system, it is alarming that ongoing efforts to revitalize primary health care fail to adequately consider climate action, both in terms of mitigation and adaptation. In this paper, we examine this disconnect, elaborate on its implications and offer recommendations for policy-makers to ensure an effective primary health care–climate crisis nexus….”
“This week is the online launch of Doughnut Economics Action Lab (DEAL). At the heart of it is a community platform, open to everyone who wants to turn Doughnut Economics from a radical idea into transformative action. …”
K-J Wabnitz et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32039-0/fulltext
With a proposal for a pledge for planetary health for health professionals, open for feedback from all.
https://www.bmj.com/content/371/bmj.m3785
“The healthcare sector has a profound responsibility and opportunity to reduce greenhouse gas emissions to limit the widespread health harms of climate change. Renee N Salas and colleagues chart a path to net zero emissions for healthcare.”
J Hickel; https://foreignpolicy.com/2020/09/30/the-worlds-sustainable-development-goals-arent-sustainable/
“There’s are big problems with the United Nations’ most important environmental metric.”
More in particular, with “the SDG Index, which was developed by Jeffrey Sachs “to assess where each country stands with regard to achieving the Sustainable Development Goals.” The metric tells a very clear story. Sweden, Denmark, Finland, France, and Germany—along with most other rich Western nations—rise to the top of the rankings, giving casual observers the impression that these countries are real leaders in achieving sustainable development….”
Boris Johnson [announced] a 30% increase in the UK’s funding of the World Health Organization, making the UK the single largest national donor after the US leaves. In an announcement at the UN General Assembly, he urge[d] it to heal “the ugly rifts” that are damaging the international fight against coronavirus. Johnson [announced] £340m in UK funding over the next four years, a 30% increase. He also suggested the body be given greater powers to demand reports on how countries are handling a pandemic.”
The proposals [will] form part of a British vision, drawn up in conjunction with the Gates Foundation, of how future health pandemics could be better controlled, including “zoonotic labs” capable of identifying potentially dangerous pathogens in animals before they transmit to humans.
… The extra UK cash comes ahead of WHO board meeting next week at which a joint Franco-German paper is to be discussed calling for more reliable, larger and less conditional funding of the WHO.
“…Johnson also use[d] his address to announce significant new investment in Covax, the international coronavirus vaccines procurement pool announced in April. The UK contributes an initial £71m to secure purchase rights for up to 27m vaccine doses for the UK. He also announced £500m in aid funding for the Covax advance market commitment, a facility to help 92 of the world’s poorest countries access any coronavirus vaccine at the earliest opportunity.”
See also FT - Johnson to boost WHO backing with £571m vaccine pledge
“Boris Johnson [will] lay out plans to make the UK one of the biggest funders of both the World Health Organisation and its vaccine procurement facility, in a set of measures intended to show Britain taking a bigger role in the international fight against the coronavirus pandemic.”
“… The amount Britain has committed to Covax is larger than the pledges of most countries and regions that have made their investments public to date. The EU, representing 27 member states, has pledged €400m ($470m), Brazil has committed $450m, Japan has pledged $165m, and New Zealand has committed $183m. Mr Johnson will also outline an ambition to use the UK’s G7 presidency next year to implement a five-point plan to prevent future pandemics and global health crises. Those measures would include setting up a network of zoonotic research hubs to identify the threat of new pandemics within animal groups before they start, increasing manufacturing capacity for the production of treatments and vaccines, and reducing trade barriers that have impeded the coronavirus response.”
For the full speech of Johnson, see UK government.
https://www.nytimes.com/2020/09/30/world/europe/ski-party-pandemic-travel-coronavirus.html
Important discussion with a view on the review of the International Health Regulations.
“The World Health Organization said open borders would help fight disease. Experts, and a global treaty, emphatically agreed. But the scientific evidence was never behind them. … … Nine months into an outbreak that has killed a million people worldwide, Ischgl is where the era of global tourism, made possible by cheap airfares and open borders, collided with a pandemic. For decades, as trade and travel drew the world closer, public health policy, enshrined by treaty, encouraged global mass tourism by calling for open borders, even during outbreaks. … When the coronavirus emerged in China in January, the World Health Organization didn’t flinch in its advice: Do not restrict travel. But what is now clear is that the policy was about politics and economics more than public health….” “… Public health records, scores of scientific studies and interviews with more than two dozen experts show the policy of unobstructed travel was never based on hard science. It was a political decision, recast as health advice, which emerged after a plague outbreak in India in the 1990s. By the time Covid-19 surfaced, it had become an article of faith. “It’s part of the religion of global health: Travel and trade restrictions are bad,” said Lawrence O. Gostin, a professor of global health law at Georgetown University who helped write the global rules known as the International Health Regulations. “I’m one of the congregants.” Covid-19 has shattered that faith.”
“…. What is vividly clear is that global public health policies are inadequate, especially regarding travel. …”
Cfr a tweet: “#IHR The new rules took effect in 2007 even as the world was rapidly making them obsolete. Focused heavily on trade, they failed to account for “a tourism industry that grows out of bounds”.”
I Torres et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30415-0/fulltext
« … The COVID-19 vaccine initiative (COVAX) shows how public–private partnerships can exacerbate existing chasms or allow organisations, such as WHO, to guide a realistic and adequate approach….”
A few suggestions to move towards the latter: “….an example could be set by evaluating initial steps, when necessary, to guarantee meaningful inclusion of countries and voices that have been traditionally excluded in WHO's Science Council and in COVAX. Second, formal conditions for organisations to directly oversee the Science Council and COVAX should be set….”
Focus on CEPI in this thoughtful blog.
Daniel Reidpath; http://www.papyruswalk.com/?p=727
“WHO needs to diversify hires at senior levels to embrace its health mandate effectively. Rethinking the essential qualifications for senior-level appointments would be a good place to start. “
https://news.un.org/en/story/2020/10/1074452
“Unless countries act now, the COVID-19 pandemic could erase recent “fragile progress” towards gender equality, the UN Secretary-General warned on Thursday, urging governments to put women at the centre of recovery and response.” “António Guterres issued the charge in a speech to a UN General Assembly high-level meeting to commemorate the 25th anniversary of the landmark Fourth World Conference on Women held in Beijing, China.”
See also an ODI blog - The Beijing Declaration 25 years on – three priorities for humanitarians
“Twenty-five years ago today – on 1 October 1995 – the Beijing Declaration and Platform of Action was agreed at the United Nations Fourth World Conference on Women. The declaration was the culmination of decades of work on concerns around women’s equality in the development sector. Yet it was not until the early 1990s that the humanitarian sector began to integrate gender into their programming. Gender mainstreaming has persisted in humanitarian policies, but in practice it has been criticised for maintaining an ‘add women and stir’ approach to gender equality, rather than understanding local communities and actors, both men and women, and the embedded nature of gender relations. Now, 25 years on, UN agencies – along with donors and NGOs – should revisit what the Beijing Declaration offered humanitarians: an agenda for gender responsive action that is groundbreaking even today.”
https://news.un.org/en/story/2020/09/1073762
“Fragile gains made over the past decade to advance women and children’s health are threatened by conflict, the climate crisis and COVID-19, according to a new report from Every Woman Every Child, released on Friday. Protect the Progress: Rise, Refocus, Recover, 2020 highlights that since the movement was launched 10 years ago, spearheaded by then UN Secretary-General Ban Ki-moon, there has been remarkable progress in improving the health of the world’s women, children and adolescents, with under-five deaths reached an all-time recorded low in 2019, and more than 1 billion children were vaccinated over the past decade….”
For the Report, see here.
Coverage via Forbes COVID-19, Climate Crisis Hits Health Services In 50% Countries
“Over 50% countries have reported partial or severe disruptions to their health services from the dual impact of COVID-19 and climate crisis, according to a report from Every Woman Every Child - a movement launched 10 years ago and spearheaded by the then UN secretary-general Ban Ki-moon. Disruptions to routine immunization services, malaria prevention campaigns, family planning and antenatal care services threaten gains made in women and children’s health over the past few decades. …”
“Most countries are failing to adequately protect women and girls during the fallout from Covid-19, according to a new UN database that tracks government responses to the pandemic. The global gender tracker has looked at how 206 countries and territories address violence against women and girls, support unpaid care workers and strengthen women’s economic security. Forty-two countries had no policies to support women in any of these areas. Only 25 had introduced some measures in all three categories….”
See also the Independent - Only one in eight countries safeguarding women against social impacts of coronavirus, UN study finds
“Only 48 nations – less than a quarter – deemed services which address violence against women and girls as a key element of their national and local coronavirus response plans…” On research carried out by UN Women and the UN Development Programme.
For the tracker, see COVID-19 Global Gender Response Tracker
“ The COVID-19 Global Gender Response Tracker monitors policy measures enacted by governments worldwide to tackle the COVID-19 crisis, and highlights responses that have integrated a gender lens. It includes national measures that are directly addressing women’s economic and social security, including unpaid care work, the labour market and violence against women. The tracker is coordinated by UNDP with substantive leadership and technical contributions from UN Women….”
https://news.trust.org/item/20200929162932-66igq/
Disturbing report. “At least 30 women said workers from the World Health Organization were involved. Women also noted men came from UNICEF, Oxfam, Medecins Sans Frontieres, International Organisation for Migration, World Vision and ALIMA. Three organisations pledged investigations into the accusations. Most aid agencies and NGOs said they received no abuse reports during the crisis. Most women said they were unaware of how to report the abuse or exploitation.”
WHO statement - WHO to investigate allegations of sexual exploitation and abuse in Ebola response in the Democratic Republic of the Congo
See also BBC News - WHO to probe 'sexual exploitation' by aid workers in DR Congo
“The World Health Organization (WHO) has pledged to investigate allegations that aid workers tackling the Ebola outbreak in the Democratic Republic of Congo sexually abused and exploited women.”
And more analysis via the New Humanitarian on the ‘sex-for-jobs’ schemes - Power, poverty, and aid: The mix that fuelled sex abuse claims in Congo.
https://www.ids.ac.uk/news/beyond-metoo-learning-from-anti-sexual-harassment-activisms-globally/
“A new IDS Bulletin examines the experiences of female-led activisms against sexual harassment in articles that cover 11 countries around the world, including Egypt, the Philippines and India. The editors, Mariz Tadros and Jenny Edwards, argue that a wider range of diverse collective actions need to be more widely recognised and learnt from to better understand how to counter sexual harassment around the world, and build collective action for accountability.”
“Africa is losing nearly $89 billion a year in illicit financial flows such as tax evasion and theft, amounting to more than it receives in development aid, a U.N. study showed on Monday. The estimate, in the United Nations Conference on Trade and Development’s (UNCTAD) 248-page report, is its most comprehensive to date for Africa. It shows an increasing trend over time and is higher than most previous estimates. The report calls Africa a “net creditor to the world,” echoing economists’ observations that the aid-reliant continent is actually a net exporter of capital because of these trends….”
“Nearly half of the total annual figure of $88.6 billion is accounted for by the export of commodities such as gold, diamonds and platinum, the report said. For example, gold accounted for 77 percent of total underinvoiced exports worth $40 billion in 2015, it showed….”
http://www.ipsnews.net/2020/09/no-excuses-time-global-economic-solutions/
“On 29 September, the world’s heads of state [will] come together (virtually) at an extraordinary meeting to discuss financing for development during the 75th UN general assembly. This will be crucial in the battle to address the Coronavirus crisis….”
