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Dear Colleagues,
Earlier this week, Justin Trudeau nicely captured the global mood, summarizing the current state of affairs as: “We are in an unprecedented global pandemic … that really sucks.” Indeed. It’s end of October, and as dr. Tedros said, we find ourselves once again “at a critical juncture” in the pandemic. Buckle up.
On a brighter note, it’s clearly “high season” for hybrid or fully virtual conferences, summits, workshops, webinars, … with this week, among many other events, the World Health Summit (WHS) and the 61st ITM colloquium , both fully digital, certainly worth flagging. Not being much of a multitasker, I suffered a heavy bout of Zoom/Twitter/webinar/conference FOMO on various days, getting dizzy as well from all the frantic hopping & tweeting. Anyway. Below a few messages that stuck with me, in the flurry of events that I happened to attend, on purpose or coincidentally.
Let’s start with a side note, though: it’s not oil that keeps this insane economic system going – it’s coffee. A vastly underestimated resource for global capitalism, including its neoliberal academia component. That and un(der)paid work, especially for women, I learnt in one of the many great WHS sessions, “Covid 50/50 – Women Leading in Crisis: A Gender Responsive Approach” with the eloquent likes of Roopa Dhatt, Clare Wenham and other Margaret Chans. Whatever it is that we build up (better?) when this pandemic is over, a feminist lens and ditto policies seem an absolute must, building a caring economy. (PS: anecdotal evidence tells me that “Volunteering” in academia & many global health taskforces tends to be gender biased as well)
The lunch webinarorganized by Medico International and Bread for the World, “Global Health Security- Preparedness or Prevention. Defence or Precaution. How conflicting concepts of Global Health Security and Public Health are shaping the COVID19 response“”, organized in the margins of the WHS in Berlin, provided also some great food for thought. Global health security framing has evolved since its origins early 90s, speakers stressed, and is evolving once again, in line with the shifting geopolitical constellation and new global challenges. Quite a few panelists pointed out that the GHS framing of the Covid pandemic has been more dominant than the social epidemiology framing so far (in spite of all the talk of a ‘syndemic pandemic’). Just one quote perhaps: René Loewenson worried that the GHS security agenda could lead to short term capability responses, rather than long-term investment in what we need. Along the lines of what happened, decades ago, with the selective primary care approach… (you can re-watch the event here )
I thoroughly missed the Bratwurst and tasty sweet pastries in Berlin, you know me, but there’s little to disagree with in this year’s M8 Alliance Declaration, starting with its guiding principle, “No one is safe until all are safe”, a quote by F-W Steinmeier at the opening plenary. The Declaration’s support for TRIPS waivers through the World Trade Organisation I found quite encouraging, for example. I also sort of agree with another WHS theme, the need for a more pro-active EU in global health ( as long as Ursula et al refrain from ‘world leadership’ bragging, they can leave that to the US & UK 🙂 ). The WHS also saw the launch of a few important (BMJ) collections, among others Democracy and health. As the editors (Bollyky & Kickbusch) note, with an understatement: “The coronavirus pandemic is not an advertisement for the healthy effects of democracy”. Very much recommended reading, if you haven’t delved into the papers yet. With China now ahead of most of the West, when it comes to its pandemic response and recovery, and also on climate change having a reputation of ‘underpromising, but overachieving’ (unlike the more or less democratic West which tends to go for the opposite), one can only hope that next week Americans will take the right decision in their presidential elections. (By that, I don’t mean by that they should vote for their own autocrat (again) 😊.) The democratic world needs a United States living up to its potential. Anyway, as mentioned before, I’m rather optimistic on that front. It’s my conviction that a populist who has to defend his track record of the past years is a rather different proposition than one going to elections for the first time. (even if the flaws of the American “democratic” system are endless, Trump has ‘delivered’ for his fans, and it will still get very ugly after Nov 3)
The first virtual ITM colloquium ( #Colloq2020 ), “Implications of Covid-19 for global and local health, and beyond”, was a success, thanks to many of my colleagues (and also a lovely platform!), with vibrant discussions on a great number of timely issues. When watching the debate on day 1, for example, on whether the pandemic response has been balanced enough, I couldn’t help but think that, whether we like it or not, the second wave will be one of polarization – the social cohesion of the first wave, even if it was a bit artificial perhaps, is no more. Even in my own institute, with scientists all around, disagreement can be quite strong on strategies to be taken, and so it’s understandable that polarization in the broader society is now sky-high. Part of the reason, of course, is that we all bring our ideology into this debate, and many of us (including the author of this intro) are by now, 8 months into the pandemic, pretty much “stuck” in our stances. The similarity with the climate change debate, till a few years ago at least, is obvious.