Excellent analysis by Eurodad, Tax Justice. Where things stand in this important battle, and where we need to go.
“The coronavirus that has claimed nearly 1 million lives has underscored the failure of the United Nations to bring countries together to defeat it, prompting renewed calls to reform the world body so that it can meet challenges far different — and more daunting — than those it faced at its birth. As U.N. Secretary-General Antonio Guterres said last week, “The pandemic is a clear test of international cooperation – a test we have essentially failed.” There is a “disconnect between leadership and power,” he said, warning that in the 21st century’s interconnected world, “solidarity is self-interest,” and “if we fail to grasp that fact, everyone loses.”…”
“… “We could criticize the U.N. for this — but who are we really talking about, when we blame `the U.N.?’” Switzerland President Simonetta Sommaruga asked. “We are in fact talking about ourselves, because the U.N. is its member states. And it is often member states that stand in the way of the U.N.’s work.”…”
Report of a particularly vicious Security council meeting last week.
“The United States butted heads with China and Russia at the United Nations on Thursday over responsibility for the pandemic that has interrupted the world, trading allegations about who mishandled and politicized the virus in one of the few real-time exchanges among top officials at this year’s COVID-distanced U.N. General Assembly meeting.
The remarks at the U.N. Security Council’s ministerial meeting on the assembly’s sidelines came just after U.N. Secretary-General Antonio Guterres decried the lack of international cooperation in tackling the still “out-of-control” coronavirus. … The sharp exchanges, at the end of a virtual meeting on “Post COVID-19 Global Governance,” reflected the deep divisions among the three veto-wielding council members that have escalated since the virus first emerged in the Chinese city of Wuhan in January. “
And some links:
· AP - At UN, Africa urges fiscal help against virus ‘apocalypse’
"African nations came out swinging on the third day of the United Nations annual gathering of world leaders Thursday, calling for dramatic fiscal measures to help economies survive the coronavirus pandemic -- which one leader called the 'fifth horseman of the apocalypse.' Africa's 54 countries estimate they need $100 billion in support annually for the next three years, pointing out that it's a fraction of the trillions of dollars some richer countries are using to revive their economies…”
· UN News - Japan to ‘proactively lead’ on COVID-19 response efforts
“Japan has signaled its intention to take a leading role in global response to the COVID-19 pandemic and its aftershocks, with new Prime Minister Yoshihide Suga highlighting the links between recovery, health and economic development.”
On Japan and its new leader, see also a new Lancet Letter: An open letter to Japan's new Prime Minister (by K Shimizu et al)
“…COVID-19 has posed sector-wide challenges and revealed the fundamental inequalities in the human security agenda. The Japanese health system is no exception. Considering Prime Minister Suga's enthusiasm for saving citizens' livelihoods and revitalising the economy, we, health-care workers and scientists, expect him to manage and control the crisis by expressing empathy to vulnerable and high-risk populations and by protecting front-line workers. A human security approach—a fundamental value in Japan's foreign policy that prioritises protecting human lives—is pivotal. Containing COVID-19 domestically through invigorated science and innovation will strengthen global and regional health security; such an approach will also help Japan revamp the highly politicised COVID-19 response and resume a leadership role in global health policy to end the pandemic.”
https://www.who.int/about/governance/executive-board/executive-board-147th-session
Will be a ‘hybrid’ session, it appears. Focus: Special session on the implementation of Resolution WHA 73.1
All documents via: https://apps.who.int/gb/e/e_ebss5.html
Key document: Update on implementation of resolution WHA73.1 (2020) on the COVID-19 response Interim report by the Director-General
Do check out also G2H2’s A civil society guide to the 73rd World Health Assembly #WHA73 and the Special Session of the WHO Executive Board #EBSS5.
“A hybrid meeting… with virtually no space/voice for civil society.”
Concluding: “NGO participation in the WHO Executive Board has been reduced to tokenism. It will be interesting to see how many NGOs will accept these new “rules of the game”, for the sake of having at least a bit of temporary visibility on the WHO website and for being able to report back to their home audience… All in all, these are dire perspectives for the upcoming resumed World Health Assembly in November. (Comment by Thomas Schwarz, MMI Network, an NGO in official relations with WHO)”
Tweet Thomas Schwarz (MMI): “Dear @drtedros : Compare this dire reality and perspectives (resumed #WHA73 in November) at @WHO insitutional level with the Secretariat's rhetoric of "more engagement with civil society in the Covid19 response"
Tweet Katri Bertram: “Sadly, there are many such multilateral examples where #CSO engagement has been pushed to the sidelines, as side meetings, or as "CSO fora" - where #leaders may or may not drop in, and CSOs are left to engage with each other. #WHO joining this is a very bad development.”
For a recent global update of trends, see Cidrap News - As COVID-19 total tops 34 million, World Bank offers vaccine plan for poorer nations (Oct 1).
Good analysis of this tragic “milestone”.
· See also The Guardian - Global coronavirus deaths pass 1m with no sign rate is slowing
Quote: “… But the official figure probably underestimates the true total, a senior World Health Organization official said on Monday. “If anything, the numbers currently reported probably represent an underestimate of those individuals who have either contracted Covid-19 or died as a cause of it,” Mike Ryan, the WHO’s top emergencies expert, told a briefing in Geneva. …”
· NPR - COVID-19 Deaths Top 1 Million Worldwide. How These 5 Nations Are Driving The Pandemic
US, Brazil, India, Mexico, UK.
· WEF (blog ) - As the COVID-19 death toll passes 1 million, how does it compare to other major killers?
Excerpt: “The WHO has warned that could double if countries don’t take greater action to tackle the pandemic. As the above chart shows, the global number of deaths being reported weekly to the World Health Organization (WHO) is trending downward from a spike in January, even though cases are still rising. Dr Mike Ryan, the WHO’s emergencies head, explained: “We’re seeing clinical case fatality rates slowly drop, we’re seeing doctors and nurses making better use of oxygen, better use of intensive care, better use of dexamethasone.” But he also warned the death toll could “sadly very likely” double to two million unless governments “do what it takes to avoid that number”. The true death toll may be higher because cases and deaths are recorded differently in each country and testing is happening sporadically in some regions….”
· Nature News - COVID has killed more than one million people. How many more will die?
“Researchers warn that official figures underestimate the pandemic’s real death toll, which could more than triple if the virus is allowed to spread unchecked.” The latter estimate, more than 3 million by January 2021, is based on an IHME ‘worst scenario’ estimate. Let’s hope it won’t come to that.
https://www.theguardian.com/business/2020/sep/29/imf-chief-covid-inequality-kristalina-georgieva
“The head of the International Monetary Fund has given a stark warning that Covid-19 will lead to a lost generation unless urgent steps are taken to prevent the pandemic widening the gap between rich and poor countries. Kristalina Georgieva, the IMF’s managing director, said financial support for the most vulnerable countries had to be stepped up to prevent long-time scarring that would roll back anti-poverty efforts of recent decades. Writing for the Guardian, Georgieva said failure to act would reverberate around the world, with greater inequality leading to social and economic upheaval….”
“In her article, the IMF managing director called for a four-pronged approach: Governments making health their priority to ensure a durable exit from the pandemic, with special focus on the elderly and vulnerable. Ensuring budgets are well spent by focusing on key areas of spending – such as education – and clamping down on corruption. Laying the foundations for the future by speeding up the transition to climate-resilient, low-carbon, digital economies. A stepping-up of support from rich countries, which required an increase not a cut in aid resources in the form of grants, concessional loans and debt relief.”
PS: “… Georgieva said debt relief efforts needed to go further. In response to a call by the IMF and the World Bank, the G20 group of leading developed and developing countries suspended official bilateral debt payments from the poorest countries this year, making about $5bn (£4bn) available to 42 low-income countries. “The initiative could be extended along with increased participation by commercial creditors,” she said.
Heaps of new information & announcements again, this week, for this key section.
“Survivors of COVID-19 from 37 countries are among almost 1,000 people who have signed an open letter to pharmaceutical industry leaders calling for a ‘people's vaccine’ and treatments that are available to all – free from patents. The letter comes on the eve of a high-level side event about the pandemic at the UN General Assembly in New York [tomorrow] (30 September). The signatories include 242 COVID-19 survivors from South Africa to Finland and New Zealand to Brazil. They also include 190 people in 46 countries who have lost relatives to the virus, and 572 signatories with underlying health conditions that mean they are more likely to develop severe forms of COVID-19 and have a greater risk of dying from it….”
“The letter says: “Some of us have lost loved ones to this killer disease. Some of us have come close to death ourselves. Some of us are continuing to live in fear that contracting this disease would be fatal for us. We see no justification why your profit or monopolies should mean anyone else should go through this.” It describes pharmaceutical corporations as “carrying on with business as usual - defending monopolies while refusing to share research and know-how” and calls on industry leaders to “ensure COVID-19 vaccines and treatments reach everyone who needs them by preventing monopolies, ramping up production and sharing knowledge.” Pharmaceutical monopolies will restrict the production of effective vaccines and treatments to a small number of manufacturers, preventing the mass production that is needed to meet global demand. The letter demands that corporations immediately license vaccine technology and intellectual property rights to the WHO COVID-19 Technology Access Pool (C-TAP).”
Update on C-TAP from late last week. That was long ago.
“While the COVAX Facility, a global initiative to pool procurement of a safe and effective COVID-19 vaccine, has been gaining momentum, another global initiative to pool intellectual property rights for tools to combat the pandemic has been moving at a much slower pace. Only three more countries have signed on to support the COVID-19 Technology Access Pool (CTAP), an initiative to pool COVID-19-related intellectual property IP, including patent rights, since the pool was first launched in 29 May. That makes 40 countries now supporting the initiative, according to WHO Access to Medicines, Biologics, and Vaccines Director Mariangela Simão, speaking at a UNGA side event hosted by Costa Rica’s President Carlos Alvarado Quesada on Friday. The high-level event also included WHO Director General Dr Tedros Adhanom Ghebreyesus and UN AIDS executive director Winnie Byanyima. Byanyima expressed concern about the lack of support the IP pool had received so far from countries as well as industry….”
Encouraging announcement, but more details are needed. “The World Bank has announced plans for a $12bn (£9.3bn) initiative that will allow poor countries to purchase Covid-19 vaccines to treat up to 2 billion people as soon as effective drugs become available. In an attempt to ensure that low-income countries are not frozen out by wealthy nations, the organisation is asking its key rich-nation shareholders to back a scheme that will disburse cash over the next 12 to 18 months. David Malpass, the World Bank president, said the initiative was needed because Covid-19 was having a much bigger impact on low and middle income countries than on the developed world. “Having this finance available will be a game changer because once a safe and effective vaccine is available it will allow people to resume their lives with confidence.”…”
See also Reuters - Exclusive: World Bank seeks board approval for $12 billion coronavirus vaccine financing plan
“…. Malpass told Reuters in an exclusive interview that the initiative, part of $160 billion in coronavirus aid financing pledged by the multilateral lender, is aimed at helping countries procure and distribute vaccines early to healthcare and other essential workers and expand global production. He said the board was expected to consider the plan in early October….”