I also very much enjoyed the second session of the Global Health Policy Research ( 4th symposium) series with among others Daniela Rodriguez unpacking the notorious concept ‘political will & commitment’ (towards vulnerable populations), and attended the closing GAP session at the WHS, where quite some speakers made the link between the GAP and the ACT-Accelerator. Eg. Peter Sands: “The Global Action Plan for Healthy Lives and Wellbeing laid the foundation & shifted norms of collaboration in the multilateral system. ACT Accelerator helps to harvest the fruit of collaboration.“ Dr. Tedros much agreed with Sands on this, but seemed slightly less impressed by Sands’ intervention on global health funding, alternating between checking his smartphone and yawning 😊. Ah, the joys of high-level event Zooming! Although Ilona Kickbusch stressed that the shift to finance global common goods (away from just ODA?) is becoming an important part of the global Covid discussion, too many global health leaders still refrain from drawing some obvious conclusions, preferring to talk about ‘rich countries’ and engaging in cheap talk of multilateralism & ‘global solidarity’, while failing to identify where the real money can be found. They better hurry up. In fact, they just need to listen to their sister Winnie Byanyima who has some great ideas on this. Because make no mistake, even if Joe Biden is elected, “multilateralism of the 21st century” will very much need progressive policies & taxation. If not, populism will come back with a vengeance, sooner rather than later.
Enjoy your reading.
Kristof Decoster
Do check out the Digital magazine.
With testimonies from EV alumni (from various cohorts). Introductions by Founding Father Wim van Damme and EV chair Dorcus Kiwanuka.
Onwards to the next 10 years!
Meanwhile, stay tuned for the official launch event (5 November) of the global HSR symposium:
HSG - Launching HSR2020 !!!
“The 30-minute launch event will feature contributions from Dr Tedros Adhanom Ghebreyesus (WHO Director General) and members past and present of the Emerging Voices for Global Health. The launch will also include welcomes from HSG Chair, Asha George, and Director General of the Dubai Health Authority, His Excellency Humaid Al Qutami….”
More info here also on the first stage of the HSR symposium. Or see the HSG newsletter (October issue).
Three days of great discussions and presentations on “Implications of COVID-19 for global and local health, and beyond”. All recordings should be available somewhere next week.
Core topic this year was obviously the Covid-19 pandemic.
And “No one is safe until all are safe” was the mantra of this year’s virtual summit.
See also:
Very nice declaration in many ways. Check out the 7 key messages.
Good to see the Declaration supports the TRIPS waiver proposal (at WTO), among others.
https://www.devex.com/news/world-health-summit-kicks-off-amid-pandemic-98402
Neat analysis, as the WHS started. “The 2020 edition of the gathering — which began virtually on Sunday after plans for a hybrid online and in-person event were scrapped last minute — aims to build an international consensus on a way through the COVID-19 pandemic, while taking stock of the damage the coronavirus has done to global health initiatives, and underscoring the importance of restoring these efforts….”
Coverage of the opening plenary.
Among others, with this quote from UNAIDS exec director Winnie Byanyima: “Speaking at the opener, UNAIDS Executive Director Winnie Byanyima echoed the WHO call on equitable distribution of future COVID-19 vaccines and went further – saying that the therapies must be a “peoples’ vaccine” in order to be and fairly distributed. “To do this, pharma companies must openly share their know-how and technology for producing the vaccines” as opposed to holding onto “patent monopolies.”
https://healthpolicy-watch.news/digital-health-is-keynote-topic-at-world-health-summit/
“At a time when the COVID-19 pandemic has exposed the fragility of health systems – digital health technologies are playing a fast-expanding role – showing their revolutionary potential to address old and new needs and gaps, said participants on a Digital Health panel at the World Health Summit on Monday. “COVID-19 is the first pandemic of the digital age. We’re seeing first-hand how these new tools can support our efforts. Digital health technologies are helping to screen populations, track infection rates, and monitor resources,” said Dr Tedros…”
“Representatives from the global south used this year’s World Health Summit to send a message to their counterparts in richer countries: They have a vision for how to emerge from the COVID-19 pandemic, and while they welcome advice and technical expertise, they are not interested in being told what to do….”
Coverage of the closing session in Berlin, on accelerating the GAP.