And see this WB (Malpass’) statement for the detail - Remarks by World Bank Group President David Malpass at the UNGA High Level Side Event on Accelerating the End of the COVID-19 Pandemic
Oxfam’s reaction: Why the World Bank should be calling for a People's vaccine
https://healthpolicy-watch.news/77209-2/
With all the (funding & commitment) details from the UNGA ACT-Accelerator event (30 September)
“… The announcement at a United Nations high-level panel on the pandemic that also included commitments from the big pharma firm Johnson& Johnson, Bill Gates and numerous heads of states – marks the first serious flow of finance into an ambitious global vaccine pool. The “Covax” vaccine pool is part of a World Health Organization co-sponsored Act Accelerator initiative to raise some $35 billion to finance 2 billlion vaccine doses, as well as diagnostic tests and treatments, for low- and middle-income countries across the globe. A handful of rich countries, including Canada, the United Kingdom, Germany and Sweden, also announced nearly $670 milllion in new pledges to the “Covax” pool, which is co-sponsored by the WHO and Gavi, the Vaccine Alliance. Some 168 rich and poor countries have joined the pool, in an unprecedented show of solidarity. But until today, the vaccine facility had only secured $3 billion in donations, far short of the billions that WHO and its partners have said they would need to roll out vaccines in 92 low- and middle-income countries that can’t afford to pay….”
“In another precedent for the fund-raising effort, Alex Gorsky, CEO of the pharma giant Johnson&Johnson also pledged to “allocate up to 500 million doses” of its Covid-19 vaccine to lower-income countries – should its candidate now under development pass Phase 3 trials with results showing it is safe and effective. …”
“… Altogether, WHO and Gavi have said that some $15 billion is needed immediately to began making the manufacturing orders and planning distribution networks that would allow for the massive rollout of a vaccine in 2021. The US$ 12 billion in World Bank finance goes a long way towards that, most immediate goal….”
“However, more money is still needed to fund other two pillars of the so-called ACT Accelerator initiative, including COVID treatments as well as 120 million rapid COVID tests – which WHO wants to roll out in low- and middle-income countries that lack the equipment for expensive PCR laboratory tests….”
See also a WHO press release - UN welcomes nearly $1 billion in recent pledges - to bolster access to lifesaving tests, treatments and vaccines to end COVID-19
With a detailed list of all new commitments & pledges.
And See also Devex - World leaders pledge $1B for ACT-Accelerator.
https://news.un.org/en/story/2020/09/1074392
Short report of the same UNGA HL meeting.
“The UN Secretary-General on Wednesday called for all nations to provide further urgently needed funds – the equivalent of the total spent on cigarettes worldwide every two weeks – on behalf of global COVID-19 vaccine efforts to ensure that everyone, everywhere, gets protection from the virus. “
PS: “… Mr. Gates announced that the Bill and Melinda Gates Foundation, earlier on Wednesday, had signed a new agreement with 16 pharmaceutical companies. “In this agreement the companies commit to, among other things, scaling up manufacturing at an unprecedented speed, and making sure that approved vaccines reach broad … as early as possible”, he said. …”
https://www.cidrap.umn.edu/news-perspective/2020/09/us-covid-19-cases-top-7-million
(as of 25 Sept) “… At a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said 67 higher income countries or economies have now joined the COVAX Facility, up from 64 a few days ago, and that another 34 are expected to join. The COVAX program, led by WHO with support from its partners, pools the risk of supporting vaccine development with securing doses for countries, both developed and developing, at reasonable prices. Brazil, Chile, Israel, and the United Arab Emirates (UAE) are among the latest countries to join, Reuters reported. At today's briefing, Tedros said Taiwan is one of the economies that has joined….”
(as of Oct 1) “The GAVI vaccine alliance’s board has approved up to $150 million to help 92 low- and middle-income countries prepare for the delivery of future COVID-19 vaccines, including technical assistance and cold chain equipment, it said on Thursday. The initial funds will help establish the COVAX facility at an operational level and ensure routine immunisation programmes continue in eligible countries, GAVI said in a statement. In all, 168 countries have joined the COVAX global vaccine facility, led by GAVI and the World Health Organization (WHO), including 76 wealthy or self-financing countries, it said….”
https://www.who.int/publications/i/item/an-economic-investment-case-financing-requirements
WHO’s updated investment case for the ACT-Accelerator. “This document lays out economic arguments for investing in the Access to COVID-19 Tools Accelerator (ACT-Accelerator). Framed within an overall context that recognizes the broader human health and societal impacts of the COVID-19 crisis, the ACT-Accelerator Economic Investment Case argues that investment in ACT-Accelerator is the world’s best bet and most viable solution for restarting the global economy. It is intended for governments, multilaterals, civil society, businesses and foundations and all those interested in the work required to change the course of the pandemic.”
As a reminder: “By the end of next year, the ACT Accelerator aims to deliver 2 billion doses of vaccine; 245 million courses of treatment; and 500 million diagnostic tests to low- and middle-income countries.”
Recommended read on the launch of the (updated) ACT-Accelerator investment case, last week on Friday.
“The World Health Organization has published an updated investment case for the Access to COVID-19 Tools Accelerator and a detailed plan for how the money will be used in the next three months — or what will happen if immediate funding fails to materialize. The investment case now includes costing for the ACT-Accelerator’s “fourth pillar,” known as the health systems connector, which has a total requirement of $9 billion. This fourth pillar is essentially meant to ensure the availability of oxygen and personal protective equipment in countries, as well as support countries in building their capacities and health systems to deploy COVID-19 tools effectively and efficiently. In addition to a reduction in costings for the vaccines pillar, this brings the initiative’s total ask from $31 billion to $38 billion, with $15 billion in funding needed immediately. The biggest share of the money, or $16 billion, is for vaccines. That includes money to support the research and development of the most promising vaccine candidates, to help increase global manufacturing capacity for the vaccines, and to allow for the procurement and delivery of potential vaccines to low-income countries. … … Of the total funding needed however, roughly only $3 billion has been pledged to date, leaving a significant gap of $35 billion.
…Of the $16 billion needed for the vaccines pillar, only $2 billion has been pledged to date. The other three pillars, meanwhile, have received significantly less than $1 billion each….”
Encouraging news from the ACT-Accelerator’s Diagnostics pillar.
“A full access package includes WHO policy guidance on the use of antigen-based rapid diagnostic tests, manufacturer volume guarantees for low and middle-income countries, catalytic funding to assist governments to deploy the tests and an initial US$50 million procurement fund. Several rapid, point-of-care antigen tests are being assessed by WHO for Emergency Use Listing (EUL). Agreements between the Bill & Melinda Gates Foundation and test manufacturers Abbott and SD Biosensor make available innovative tests priced at a maximum of US$5 for low- and middle-income countries (LMICs). The Global Fund commits an initial US$50 million to enable countries to purchase the new tests, with the first orders expected to be placed this week. Expedited market introduction of these tests in multiple LMICs is being supported through the Africa Centres for Disease Control and Prevention (Africa CDC), Unitaid, FIND, CHAI, and their partners. This is the latest move from the Access to COVID-19 Tools (ACT) Accelerator to develop, procure and distribute critical new tools to fight the pandemic; new tests are urgently needed to meet the huge unmet needs for testing worldwide.”
Coverage, see the Guardian: Covid-19 tests that give results in minutes to be rolled out across world
“Global initiative will supply 120m rapid antigen tests to low- and middle-income countries.”
“… In return for a volume guarantee from the Gates Foundation, the companies are making 20% of their production available to low- and middle-income countries and 80% to the rest. Germany has already ordered 20m tests and France and Switzerland are following suit.”
Still, a funding gap, though: “…However, US $1.7 billion in funding is still required to before the end of the year to ensure that all tests can be distributed to countries in need, according to Catharina Boehme, the CEO of the Foundation for Innovative New Diagnostics (FIND), a co-convener of the ACT Accelerator’s diagnostics pillar. Some US $650 million of the required funds will be used help finance the roll-out and distribution of tests in countries. …”
“Collaboration among the Serum Institute of India (SII), Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation will accelerate manufacturing and delivery of up to an additional 100 million doses of future vaccines, if proven to be safe and effective, for low- and middle-income countries in 2021. The expansion follows August’s announcement of up to 100 million doses to be delivered by the collaboration, bringing the total now to be delivered by the partnership to up to 200 million doses of COVID-19 vaccines, priced at a maximum of US$ 3 per dose, with an option to secure more.”
https://www.reuters.com/article/us-health-coronavirus-trade-interview-idUSKBN26K2Q3
“ A key contender to head the World Trade Organization told Reuters on Tuesday she thinks the body should play a role in helping poorer countries access COVID-19 drugs and vaccines, and this topic should be part of negotiations if she wins. Nigeria’s Ngozi Okonjo-Iweala, seen by delegates as a top candidate to lead the WTO, currently chairs the GAVI vaccine alliance board and stressed her credentials among five remaining candidates “at the intersection between public health and trade”. …. “Trade can contribute to public health - seeing that connection, invoking those (WTO) rules, actively discussing COVID-19 issues and how WTO can help,” the former finance minister and World Bank managing-director said. “For me, that would be a priority.” … Okonjo-Iweala, one of two African candidates in the second of three rounds, says she is discussing with members the options for using WTO intellectual property rules to get special licences to deliver COVID-19 medicines to poorer countries….”
https://www.devex.com/news/africa-cdc-launches-vaccine-perception-survey-98202
“Data collectors are spreading out through five African nations to conduct a survey for four weeks to see how people feel about a COVID-19 vaccine, according to John Nkengasong, director of the Africa Centres for Disease Control and Prevention. After months of preparation, teams in South Africa, the Democratic Republic of the Congo, Gabon, Côte d'Ivoire, and Nigeria took to the field to gauge the perceptions of communities as part of the Africa COVID-19 Vaccine Perceptions Survey. At his weekly press briefing last week, Nkengasong stressed that understanding perceptions and community engagement is essential, as they will help determine the continent’s vaccine uptake strategy….”
“Researchers warn that vaccines could stumble on safety trials, be fast-tracked because of politics or fail to meet the public’s expectations.”
Summary via Nature: “Several ongoing coronavirus-vaccine trials — from Moderna, Pfizer and the University of Oxford–AstraZeneca — could announce game-changing results next month. Here are the areas that scientists are watching closely:
Whether trials will be allowed to run long enough to collect long-term safety data. Convincing preliminary results could end trials early.
“Moscow is in various stages of talks and has received requests to supply as many as 1.2 billion doses of its vaccine, which is still in the trial phase.”
“Russia has struck preliminary agreements to sell its Covid-19 vaccine to more than 10 countries in Asia, South America and the Middle East, a development that could give Moscow valuable economic and political leverage internationally. Russian officials say they have secured preliminary deals for the vaccine to be delivered to countries such as Brazil, Mexico, Saudi Arabia and India. In addition, Russia says it is in various stages of talks with roughly 10 other countries to buy the vaccine. All told, it has received requests or expressions of interest in the vaccine for a total of 1.2 billion doses. The vaccines will be manufactured abroad and distributed world-wide from there as soon as November. The shot will require local regulatory approval before being distributed, officials say. … there is strong demand for the Russian vaccine from the developing world, said Russian officials.”
See also the Guardian - 'Only time will tell': Russia places huge bet on Covid vaccine
“Country will be giving 10m doses of Sputnik V a month by December, says head of fund backing vaccine.”
“Chinese vaccine developer Sinovac Biotech Ltd. said that countries running its final-stage clinical trials like Brazil, Indonesia and Turkey will get its coronavirus shots at the same time as China, underscoring how vaccine supply agreements could cement diplomatic ties in the Covid-19 era….”
https://www.reuters.com/article/us-un-assembly-india-idUSKBN26H0L0
“Indian Prime Minister Narendra Modi pledged at the United Nations on Saturday that his country’s vaccine production capacity would be made available globally to fight the COVID-19 crisis….”
https://www.statnews.com/2020/09/28/operation-warp-speed-vast-military-involvement/
“… Now, an organizational chart of the $10 billion initiative, obtained by STAT, reveals the fullest picture yet of Operation Warp Speed: a highly structured organization in which military personnel vastly outnumber civilian scientists. The labyrinthine chart, dated July 30, shows that roughly 60 military officials — including at least four generals — are involved in the leadership of Operation Warp Speed, many of whom have never worked in health care or vaccine development. Just 29 of the roughly 90 leaders on the chart aren’t employed by the Department of Defense; most of them work for the Department of Health and Human Services and its subagencies.”
“Today we launch a new paper that uses mathematical modelling and expert interviews to learn more about COVID-19 vaccine portfolio and generate probabilistic estimates on when we will have a safe and efficacious vaccine and how long will it take for manufacturing scale up to produce sufficient doses.”
“ ….Using the inputs from our experts and background information, the model suggests that there is a 50 percent chance that by the end of April 2021 there will be at least one vaccine safe and efficacious enough to win approval from a stringent regulator as defined by WHO. By the end of 2021, this rises to 85 percent. When we feed these results into the manufacturing model, the results demonstrate it will probably take more than a year to produce enough doses to vaccinate healthcare professionals globally, and that it could be September 2023 before we have enough doses to cover the global population. We may well need fewer doses to reach herd immunity globally, and the timelines within each country are likely to be very different too given the number of bilateral deals and distinct country coalitions.”
Quote: “Our core message is less about the “when” (which is an estimate surrounded by considerable uncertainty), and more about the value of portfolio diversification. Diversification will maximise the chances of getting to a vaccine that works as soon as possible.”
P Patnaik; Geneva Health Files;
Focus on the Diagnostics pillar of the ACT-Accelerator, this week. A “full picture” on the diagnostics challenge for LMICs is exactly what she offers in this piece.
Some other snippets:
“Not everyone in China will need to get vaccinated against Covid-19, according to the country's top medical official, as Beijing looks to prioritize frontline workers and high-risk populations in a move that underscores rising confidence among policy-makers of their ability to contain the virus….”
· Reuters - China says WHO gave blessing for coronavirus vaccine emergency use programme
· New Yorker - Chinese Citizens Are Already Receiving a Coronavirus Vaccine
“… many Chinese citizens haven’t waited for full approval before getting injected. The state press has reported that hundreds of thousands have already been vaccinated by C.N.B.G., under an emergency-use approval granted by the government. The volunteers include many government officials and pharmaceutical executives who received the two-stage vaccination….”
· The Conversation - Canada’s ‘me first’ COVID-19 vaccine strategy may come at the cost of global health
By R Labonté et al. With some interesting suggestions, also for other “rich” countries.
“ if Canada and other rich countries in their vaccine nationalism continue inadvertently to crowd out access for poor countries, they should compensate by massively underwriting the investments such countries need to provide the social protection, income support and food security basic to their citizens’ health, and to strengthen their health systems with the public health capacity to suppress outbreaks as they arise….”
As a reminder, Canada’s participation in COVAX: “The Prime Minister also announced Canada’s participation in the COVID-19 Vaccine Global Access (COVAX) Facility… The Government of Canada is committing approximately $220 million to the Facility to procure up to 15 million vaccine doses for Canadians. An additional $220 million will be channeled through the COVAX Advance Market Commitment to purchase doses for low- and middle-income countries… ….”
· Reuters - Exclusive: AstraZeneca gets partial immunity in low-cost EU vaccine deal
“European governments will pay claims above an agreed limit against AstraZeneca over side-effects from its potential COVID-19 vaccine, under different terms to a deal struck with Sanofi, an EU official told Reuters…” “The deals reflect different strategies by two of the world’s top drugmakers for protecting themselves as a debate rages about liabilities for vaccines aimed at ending the pandemic….”
TWN - COVID-19: $1.2 trillion needed to guarantee social protection, says ILO https://www.twn.my/title2/health.info/2020/hi200904.htm
“Developing countries will need to invest an additional US$1.2 trillion – equivalent to 3.8 per cent of their gross domestic product (GDP) – to close the annual financing gap in social protection in 2020, the International Labour Organization (ILO) has said. In its latest policy brief, the ILO said that low-income countries represent US$77.9 billion of this total financing gap, equivalent to 15.9 per cent of their GDP. According to the ILO, the amount required to close the financing gap in social protection has increased by approximately 30 per cent since the onset of the COVID-19 crisis. “This is the result of: (a) the increased need for health-care services and income security for workers who have lost their jobs because of lockdown and other measures, and (b) the reduction of GDP caused by the crisis,” it said….”
“Global Health Council welcomes the nearly $10 billion to support the global response to COVID-19, including significant funds for Gavi, the Global Fund, PEPFAR, health systems, and more, included in the revised COVID-19 emergency bill released by House leadership last night. These funds are critical to respond to the evolving pandemic and maintain essential health services. The global effort to end the COVID-19 pandemic will be a long road, but an investment in the global response now is a down-payment on maintaining progress against the pandemic. We urge Congress and the Administration to continue to work toward and pass legislation that addresses these urgent needs….”
Let’s see what happens after November in Congress. See Devex: “It is still well short of the $20 billion that advocates were pushing Congress to approve, and it is still unclear whether this bill might become law as Congress and the presidential administration attempt last-minute negotiations.”
F Krammer; Nature;
“Virologist and vaccinologist Florian Krammer offers a comprehensive review of the SARS-CoV-2 vaccine landscape, including the status of the front-running candidates and their approaches. He also notes the enormous practical challenges and many unanswered questions, such as how long vaccine immunity will persist. The outlook is “cautiously positive”, writes Krammer. “It is certainly possible that vaccines with safety and efficacy proven in phase III trials might already enter the market in 2020.”
AP;
“The nearly 1 million people around the world who have lost their lives to COVID-19 have left us a gift: Through desperate efforts to save their lives, scientists now better understand how to treat and prevent the disease — and millions of others may survive. …. there also are signs that death rates are declining and that people who get the virus now are faring better than did those in the early months of the pandemic. “Some of the reason we’re doing better is because of the advances,” Dr. Francis Collins, director of the U.S. National Institutes of Health, told The Associated Press. Several drugs have proved useful and doctors know more about how to care for the sickest patients in hospitals, he said. We’re in the “stormy adolescence” phase of learning what treatments work — beyond infancy but not “all grown up either,” Collins said….”
“Results from an early safety study of Moderna Inc’s coronavirus vaccine candidate in older adults showed that it produced virus-neutralizing antibodies at levels similar to those seen in younger adults, with side effects roughly on par with high-dose flu shots, researchers said on Tuesday….”
That didn’t last long. “ A fresh upsurge in infections has quelled hopes that Manaus city had achieved herd immunity against the virus.”
More than a bit worrying, this article.
“…We all expect an effective vaccine to prevent serious illness if infected. Three of the vaccine protocols—Moderna, Pfizer, and AstraZeneca—do not require that their vaccine prevent serious disease only that they prevent moderate symptoms which may be as mild as cough, or headache. … …These protocols do not emphasize the most important ramifications of Covid-19 that people are most interested in preventing: overall infection, hospitalization, and death. …”
“The findings of two studies presented at this week's virtual European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Conference on Coronavirus Disease suggest that patients' loads of SARS-CoV-2, the virus that causes COVID-19, declined as the pandemic progressed, which may help explain falling rates of coronavirus-related intensive care unit (ICU) use and deaths….”
https://www.nytimes.com/2020/09/30/health/covid-india-children.html
“ An ambitious study of nearly 85,000 of those cases and nearly 600,000 of their contacts, published Wednesday in the journal Science, offers important insights not just for India, but for other low- and middle-income countries.”
“Among the surprises: The median hospital stay before death from Covid-19, the illness caused by the coronavirus, was five days in India, compared with two weeks in the United States, possibly because of limited access to quality care. And the trend in increasing deaths with age seemed to drop off after age 65 — perhaps because Indians who live past that age tend to be relatively wealthy and have access to good health care. … … The contact tracing study also found that children of all ages can become infected with the coronavirus and spread it to others — offering compelling evidence on one of the most divisive questions about the virus. And the report confirmed, as other studies have, that a small number of people are responsible for seeding a vast majority of new infections….”
PS: “… The study focused on two southern Indian states, Andhra Pradesh and Tamil Nadu, which together have a population of about 128 million, and represent two of the five Indian states with the most cases. They also have among the most sophisticated health care systems in the country. … Dr. Jha said he appreciated the study over all, but cautioned against extrapolating its findings too far. He is from the state of Bihar, among the most rural and poor states in India, whereas Andhra Pradesh and Tamil Nadu, the two states in the study, are among the best equipped to deal with an outbreak, he said. … … “It is really important to understand this is not the experience of Bihar, this is not the experience of D.R.C.,” he said, referring to the Democratic Republic of Congo. “This is a much rosier picture than what you are likely to see in those places.””
See also LA Times - Largest study of COVID-19 transmission highlights essential role of super-spreaders
“Young people are as diligent about coronavirus hygiene routines as their older peers but also more stressed out by the pandemic and willing to give up a higher percentage of their income to stop it, according to a global survey that calls into question the stereotype of feckless youth driving up infection rates. A new survey, which polled the pandemic behaviour of nearly 12,000 respondents from more than 130 countries, found that 18 to 25-year-olds were only marginally less likely to take regular measures to protect themselves than those aged 45 or older….”
“But 711 million children globally remain out of school, the majority in lower-and middle-income countries.”
https://www.sciencemag.org/news/2020/09/provocative-results-boost-hopes-antibody-treatment-covid-19
“A second company has now produced strong hints that monoclonal antibodies, synthetically produced versions of proteins made by the immune system, can work as treatments in people who are infected with the pandemic coronavirus but are not yet seriously ill. The biotech Regeneron Pharmaceuticals has developed a cocktail of two monoclonal antibodies that attach to the surface protein of that coronavirus, SARS-CoV-2, and attempt to block it from infecting cells. Yesterday at an investor and media webcast, the firm revealed early results….”
And some links:
Guardian - Scientists work on nasal spray that could stop Covid virus replicating
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32064-X/fulltext
“The COVID-19 syndemic is entering its most dangerous phase. There is a mounting breakdown of trust. Not only between politicians and the public. But also among politicians and publics with science and scientists. This breach of faith with science is far more threatening. For the public is slowly turning against those who have sought to guide the political response to COVID-19. As countries face a resurgence of coronavirus transmission, scientific advisers are recommending further restrictions to our liberties. There is now a palpable public reaction against these mandates….”
… The reasons for this crisis in the science of COVID-19 are mostly self-inflicted. An early consensus about how to manage the spread of the virus has disintegrated. We see scientists splintering into factions.
Horton also offers some ways forward.
Kim R van Daalen et al; https://gh.bmj.com/content/5/10/e003549
Some key messages: “Despite numerous global and national commitments to gender-inclusive global health governance, COVID-19 followed the usual modus operandi –excluding women’s voices. A mere 3.5% of 115 identified COVID-19 decision-making and expert task forces have gender parity in their membership while 85.2% are majority men. With 87 countries included in this analysis, information regarding task force composition and membership criteria was not easily publicly accessible for the majority of United Nations Member States, impeding the ability to hold countries accountable to previously made commitments. Lack of representation is one symptom of a broken system where governance is not inclusive of gender, geography, sexual orientation, race, socio-economic status or disciplines within and beyond health – ultimately excluding those who offer unique perspectives and expertise. Functional health systems require radical and systemic change that ensures gender-responsive and intersectional practices are the norm – rather than the exception….”