“New modes of interagency collaboration triggered by the COVID-19 pandemic should be used as a model to advance more progress, post-pandemic, on important Sustainable Development Goals (SDGs) related to health, said a group of top international agency leaders in Tuesday’s closing session of the World Health Summit. …. … the concluding panel, leaders at the World Health Organization, UNICEF, The World Bank, The Global Fund and Unitaid, which had signed on last year to an ambitious Global Action Plan for Healthy Lives and Well-being (GAP) to accelerate progress on health- related SDGs, talked about how plans had both been upended and advanced by the pandemic….”
Quote: “Panellists underlined that some of the active cooperations between agencies that have been launchd around the pandemic, like the WHO-coordinated Access to COVID-19 Tools Acclerator – should help advance the GAP’s overall aims – although they were scarce on the details of immediate plans. …”
Some links:
· UN News - Science, unity and solidarity, key to defeating COVID: UN chief
(on Guterres’ address to the WHS, at the opening plenary).
· Devex - Can funders help bridge the gap between development and health research?
“ Researchers and development experts have a lot to learn from each other, but how public and private funders might bring them together was the subject of some debate during the second day of the World Health Summit….”
https://www.bmj.com/democracy-and-health
Fabulous stuff.
“The coronavirus pandemic is not an advertisement for the healthy effects of democracy. As of October 2020, 9 of the 10 nations with the highest cumulative cases of covid-19 are democracies. The mixed performance of democracies represents a departure from their success in confronting other health challenges, relative to other forms of governments. Democracy remains the preferred form of government on all continents, but this vision of democracy works in a crisis only if it is promoted in normal times. This collection takes a closer look at the progress of different political systems achieving universal health coverage, explanations for the links between democracy and health, and what measures must be undertaken to better “pandemic proof” this political system….”
“The collection was launched at the World Health Summit, 25-27 October 2020, Berlin, Germany. Funding for the articles, including open access fees, was provided by a grant from Bloomberg Philanthropies to the Council on Foreign Relations, support from the Konrad-Adenauer-Stiftung to the Graduate Institute of International and Development Studies, and the Institute for Health Metrics and Evaluation….
Start with the BMJ Editorial - Preparing democracies for pandemics (by T Bollyky & A Kickbusch – who compiled the series)
But make sure you read the whole series!
Among others:
· Autocratisation and universal health coverage: synthetic control study “A special paper from Simon Wigley and colleagues finds that countries that move away from democratic principles perform poorly on life expectancy, effective health coverage, and levels of out-of-pocket spending.”
· Investing in civil society for better democracy and better health “Roopa Dhatt and colleagues recommend a three-pronged call to action asking that civil society is engaged, funded, and protected in global health governance.”
“The 1995 Beijing Declaration and Platform for Action on Women was a landmark global policy framework to promote the human rights of women and girls and gender equality. These were also identified as a prerequisite for women’s health and wellbeing. Over the past 25 years there has been important progress in several areas of women’s health, however, gender discrimination, bias and inequalities in women’s health persist. There are also new and emerging threats to women’s health. The covid-19 pandemic is one such threat disproportionately impacting women’s health and social and economic wellbeing in the immediate and long-term. This collection, launched at the World Health Summit 2020, aims to provide insights into how to advance women’s health and gender equality. The papers draw on successes, challenges and evidence-based strategies over the last 25 years and includes analyses of new and emerging threats to women’s health. The series of papers push for real change in women’s health now and over the next 25 years.”
With a wealth of articles. Launched at this WHS session.
Make sure you read, at the very least, Employment based health financing does not support gender equity in universal health coverage “Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues.”
“Big US technology companies are exploiting loopholes in global tax rules to avoid paying as much as $2.8bn (£2.1bn) tax a year in developing countries, according to research by the anti-poverty charity ActionAid International. Facebook, Google and Microsoft have been accused of failing to pay a fair amount of taxes in poor countries where governments are struggling to provide even basic healthcare or education to their citizens. ActionAid International said its research showed the income lost from the “tax gap” could have been used to pay for more than 700,000 new teachers or 850,000 primary school teachers. There is no suggestion that the tech firms are breaking the rules or actively evading tax. ActionAid said the potential taxes are being lost due to world leaders’ failure to implement global standards on tax that would force multinational companies to pay more tax in the countries where they generate their income….”
“ A United Nations committee has signaled support for an effort to help developing countries tax tech giants, but final approval will likely wait until 2021….”