N Birdsall; https://www.cgdev.org/blog/curse-falling-expectations
On the risks of the global Covid depression for political stability in the developing world.
James Love ; https://www.globalpolicyjournal.com/blog/28/09/2020/use-and-abuse-phrase-global-public-good
Recommended. Linking the debate back to a proposal from Paul Samuelson from 1954. “A flawed understanding of the concept of “public good” hampers the fight for equitable access to the upcoming COVID-19 vaccine.”
“What makes people more likely to comply with a lockdown? Christian Krekel (LSE), Sarah Swanke (LSE), Jan-Emmanual De Neve (Oxford University) and Daisy Fancourt (UCL) drew on large-scale surveys and found that happiness predicts compliance, over and beyond a wide range of people’s other observable characteristics. Older and less healthy people seem to be predominantly motivated by risk-avoidance, whereas the motivations of younger ones seem more mixed. People are less likely to follow the rules if they were unhappy.”
“The UN reckons the pandemic could cast 490m in 70 countries into poverty, reversing almost a decade of gains.”
Good overview of the briefing by WHO Afro, over a week ago.
“Africans may be twice as likely to experience COVID-19 without any illness, compared with people in the rest of the world, according to preliminary analysis by the African branch of the World Health Organization. The results from several blood-sample studies in Africa could help to explain the low death rate that has confounded the early predictions of devastation on the continent….” “More than 80 per cent of Africans who were infected with the virus were asymptomatic, the preliminary analysis found, based on testing in several African countries. This compares with an estimated 40 per cent to 50 per cent who were asymptomatic in the rest of the world.”
“… At the WHO briefing, experts cited several possible factors to explain the lower rates of death and illness in Africa, although they emphasized that more study is needed. The most widely accepted factor is Africa’s youthful population. Only about 3 per cent of Africans are over the age of 65, the age group in which illness and death from the coronavirus are most common. (By comparison, about 18 per cent of Canada’s population is over the age of 65.) Another factor could be Africa’s lower population density and the fact that many people live in rural areas, spending more time outdoors, analysts say. There is growing evidence that outdoor spaces, because of their greater ventilation, tend to reduce exposure to the virus, making it less dangerous. … A third factor was the imposition of early strict lockdowns in many African countries, at a time when case numbers were relatively small. This postponed the worst of the pandemic, allowing hospitals and health workers to be better prepared with the latest treatment methods. … A fourth factor, she said, was Africa’s relatively poor road network and access to international flights, which slowed the arrival of the virus and its transmission to rural areas...”
For more analysis, see also The wire - How Does Africa Have Such Low Fatality Rates from COVID-19?
“Just like every emergency, Covid-19 is racist, ageist, classist and sexist. The world response to the pandemic must reflect this.”
Linked to a new Care International report.
Partnership for Evidence-Based Covid-19 response
Second report by PERC. “This report was produced by the Partnership for Evidence-Based Response to COVID-19 (PERC), a public-private partnership that supports evidence-based measures to reduce the impact of COVID-19 on African Union (AU) Member States. The aim of this report, and the partnership in general, is to help governments determine the acceptability, impact and effectiveness of public health and social measures (PHSMs) for COVID-19, including their secondary impacts on health, food security and the economy. The report draws on findings from a telephone poll of more than 24,000 adults in 18 AU Member States (conducted between 4 and 17 August, 2020) as well as social, economic, epidemiological, population movement, media and security data. Briefings on each of the 18 AU Member States are available at: https://preventepidemics.org/covid19/perc/....”
A Glassman; https://www.cgdev.org/blog/what-matters-most-policy-now-better-mortality-data
Blog from last week, announcing a new conversation & agenda. “Despite mortality data being crucial to our collective fates, the state of mortality reporting is dire. How is it possible to assess whether sub-Saharan African countries are winning the fight against COVID-19 if more than 70 percent of total deaths in a non-COVID year go unreported?...”
“Today, we’ll hold an online event to kick off a conversation and agenda on low-cost, high-impact strategies to collect better quality mortality data in real-time, and country experiences to date with Philip Setel and Fatima Marinho from Vital Strategies, as well as Samira Asma of WHO and Erin Nichols of the US Centers for Disease Control and Prevention. Next week, my colleague Damian Walker will follow with a blog on the role of mortality data in assessing progress in COVID-19 control. Ideas welcome.”
On the importance of mortality data, for Covid and far beyond, see also NPR - Why The Pandemic Could Change The Way We Record Deaths
“… The pandemic has been a game-changer," says Romesh Silva, a demographer working for the United Nations Population Fund. "It's prompted the realization [among national governments] that comprehensive death registration is the most preferable way of understanding mortality." Public health experts agree: From the perspective of national planning, having good death data is imperative. You need good numbers to assess and understand risk factors that cause death. And to assess the success of health programs. That's why counting the dead and describing causes represent "the GPS" to better global health, says Dr. Prabhat Jha, an epidemiologist and the founding director of the Centre for Global Health Research. Without the numbers, he says, you're flying blind. … … … Raising the stakes, death registration infrastructure is often weakest where need is most severe, Jha says. The largest gaps are in South Asia — India, Bangladesh and Pakistan — and in sub-Saharan Africa, precisely the places where premature mortality is the highest. In other words, though these nations face a disproportionate number of preventable deaths, they have much weaker systems to be able to report the causes of death….”
“Global fatalities may be closer to 1.8 million, academic says.”
"The world will officially record 1 million deaths from Covid-19 in the next few days, but the real tally might be almost double that. Actual fatalities from the worst pandemic in a century may be closer to 1.8 million -- a toll that could grow to as high as 3 million by the end of the year, according to Alan Lopez, a laureate professor and director of the University of Melbourne's global burden of disease group….”
Interview with Bill Gates from a few weeks ago. Mainly for this telling paragraph, a rather bleak assessment on when ‘global health’ really gets the attention of people in rich countries:
“Yong: Do you think that the pandemic should change the way we think about global health? In this crisis, many of the richest countries have fared appallingly, whereas many poorer ones, Senegal to Vietnam, have actually done really well. Do you think that this should be cause for humility and change in our approach? ;… … Yes. People didn’t think about infectious diseases, mostly because we’ve made so much progress that rich countries kind of ignore them. But this thing has cost trillions of dollars. The [cost of] preparedness, as a percentage of the damage this thing has done, is not even close to 1 percent. There’s basically no country that hasn’t had very big damage. If you care about education, and if you care about race, if you care about mental health, if you care about gender, if you care about government budgets and having money to do things that you want the government to do, this has cost so much. So yes, it takes rich people getting sick. It takes rich economies being affected. But when that happens, the world gets together….”
J Hargreaves et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1825771
“COVID-19 ‘lockdown’ policies may have unintended consequences for individuals, households and country economies. …. The repeal and alteration of lockdown policies mark a symbolic transfer of responsibility for epidemic control from state to individual. This has the potential to catalyse fear, blame and judgement within and between populations. We draw on experience from the HIV pandemic to show that this will worsen during later phases of the pandemic if COVID-19 stigma increases, as we fear it could. We suggest policy recommendations for ‘lockdown lifting’ to limit COVID-19 stigma. We suggest three policy priorities to minimise potential increases in COVID-19 stigma: limit fear by strengthening risk communication, engage communities to reduce the emergence of blaming, and emphasise social justice to reduce judgement. ‘… … This period has the potential to see the emergence of fear, blame and judgement, intersecting with existing inequalities, as governments seek to share responsibility for preventing further Sars-Cov-2 transmission. As we have learned from HIV, it is critical that a wave of COVID-19 stigma is prevented from flourishing.”
https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-33-vaccine/
“… Here we identify optimal vaccine allocation strategies within and between countries to maximise health (avert deaths) under constraints on dose supply. We extended an existing mathematical model of SARS-CoV-2 transmission across different country settings to model the public health impact of potential vaccines, using a range of target product profiles developed by the World Health Organization. We show that as supply increases, vaccines that reduce or block infection – and thus transmission – in addition to preventing disease have a greater impact than those that prevent disease alone, due to the indirect protection provided to high-risk groups. We further demonstrate that the health impact of vaccination will depend on the cumulative infection incidence in the population when vaccination begins, the duration of any naturally acquired immunity, the likely trajectory of the epidemic in 2021 and the level of healthcare available to effectively treat those with disease. Within a country, we find that for a limited supply (doses for <20% of the population) the optimal strategy is to target the elderly and other high-risk groups. However, if a larger supply is available, the optimal strategy switches to targeting key transmitters (i.e. the working age population and potentially children) to indirectly protect the elderly and vulnerable. Given the likely global dose supply in 2021 (2 billion doses with a two-dose vaccine), we find that a strategy in which doses are allocated to countries in proportion to their population size is close to optimal in averting deaths. Such a strategy also aligns with the ethical principles agreed in pandemic preparedness planning.”
M S Khan et al; https://gh.bmj.com/content/5/9/e002830
“COVID-19 has demonstrated that most countries’ public health systems and capacities are insufficiently prepared to prevent a localised infectious disease outbreak from spreading. Strengthening national preparedness requires National Public Health Institutes (NPHIs), or their equivalent, to overcome practical challenges affecting timely access to, and use of, data that is critical to preparedness. Our situational analysis in collaboration with NPHIs in three countries—Ethiopia, Nigeria and Pakistan—characterises these challenges….”
A P Sundaja & S Bhaumik; https://blogs.bmj.com/bmjgh/2020/09/30/science-society-politics-getting-the-basic-rights-for-future-pandemics/
Recommended. Conclusion: “COVID-19 has shown us, future global health practitioners, that there is no scope for being a Sci-Fi “hero” scientist who “saves the world”. We rather need to work, day-in and day-out to build stronger health systems. Building trust, reaching out to communities, embedding institutions is not as cool as “disruptive innovation” but is the only sustainable way for humanity to progress.”
https://www.ft.com/content/a9101163-f4e8-4bf2-a16f-2ae14d5746a3 “… now Covid-19, which flourishes in areas of high human density, is forcing governments in emerging economies to rethink their approach to urban development. According to UN data, more than half of the population of the world’s developing economies live in cities. But their often haphazard and unplanned growth has also brought large-scale squalor and inequality. The virus has spread almost entirely in cities: according to the UN, at least 90 per cent of Covid-19 cases have been in urban areas. While studies have shown a high correlation between rates of urbanisation and the impact of the virus at the national level, local conditions within cities appear to be more significant. High population density is the most obvious culprit, but two World Bank studies — one of New York and the other of 284 cities in China — show it is less a factor than it may at first appear. “It is not about population density per se but about how that density is managed,” said Sameh Wahba, the World Bank’s global director for urban resilience and disaster risk management and co-author of the studies. The pandemic . . . has shown, in a very dramatic way, where the vulnerabilities are in the urban system . “What matters is how the built environment can transform density from overcrowding to liveable density,” Mr Wahba said. “The worst results are invariably where you have a poorly built environment.” As a result, the pandemic has become a catalyst for cities from Bogotá and Buenos Aires to Chennai and Jakarta to rethink their approach to urbanisation….”
“Draconian surveillance measures introduced during the Covid-19 epidemic are handing “unchecked powers” to authoritarian regimes across Asia, human rights experts are warning. In a report out today, privacy analysts warn that “extreme measures and unchecked powers” brought in to tackle Covid-19 could become permanent features of government across the region, and have an impact on the rights and privacy of millions of people….”
G Williams et al; https://thepolicypractice.com/wp-content/uploads/2020/09/Pandemic-Policy-Brief.pdf
With a number of recommendations. 7-pager.
This policy brief suggests that the neglect of the health security agenda in SSA is above all a political economy problem.
https://www.nytimes.com/2020/09/27/world/asia/covid-19-india-children-school-education-labor.html
“…Former students are taking illegal and often dangerous jobs in India and other developing countries, potentially rolling back years of progress in social mobility and public health. … United Nations officials estimate that at least 24 million children will drop out and that millions could be sucked into work. Ten-year-olds are now mining sand in Kenya. Children the same age are chopping weeds on cocoa plantations in West Africa. In Indonesia, boys and girls as young as 8 are painted silver and pressed into service as living statues who beg for money. The surge in child labor could erode the progress achieved in recent years in school enrollment, literacy, social mobility and children’s health.”
“… Child labor is just one piece of a looming global disaster. Severe hunger is stalking children from Afghanistan to South Sudan. Forced marriages for girls are rising across Africa and Asia, according to U.N. officials, as is child trafficking. Data from Uganda showed teen pregnancies shooting up during pandemic-related school closures. Aid workers in Kenya said that many families were sending their teenage girls into sex work to feed the family….”
See also the Telegraph – Children for sale: How the pandemic is forcing poverty-stricken parents to make desperate choices
“Families are being forced to commodify their children during the pandemic through child marriage, labour or being trafficked across borders.”
“A recent UN estimate suggested that the number of children in poverty had already risen by 15 per cent – defined as living on less than $1.90 a day – to 1.2 billion during the pandemic. As such, Unicef and Save The Children have suggested that gains on child labour made since 2000 – 94 million children taken out of work – could be almost entirely reversed. … In countries where things like child labour or child marriage were already common, they become what Unicef described as a "coping mechanism" in times of crisis…”
“Up to 2.5 million more girls around the world are at risk of being forced into child marriage over the next five years as a result of the impact of Covid-19, according to a report by Save the Children. The charity predicts the worst surge in rates of child marriage in 25 years, as the pandemic has shuttered schools and pushed poor families further into destitution. According to the report, Global Girlhood 2020: how Covid-19 is putting progress in peril, half a million more girls will be pushed into arranged marriage this year alone, reversing more than two decades of progress that had begun to push the practice into decline globally. It will bring the total number of child marriages to around 12.5m in 2020….”
J McMahon et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32012-2/fulltext
“…In the past months, we have also seen how advances in confronting the global HIV epidemic have had a positive impact on the COVID-19 response….”
https://news.un.org/en/story/2020/09/1073682
“Amid a potential global shortage in influenza vaccines and the ongoing COVID-19 pandemic, the UN health agency has advised countries to protect the elderly and health workers first. The updated recommendations from the World Health Organization (WHO), come as the northern hemisphere braces for the seasonal bug, which claims hundreds of thousands of lives from respiratory-related causes every year….”
WHO - WHO launches portal for global data on the health and well-being of older people
“On the International Day of Older Persons, WHO is launching the first data portal that brings together in one place data on global indicators for monitoring the health and well-being of people aged 60 and over. … …. During the Decade of Healthy Ageing (2020-2030), endorsed by the World Health Assembly in August 2020, the portal will remain a gateway for accessing all global data related to older persons produced by WHO, other international organizations such as the UNDESA, the ILO, the World Bank and the OECD, as well as academic institutions such as the Institute for Health Metrics and Evaluation.”
https://www.who.int/news-room/detail/28-09-2020-world-rabies-day-2020
“A new United Against Rabies Forum aims to accelerate progress towards the elimination of human deaths from dog-mediated rabies by 2030. The disease continues to kill one person every nine minutes - almost half of them children. The Forum, launched by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (OIE) - the global agencies responsible for human health, animal health and food and agriculture - will bring together partners across government institutions, human and animal and environmental health sectors, the private sector, civil society as well as research and academia. It aims to increase understanding of what policy and research work is required and improve coordination (including of resource mobilization) and information sharing between partners….”
“Unaffordable prices can be one of the biggest barriers to access to pharmaceutical products. A new WHO guideline for countries on managing pharmaceutical prices aims to help governments overcome this barrier and better address national public health needs…. “
“It covers ten pricing policy approaches:…”
Take a look at the new data visualization tool which monitors, tracks, and compares national #HIV policy adoption across 33 indicators and 194 countries.
For more info, see the press release - New HIV Policy Lab uses law and policy data in the HIV response.
M Kavanagh et al https://gh.bmj.com/content/5/9/e003695
“Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance—building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate substantial variation in the content of law and policies between countries, regions and policy areas. Given progress in basic and implementation science, it would be tempting to believe most countries have adopted policies aligned with global norms, with a few outliers. Data show this is not the case. Globally, alignment is higher on clinical and treatment policies than on prevention, testing and structural policies. Policy-makers, researchers, civil society, finance agencies and others can use these data to better understand the policy environment within and across countries and support reform. Longitudinal analysis enables evaluation of the impact of laws and policies on HIV outcomes and research about the political drivers of policy choice.”
https://www.amnesty.org/en/latest/news/2020/09/amnesty-releases-updated-policy-on-abortion/
“Access to safe abortion is an essential component of a fair and equal society, and is integral to realizing the full range of human rights, Amnesty International said today. The organization has published its updated policy on abortion that aligns with evolving human rights law and standards. The policy equips the organization to undertake stronger campaigning and advocacy around abortion and to better support local movements advancing sexual and reproductive rights. The updated policy recognizes abortion, provided in a manner that respects human rights, autonomy, and dignity, as the right of anyone who can become pregnant. Amnesty International is also calling for universal access to safe abortion and related care and information, in addition to full decriminalization…..”
“UN Experts joined together to remind states of their human rights duty to ensure access to contraception for anyone who wants it, including during COVID-19. On World Contraception Day (26 September), the experts, led by the new Special Rapporteur on the Right to Health, Dr Tlaleng Mofokeng …”
WP;
“Across the globe, the pandemic has made it harder for women and girls to access reproductive services, as clinics close and barriers to medical care rise. The United Nations warned that millions of unintended pregnancies could result, with some 47 million women potentially cut off from modern contraception….”
This article looks at developments in six settings, including Argentina, Colombia, US, Poland, …
R Loewenson et al ; https://gh.bmj.com/content/5/9/e003886
Essential message from these SHAPES authors.
“Global and national responses to the COVID-19 pandemic highlight a long-standing tension between biosecurity-focused, authoritarian and sometimes militarised approaches to public health and, in contrast, comprehensive, social determinants, participatory and rights-based approaches. Notwithstanding principles that may limit rights in the interests of public health and the role of central measures in some circumstances, effective public health in a protracted pandemic like COVID-19 requires cooperation, communication, participatory decision-making and action that safeguards the Siracusa principles, respect for people’s dignity and local-level realities and capacities. Yet there is mounting evidence of a dominant response to COVID-19 where decisions are being made and enforced in an overcentralised, non-transparent, top-down manner, often involving military coercion and abuse in communities, even while evidence shows the long-term harm to public health and human rights. In contrast, experiences of comprehensive, equity-focused, participatory public health approaches, which use diverse sources of knowledge, disciplines and capabilities, show the type of public health approach that will be more effective to meet the 21st century challenges of pandemics, climate, food and energy crises, growing social inequality, conflict and other threats to health.”
A Tandon et al ; https://www.sciencedirect.com/science/article/pii/S0277953620303907
“Identifying ways to increase public spending on health is critical for the achievement of universal health coverage. While policymakers and donors often look at available options for increasing public spending for health in the medium-term, examining trends and drivers of past growth can help countries elucidate important lessons and to anticipate changes in the future. This note analyzes trends in inflation-adjusted per capita public spending for health vis-à-vis economic growth within and across a sample of 150 countries over the 2000–2017 period. Since 2000, per capita public spending for health across low- and middle-income countries has more than doubled. Less than one-fifth of this increase, however, resulted from a higher priority for health in government budgets. The remainder was largely due to conducive macroeconomic conditions such as economic growth and increases in total public spending. Furthermore, across most countries, a single time trend does not adequately capture the evolution either of economic growth or of per capita public spending on health. Instability in growth rates is large for both indicators, revealing distinct episodic patterns.”
L Dean et al ; https://gh.bmj.com/content/5/9/e002873
“Health workers in fragile settings are constantly exposed to stressors that become exacerbated in times of crisis; the scarcity within which they operate is now increasingly globally acknowledged. Many providers—whether based in facilities or communities—may still carry unresolved trauma from earlier shocks. Health systems resilience may require fundamental changes in resources and other structural factors, but also key to this is facilitating health workers access to long-term psychological support to enable them to navigate psychological distress. Psychological support during shocks should be available for all health workers early, consider needs across cadres (including close to community providers) and respond to cumulative and historic trauma as well as associated stigma. Health system planners need to design context-specific responses that are informed by close to real-time data and systematic research focused on improving understanding of healthcare workers stresses and mental health needs.”
Okiki Badejo et al ; https://gh.bmj.com/content/5/9/e003349
“Interprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be collaborative, professional hierarchies and discipline-specific patterns of socialisation can result in unhealthy rivalry and conflicts which disrupt health system functioning. A better understanding of interprofessional dynamics is necessary to avoid such negative consequences. We, therefore, conducted a historical analysis of interprofessional interactions and role-boundary negotiations between health professions in Nigeria….”
E V Langlois et al ; https://www.who.int/bulletin/online_first/BLT.20.252742.pdf?ua=1
“…. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary healthcare systems were identified by thematic content analysis. We found that: (i) despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii) community health workers were often underresourced, poorly supported and lacked training; (iii) out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv) health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary care health. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policymaking should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.”
Check out also, in WHO Bulletin - Primary health care contributions to universal health coverage, Ethiopia (by Yibeltal Assefa et al).
S M Al Sabahi et al; http://www.ijhpm.com/article_3918.html
“In response to worldwide calls for the need to support evidence-informed policy-making (EIPM), more countries are increasingly interested in enhancing their efforts to use research to inform policy-making. In order to inform the efforts of those asked to lead the support of EIPM, our aim is to develop a conceptual framework to guide the process of establishing a policy support organization (PSO)….”
T A Collyer et al ; https://www.sciencedirect.com/science/article/pii/S0277953620305499
« Our atlas of health equity research identified eight clusters with varying connectivity. No single factor neatly explained observed fragmentation. Authors' geographic location, discipline, institution seem to influence citation flows….”
D Weiss et al ; https://www.nature.com/articles/s41591-020-1059-1
“Access to healthcare is a requirement for human well-being that is constrained, in part, by the allocation of healthcare resources relative to the geographically dispersed human population. Quantifying access to care globally is challenging due to the absence of a comprehensive database of healthcare facilities. We harness major data collection efforts underway by OpenStreetMap, Google Maps and academic researchers to compile the most complete collection of facility locations to date. Leveraging the geographically variable strengths of our facility datasets, we use an established methodology to characterize travel time to healthcare facilities in unprecedented detail. We produce maps of travel time with and without access to motorized transport, thus characterizing travel time to healthcare for populations distributed across the wealth spectrum. We find that just 8.9% of the global population (646 million people) cannot reach healthcare within one hour if they have access to motorized transport, and that 43.3% (3.16 billion people) cannot reach a healthcare facility by foot within one hour. Our maps highlight an additional vulnerability faced by poorer individuals in remote areas and can help to estimate whether individuals will seek healthcare when it is needed, as well as providing an evidence base for efficiently distributing limited healthcare and transportation resources to underserved populations both now and in the future.”