“The World Trade Organization’s effort to name a new leader hit a new roadblock Wednesday after the Trump administration said it won’t back the appointment of Ngozi Okonjo-Iweala to be the WTO’s next director-general. The U.S. could not support a consensus decision to appoint Okonjo-Iweala, Deputy U.S. Trade Representative Dennis Shea said during a meeting of WTO delegates in Geneva, according to three officials who were monitoring the proceedings. All WTO decisions are taken by a consensus of its 164 members, which means the U.S. move will act as a veto that disrupts the process. A WTO official said work would continue to reach a consensus ahead of meeting of the General Council tentatively set for Nov. 9. The development came after Okonjo-Iweala, Nigeria’s former finance minister, received a key endorsement Wednesday from the WTO selection committee, which moved her a step closer to becoming the WTO’s first female director-general.”
Final decision is planned for 9 November.
See also the Guardian - US blocking selection of Ngozi Okonjo-Iweala to be next head of WTO
“Sources said it was unclear whether Washington’s opposition to Ngozi was a deliberate attempt to sabotage an organisation much criticised by Donald Trump. A WTO spokesman said her candidacy would be put to a meeting of the body’s governing general council on 9 November, adding that there was likely to be “frenzied activity” in the meantime to secure consensus….”
As for the EU, AFP reported that the EU backs Nigerian WTO candidate Okonjo-Iweala
“Nigerian finance ministrer Ngozi Okonjo-Iweala picked up crucial backing from the EU on Monday, sources said, giving her bid to become the first African head of the WTO a major boost. The World Trade Organization will announce its new director general next month, but sources said the EU [will] publicly announce its support for the 66-year-old economist on Tuesday….”
More analysis on the current state of affairs via HPW - Gavi Board Chair Okonjo-Iweala Is Recommended As Next World Trade Organization Director-General – US Opposition Stalls Final WTO Decision
https://cepi.net/news_cepi/usa-joins-cepi-to-support-the-development-of-epidemic-vaccines/?swcfpc=1
“The US Agency for International Development, USAID, has …. announced US$20 million in financial support of CEPI to advance the development of vaccines against emerging infectious diseases….”
“These funds will be provided over a five year period, subject to Congressional approval each year, to support CEPI’s development programs for several specific diseases, including Lassa fever, Middle Eastern Respiratory Syndrome, Nipah, Chikungunya, Rift Valley Fever, and Ebola. They will also help progress novel vaccine platform technologies for the rapid development of countermeasures to unknown pathogens. This latter effort is already targeting COVID-19.”
“The Unitaid Executive Board is delighted to announce the appointment of Dr Philippe Duneton as Executive Director. Dr Duneton played an essential role in the founding of Unitaid as well as in the numerous successes achieved by the organization since then. He has been acting Executive Director since March 2020 and has been instrumental in leading Unitaid’s response to the COVID-19 pandemic….”
https://phmovement.org/phm-strategic-plan-2020-2025/
Cfr a tweet by Fran Baum: “The People's Health Movement @PHMglobal knows that the world is getting more unequal and less healthy for humans and the natural environment - here's what we are planning to do to help restore health and equity over the next five years.”
M Kavanagh; https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30211-5/fulltext
“…isolationism has not enabled the USA to stop the spread of SARS-CoV-2. But global health programmes centred on sharing US expertise with low-income and middle-income countries (LMICs) have also not ensured the USA, or the world, can respond effectively in the face of a complex virus and global competition for the goods and technologies to stop it. The next US administration should shift foreign policy towards thinking and acting holistically about pandemics, strengthening multilateralism, and embracing solidarity. Learning lessons from what has worked, and what has not, the next US administration should launch a concrete, sufficiently funded global pandemics initiative with three focuses. First, to better link responses to HIV, tuberculosis, and malaria with those addressing emerging outbreaks. Second, to put climate change at the centre of global health and health into international climate policy. Third, to build multilateral capacity and power. In tackling pandemics as a central element of engaged foreign policy, the next US administration could lead an historic shift….”
T Agartan et al ; https://journals.sagepub.com/doi/full/10.1177/1468018120957247
Very good introduction to the papers in this Forum: “…This Forum brings together an outstanding group of scholars, practitioners and advocates to reflect on WHO’s response to this complex global crisis within the context of broader conversations on global health, security and development, and contemporary threats to multilateralism and global solidarity. In this introduction, we highlight the key themes of the Forum articles, including the challenges to the mandate of WHO and the politicization of its role in the crisis, while also considering what a distinctive global social policy (GSP) perspective offers to this debate….”
Check out also:
· Global Social Policy - COVID-19 response exposes deep flaws in global health governance by David Legge. He’s no fan of the ACT-Accelerator, among others.
· Global Social Policy - COVID-19: Reflecting on the role of the WHO in knowledge exchange between the Global North and South (by A Ekpenyong et al).