Z C Shroff et al ; https://gh.bmj.com/content/5/9/e003801
The authors conclude: « The alignment of service delivery approaches, provider payment mechanisms and information systems described previously will be crucial in building people’s trust and public confidence. The long-term success of India’s reform towards UHC depends on the PM-JAY being connected to a well-functioning and adequately staffed primary healthcare system that goes beyond curative care to encompass broader health promotion and prevention efforts which are necessary to improve population health. Investments in developing new cadres such as mid-level health providers will need to be complemented by policies to ensure their appropriate distribution and deployment. In addition, a robust and comprehensive information system is a pre-requisite both for effective referral and well-functioning provider payment systems. We recognise that alignment is needed beyond these three areas. However, addressing them would be an important first step. Indeed, they would create the linkages that are vital for this reform to take India closer towards UHC.
https://www.who.int/bulletin/volumes/98/10/en/
Do read the Editorials first:
· COVID-19 and sustainable development goals (by K Heggen et al).
“ While the SDGs do not have a dedicated pandemic response plan, we believe it is essential not to de-link the response to the pandemic from the SDGs. We argue that the COVID-19 crisis demonstrates the need to integrate the SDGs at the national level as well as in individual health-care decisions. We also call for a focus on sustainable health decisions, meaning decisions that are made in the present do not compromise future needs, whether local or global….”
· And Behavioural and social sciences for better health: call for papers (Deadline: 31 Dec)
“As part of its efforts to scale up the use of behavioural and social sciences in public health, the World Health Organization created a multidisciplinary technical advisory group for behavioural insights and sciences for health in 2020. The Bulletin of the World Health Organization will publish a theme issue on behavioural and social sciences for better health in 2021. We invite practitioners and researchers, particularly from low- and middle-income countries, to submit manuscripts with original research, reviews, perspectives and lessons from the field on the unique opportunities the behavioural and social sciences provide in achieving health for all….”
R Silverman et al ; https://www.cgdev.org/publication/family-planning-and-global-financing-facility-current-evidence-and-learning-agenda
“… The Global Financing Facility (GFF), launched in 2015, aims to “create the conditions for sustainable financing and scale-up of high priority reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) interventions.” The GFF offers grants to countries for Family Planning (FP) among other RMNCAH-N areas alongside routine World Bank lending for health—an opportunity to firmly embed FP within the continuum of care and in public budgets. The GFF has expanded to support 36 countries; implementation is currently underway in 19. The GFF—alongside other bilateral and multilateral financiers—can play a pivotal role in addressing the immediate and long-term challenges to sustaining and expanding quality FP services. In the short term, GFF resources can help expand budgetary space and ensure appropriate prioritization to sustain access to FP and provision of broader RMNCAH-N services. In the long term, the GFF can help entrench FP within national budgets and HBPs, creating a glide-path for sustainability. The extent of the GFF’s impact on FP provision, in both the short- and long-term, will thus depend on its ability to channel GFF/World Bank and national resources toward FP, including through inclusion in country RMNCAH-N investment cases, World Bank projects, and national Health Benefits Packages (HBPs). “
“To understand the current role of the GFF and inform its next steps to best fulfill this mandate, this note takes stock of our collective knowledge on inclusion of contraception in HBPs; incorporation of FP in country RMNCAH-N investment cases and corresponding World Bank projects; and GFF influence over government and donor resource allocation for cost-effective FP services. It concludes with a research agenda to guide future policy….”
On a recent Abt Associates paper. “The paper summarizes how Abt has applied PEA to education and health sector programming in 13 countries in Asia, the Pacific and Africa – another plus, as most such discussions are limited to the relative backwater of aid sector governance programmes, whereas H&E are big money items….” Duncan Green summarizes some of the key findings and common themes.
B Cichoka & I Mitchell; https://www.cgdev.org/blog/gender-and-cdi-how-committed-are-countries-gender-equality-international-policies
“Earlier this year, we launched the Commitment to Development Index (CDI), after commissioning a holistic two-year review to reassess which policies from the world’s major economies matter most for global development. One major area of feedback in the review discussions was that we should assess policies that support gender equality in development.”
Quote: “Overall, we find that Australia and Norway rank highest on the gender indicators we assess, while Turkey and India lag furthest behind—a result generally consistent with their ranks in the overall CDI. However, if we zoom in, we can see that there are some large variations between a country’s overall commitment to development, and its performance against these gender indicators. Notably, Germany, which comes in the top five countries on the overall CDI for its strong commitment to trade, investment, and migration, also comes in the bottom 10 countries when we assess performance only based on gender indicators. …”
K Bertram; https://pfipartners.org/2020/09/29/pragmatism-vs-planning-partnerships/
“In this blog we provide guidance on how to best balance pragmatism and planning in partnerships. We also look at which pathway leads to more impact….”
Excerpt: “Covid-19 is an example of a change in circumstances. Many international development organisations have pivoted their focus – and also partnerships – in response to the pandemic. New partnerships and initiatives have been formed, and many existing partnerships have refocused their collaboration. In a time of crisis, existing relationships have allowed many partners to respond to the pandemic pragmatically and fairly quickly. For example, the group of organisations who came together to develop and ensure equitable access of Covid-19 tests, treatments, and vaccines (around the ACT Accelerator) have been working together regularly for several years, and many of the organisations are intertwined in various partnerships. The organisations involved have been able to build on these existing relationships and partnerships. However, as the ACT Accelerator example shows, many important stakeholders are left out when pragmatic partnerships are formed based on existing relationships. Civil society, for example – which is critically important for demand creation, community engagement, advocacy, and buy-in – has not been included in a meaningful way. This has resulted in delayed fundraising, weak advocacy, lack of transparency – and ultimately less impact to date..”
(on R Loewenson et al’s (SHAPES) commentary in BMJ GH)
“Time to step up & reclaim public health approach to 21st century challenges of pandemics, climate crisis, growing inequality, conflict & other threats to health. equity-focused, rights-based & participatory drawing on diverse knowledge & capabilities Reclaiming comprehensive public health “
“Several of the speakers at the UN event on C-TAP have talked about COVAX, which is not the same thing. One is about products (COVAX), the other is about access to know-how, cell-lines and IP. (C-TAP).”
On a framing of COVAX that is gaining more and more momentum:
“#COVAX is the biggest multilateral effort since the Paris climate agreement. I’m delighted by the incredible commitment from every region around the world.”
“"Africa has many lessons to teach the world about how to be resilient & how to be creative. We need to look at the bottom-up approaches in Africa, the way responses are localized & communities participate." -@DrMikeRyan at @WHO #COVID19 briefing 25 September.”
“"The health of populations is the business of the WTO" The world can’t wait. @WTO must play a central role in the COVID-19 supply chain. And a strong WTO needs to lead in trading our way out of the global recession.”
"Talk about solidarity has not yet been given concrete action … The funders of R&D, including primarily governments, but also foundations like the Gates Foundation, have not used their leverage to open source the know-how or rights in patents or data."
“As researchers in #globalhealth I think we need to question the utility and meaning of 'low- and middle-income country' as a category. Often ends up being a bundle of assumptions that do not have bearing on the research question, nor on the transferability of results #decolonize”
“There is an urgent need for a global and coordinated initiative to enhance the resilience and performance of national #SocialProtection systems worldwide, both in the short and the long term.”
“We need #UHC thru #PHC more than ever. And Covid has brought that message home, all we have to do is realize and act accordingly! 15% of budget. 5% of GDP. Majority on PHC! @yates_rob.”
Do register!
With three days of scientific sessions & great discussions.
https://www.worldbank.org/en/events/2020/10/16/civil-society-policy-forum
“The Civil Society Policy Forum (CSPF), Monday, September 28, through Friday, October 9, includes approximately 15 sessions on a wide range of topics that provide an opportunity for CSOs to exchange views with stakeholders.”
Coming up: Annual meetings IMF/WB: Oct 12-18 https://www.worldbank.org/en/meetings/splash/annual
http://g2h2.org/posts/tedros2020/
Check out the series of meetings between Tedros & civil society.
https://www.socialwatch.org/node/18542
In case you missed the event on 18 September. “Policy conclusions were presented by Ignacio Saiz (Executive Director of the Center for Economic and Social Rights) and Barbara Adams (President of Global Policy Forum). The event was moderated by Bodo Ellmers (Director of Sustainable Development Finance, Global Policy Forum Europe) and Elisabeth Bollrich, Global Economy Expert at Friedrich-Ebert-Stiftung).”
Deadline 30 November.
“This call for papers is jointly organised by the journal Health Policy and Planning, and the organizer of the Sixth Global Symposium on Health Systems Research – Health Systems Global. Accepted papers will be published as a special journal supplement of the Sixth Global Symposium on Health Systems Research…”
Series of webinars. Warmly recommended!
Opening plenary: Covid-19 and the future of global health policy analysis (20 Oct 2020) 12:00 - 1:30 PM GMT.
Check out the latest GFO issue.
With among others: “Is there a leader in GF supported HHS?” : “Funding applications have systematically incorporated a health system strengthening component. Even though a strategy and tools have been developed to facilitate planning, resilient and sustainable systems for health remains a difficult subject to comprehend, especially when attempting to put it into operation for Global Fund teams and implementing countries.”
Review of a new book on international cooperation trends. “Redesigning international cooperation serves several purposes, including, for example, better involving countries that graduate from low-income status or transcending the asymmetric aid mentality.”
“International cooperation has been changing in recent years. Reasons include the shifting balance of global power and the United Nation’s adoption of the Sustainable Development Goals. A recently published book assesses such trends. Its title is „Transforming international cooperation“ and it is the result of a GIZ research project….”
“In spite of growing polarization and isolationism, a massive, worldwide survey suggests the public overwhelmingly believes global cooperation is vital to dealing with today’s complex political and public health challenges. And the majority of respondents also want the United Nations to change and innovate, becoming more transparent, accountable, and effective. These are some of the new findings produced by the office of Fabrizio Hoschchild, U.N. undersecretary-general and special adviser on the 75th anniversary commemoration. Over 1 million people worldwide voiced their opinions in surveys and consultations on how the U.N. should evolve, ahead of the institution’s 75th birthday this September….”
https://www.devex.com/news/top-donors-call-for-more-humanitarian-burden-sharing-98174
“The world’s top 10 donors contribute 80% of humanitarian funding, a situation they say is unsustainable in light of budget pressures and increased needs due to the COVID-19 pandemic. Representatives from the largest donor governments spoke Thursday at a United Nations General Assembly side event convened by the U.S. Many of them stressed the need for greater “burden-sharing” in humanitarian assistance, particularly by expanding the donor base to include new governments.”
“Sibylle Sorg, Germany’s director general for crisis prevention and stabilization, post-conflict peace building, and humanitarian assistance: “We, the top 10, should collectively reach out to new donors, encouraging them to enter the field of humanitarian assistance. And we should increase, or at least maintain, our funding levels from 2019. This is crucial to remain credible in our endeavor to broaden the bases,” Sorg added….”
https://www.devex.com/news/use-aid-to-make-uk-a-hub-for-philanthropic-funds-kruger-report-says-98181
The utter horror.
https://www.devex.com/news/german-development-minister-joins-team-eib-98203
“Outgoing German development minister Gerd Müller fanned the smoldering rivalry between the European Investment Bank and European Bank for Reconstruction and Development on Monday, nominating EIB as his preferred option to lead a possible European Development Bank. The idea of a single entity to better coordinate EIB, EBRD, and European development banks’ work outside the bloc dates back to at least 2010, but reached its apex at the end of last year as the two multilateral lenders sparred in public hearings with European Union member states. The impetus was a high-level wise persons’ report from nine development finance experts who were charged by France and Germany with finding ways to give Europeans more impact and brand recognition in their development efforts, particularly in Africa….”
https://www.gavi.org/news/media-room/jose-manuel-barroso-named-new-chair-gavi-board
“Gavi Board unanimously approves the selection of former Prime Minister of Portugal and President of the European Commission José Manuel Barroso as its new Chair. Barroso will replace Dr Ngozi Okonjo-Iweala, whose term ends in December 2020.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32036-5/fulltext
“In the race for the White House, where do US President Donald Trump and his Democratic challenger, former Vice President Joe Biden, stand on public health? Susan Jaffe reports from Washington, DC.”
Includes a Global Health section. Among others, on the Global Gag rule, US & WHO, …
https://news.err.ee/1142077/estonia-to-sign-digital-health-cooperation-deal-with-who
“The government will work more closely with the World Health Organization (WHO) in the digital health sphere, a move which it says will raise Estonia's digital international profile both in providing solutions to the COVID-19 pandemic and beyond.”
And via Twitter: WHO is establishing a Youth Council.
Edited by S Thomson et al; https://www.euro.who.int/en/about-us/partners/observatory/publications/studies/private-health-insurance-history,-politics-and-performance-2020
“A collection of comparative case studies analysing the history, politics and performance of private health insurance globally and its implications for universal health coverage. This is essential reading for graduate students, scholars and policy-makers working on health systems financing worldwide….”
D Duran, M Kruk et al ; https://gh.bmj.com/content/5/9/e002934
Cfr a tweet by M Kruk: “Whatever its merits and limits, #PBF works best as part of a broader heart system reform that tackles governance, management, and measurement says @denizhan_duran in this paper hot off the press. »
https://www.uhcpartnership.net/wp-content/uploads/2020/09/Stories-from-the-field_issue4_WEB.pdf
“…with a set of stories from all six WHO regions, which document how countries are reshaping their health systems amid one of the most devastating pandemics in history. The UHC Partnership, one of WHO’s largest initiatives for international cooperation for UHC, is providing vital and timely support that is enabling countries to take advantage of the opportunity to emerge stronger from the pandemic. It is working to ensure that the investments made throughout the COVID-19 response will result in health system reforms that improve both health security and progress towards UHC….”
A Stoner; https://journals.sagepub.com/doi/abs/10.1177/0896920520958099
“The aim of neoliberal environmentalism was to unleash the market to protect the environment; but as it turns out, things are getting worse on our way to catastrophe. Despite persistent failures, neoliberal environmentalism remains prevalent—and apparently without alternative. This paper directs focus on an often-overlooked dimension of this apparent stasis: the nexus of self and society in advanced capitalism, as shown in the linkage between neoliberal environmentalism and the autonomous ecoconsumer. Marcuse’s concept of repressive desublimation is engaged to better understand how environmentalist desire is currently being thwarted in ways that inhibit movement toward socioecological emancipation. The paper provides an illustrative example of desublimated environmentalist desire in the current recycling crisis.”
Neat & short analysis. On feasilibity & likelihood.
https://www.theguardian.com/environment/2020/sep/30/world-plant-species-risk-extinction-fungi-earth
“Two in five of the world’s plant species are at risk of extinction as a result of the destruction of the natural world, according to an international report. …” “…The 2016 State of Plants report found one in five were threatened, but the new analysis reveals the real risk to be much higher….”
“The climate crisis is heating up nights faster than days in many parts of the world, according to the first worldwide assessment of how global heating is differently affecting days and nights.
The findings have “profound consequences” for wildlife and their ability to adapt to the climate emergency, the researchers said, and for the ability of people to cool off at night during dangerous heatwaves….”
https://www.sciencedirect.com/science/article/pii/S0959378020307512?via%3Dihub
“Providing Decent Living with Minimum Energy: A Global Scenario. As ecological breakdown looms, the basic material needs of billions remain unmet. We estimate the minimal energy for providing decent living globally & universally. Despite population growth, 2050 global energy use could be reduced to 1960 levels. This requires advanced technologies & reductions in demand to sufficiency levels.”
“…Here, we develop a simple, bottom-up model to estimate a practical minimal threshold for the final energy consumption required to provide decent material livings to the entire global population. We find that global final energy consumption in 2050 could be reduced to the levels of the 1960s, despite a population three times larger. However, such a world requires a massive rollout of advanced technologies across all sectors, as well as radical demand-side changes to reduce consumption – regardless of income – to levels of sufficiency. Sufficiency is, however, far more materially generous in our model than what those opposed to strong reductions in consumption often assume.”
https://www.ft.com/reports/communicable-diseases
“The year-old outbreak of Ebola in DRC underlines the urgent need for new approaches to the threat of epidemic disease. FT writers examine the latest thinking from industry and public health authorities.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32063-8/fulltext
« No matter the outcome of the 2020 US election, the path forward is not only one that builds back from the COVID-19 pandemic, but also addresses AMR in the context of pandemic preparedness (panel). A coordinated One Health response is needed, with action from multisectoral and cross-sectoral stakeholders in human and veterinary medicine, agriculture, finance, environment, industry, and consumers, to address what is as much an environmental issue as an economic one. The USA cannot do this alone, but should be an active participant in the global system to accelerate action and advance a shared global vision on tackling AMR. Through leadership and accountability, national governments can be greater than the sum of their parts. Finally, to accelerate and sustain progress against AMR, the USA should support the multilateral global architecture needed to confront AMR, including WHO, the UN Food and Agriculture Organization, and the World Organisation for Animal Health. ….”
“The ICC’s 6th Business Dialogue, involving Teresa Moreira, Head Competition and Consumer Policies Branch of UNCTAD, the UN’s main body for trade, investment and development issues, and Vice President External Affairs of Philip Morris International Gabriela WURCEL, took place on Wednesday evening at the Four Seasons Hotel in Geneva. Face-to-face meetings in such fora are supposed to be taboo in the UN system, according to the model policy for agencies of the United Nations system on preventing tobacco industry interference, which was developed out of the WHO Framework Convention on Tobacco Control (FCTC), a WHO official told Health Policy Watch….”
Analysis of the past 4 years.“The U.S. administration exports anti-abortion policies abroad and strips international agreements of references to “sexual orientation” and “gender identities.””
M Ross et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1816526#.X3LjFQeTT5w.twitter
Based on a study in Tanzania. “There is speculation that abuse of sexual minority men by Healthcare workers in public clinics is due to factors in addition to their sexual behavior as gay/bisexual, and that it is due to violating perceived gender roles. Data confirm that perceived feminine gender role is a significant predictor, of abuse in healthcare and other settings. Common confusion between homosexual behavior and gender role norms may trigger discrimination, which may be as much due to violation of perceived gender roles as having sex with other men….”
“The editors of PLOS Medicine together with Guest Editors Prof. Zulfiqar A. Bhutta, Prof. Kathryn M. Yount, and Prof. Quique Bassat, announce a forthcoming special issue devoted to child and adolescent health….”
“One-quarter of married, fertile-age women in Sub-Saharan Africa report not wanting a pregnancy and yet do not use contraceptives. To study this issue, we collect detailed data on women’s subjective probabilistic beliefs and estimate a structural model of contraceptive choices. Our results indicate that costly interventions like eliminating supply constraints would only modestly increase contraceptive use. Alternatively, increasing partners’ approval of methods, aligning partners’ fertility preferences with women’s, and correcting women’s beliefs about pregnancy risk absent contraception have the potential to increase use considerably….”
Coverage of new NEJM study. “Vaccinating populations against the human papillomavirus, which causes most cases of cervical cancer, is effective and saves lives, according to a milestone Swedish study. The results were welcomed as a significant moment in the fight to eradicate cervical cancer, which kills more than 250,000 women a year. The large-scale study by the Karolinska Institutet found that women vaccinated against HPV have a significantly lower risk of developing cervical cancer, with women vaccinated at a young age benefiting the most….” “Jiayao Lei, a researcher at the department of medical epidemiology and biostatistics at Karolinska Institutet, said the study was the first to show that HPV vaccination helped protect against invasive cervical cancer, not just cervical pre-cancer.”
And some links:
Globalization & Health - Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context
BMC Health Services - Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review
D Gotham et al ; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239118
“In 2012, bedaquiline became the first new treatment from a novel class to be approved for tuberculosis in nearly five decades and is now a core component of the standard of care for multidrug-resistant tuberculosis. In addition to the originator pharmaceutical company, Janssen, a range of governmental and non-profit entities have contributed to the development of bedaquiline. We identified various avenues of public investments in the development of bedaquiline: direct funding of clinical trials and a donation programme, tax credits and deductions, and revenues resulting from the priority review voucher (PRV) awarded to the originator….”
Results & conclusion: “Public contributions through clinical trials funding were estimated at US$109–252 million, tax credits at US$22–36 million, tax deductions at US$8–27 million, administration of a donation programme at US$5 million, PRV revenues at US$300–400 million. Total public investments were US$455–747 million and originator investments were US$90–240 million (if capitalized and risk-adjusted, US$647–1,201 million and US$292–772 million, respectively). Estimating the investments in the development of a medicine can inform discussions regarding fair pricing and future drug development. We estimated that total public investments exceeded the originator’s by a factor of 1.6–5.1.”
S Mancini (MSF) https://medium.com/@MSF_access/transparency-matters-italy-moves-against-the-secrecy-surrounding-the-cost-of-medicines-4468a6e0ced6
“How much do medicines cost to develop? The answer to this critical question is that we don’t know. What we do know is that the lack of transparency and secrecy surrounding these costs allows pharmaceutical companies to charge just about any price they want for their drugs. Now Italy has taken a pioneering step in requiring more transparency from the industry.”
https://www.ed.ac.uk/news/2020/partnership-serves-global-healthcare-solutions
“A project to equip nurses and midwives to tackle global healthcare challenges has been launched at the University.”
“The first pioneering projects of the Edinburgh Global Nursing Initiative will improve care for people who use health services in the Democratic Republic of the Congo, the Republic of Liberia and Uganda. The Edinburgh Global Nursing Initiative will connect and empower nurses worldwide to share research, innovations and knowledge to improve people’s health outcomes….”
https://www.nature.com/articles/d41586-020-02708-4
“Researchers will also recommend an open-access policy that promotes research being shared on online repositories.”
“The Indian government is pushing a bold proposal that would make scholarly literature accessible for free to everyone in the country. The government wants to negotiate with the world’s biggest scientific publishers to set up nationwide subscriptions, rather than many agreements with individual institutions that only scholars can use, say researchers consulting the government. The proposal is expected to be part of the government’s latest science, technology and innovation policy, which is being developed by the Office of the Principal Scientific Adviser to the Government of India and the Department of Science and Technology….”
Bilateral aid commitments reported to the International Aid Transparency Initiative in the first five months of 2020 are about 30 percent lower than during the same period in 2019, points out Aleksandra Morozkina.
Good.