“The Independent Panel for Pandemic Preparedness and Response (IPPPR), the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (IOAC) and the Review Committee of International Health Regulations (IHR) are important opportunities to consider the World Health Organization (WHO) and states’ response to the COVID-19 pandemic from a gender perspective. National governments are responsible for developing and implementing laws and policies to respond to crises, and mitigating outbreak impacts on different sectors of society. WHO is responsible for global priority-setting and coordination, information dissemination and knowledge sharing. IHR must mainstream gender in planned actions and obligations. This brief by Women in Global Health and the Gender and COVID-19 Project provides advice for gender mainstreaming as states and WHO i) prepare for an outbreak, ii) engage in decision making and advice during the crisis and iii) respond to epidemics and potential pandemics.”
Cfr tweet Arush Lal: “Reform #IHR to explicitly address gender; Link national health security action plans w/ human rights/UHC agenda; Mandate equity in GHS leadership.”
https://www.devex.com/news/the-healthy-brains-global-initiative-the-next-global-fund-98412
“Brad Herbert hopes to raise $10 billion for a new global initiative set to launch in 2021 at Davos. But with the coronavirus creating a global economic crisis, he is aware raising funds is going to be a huge challenge. … … Herbert, who sits as the interim CEO at the Healthy Brains Global Initiative — a global financing mechanism that aims to fuel research on neurological and mental health disorders — finds that it’s important to get started. COVID-19 has created conditions that impact the mental health of populations globally … HBGI aims to fund basic, translational, and implementation research on mental and neurological disorders. It takes inspiration from established multilateral institutions in global health, such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, where Herbert used to be chief of operations. He plans to apply some of the policies he helped introduce or witnessed during his time at The Global Fund to HBGI, such as performance-based funding and having people affected by the disease or condition as part of the decision-making processes…. Herbert isn’t expecting to raise $10 billion right away. But he thinks it’s possible to raise at least $100 million within a year, out of a target of $500 million, to start work on the mental health challenges posed by COVID-19, based on conversations he’s having with different foundations and those involved in philanthropy.”
This week’s newsletter has an interview with Sridhar Venkatapuram, among others. Must-read.
“He has spearheaded the Independent Resource Group for Global Health Justice (IRG-GHJ “URGE”), along with other philosophers and experts to address the some of the biggest questions of the times we are now living in. You can also watch this recent event where these experts lucidly explain what they intend to do in getting organizations to discuss complex global justice matters and the ethical issues that this pandemic has thrown up. He spoke to Geneva Health Files at length on how issues around allocation and distribution of medical products, for example, are being framed and why it is important to question the framing of these matters….”
https://www.devex.com/news/5-things-for-the-development-community-to-watch-in-the-us-election-98399
“ Global development might not be at the top of the list of issues voters are considering as they cast their ballots in the U.S. election on Nov. 3, but the outcome could have big implications for America’s approach to foreign aid, global health, and development for the foreseeable future. … …
“Here are five issues at stake for U.S. global development in this presidential election — and the days, weeks, or even months after that….” First one: Global COVID-19 funding.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32201-7/fulltext
“President Donald Trump pledges to replace the Affordable Care Act while his Democratic opponent Joe Biden offers detailed proposals to improve it. Susan Jaffe reports from Washington, DC.”
And a tweet from Benjamin M Meier: “Diplomatically savvy of @WHO to postpone #WHA73 until after US election. After #Election2020, let the Trump administration shout into the void of its own making.”
As usual, with focus on key WHO messages & global trends.
PS: For some of these global trends (also over time), see for example: BBC - Covid-19 pandemic: Tracking the global coronavirus outbreak (with some neat data visualizations)
“Global coronavirus cases rose by more than 500,000 for the first time on Wednesday, a record one-day increase as countries across the Northern Hemisphere reported daily spikes. … … Most western countries and parts of Latin America have reported their highest single-day surges in the past few weeks. Many governments, with the notable exception of the United States, have started taking stronger measures to bring the spread of the virus under control. The global coronavirus tally stands at 44.7 million cases and about 1.17 million deaths. Europe, North America and Latin America account for over 66% of global cases and over 76% of global deaths….”
(Oct 26) “Led by a surge of cases in the United States and many European countries, the global total yesterday topped 43 million cases, a day after the World Health Organization (WHO) reported the biggest single-day case rise in the pandemic. At a WHO briefing today, WHO officials said last week saw the highest number of cases of the pandemic so far, and 46% were from Europe. Director-General Tedros Adhanom Ghebreyesus, PhD, said steep case rises in Northern Hemisphere countries are leading to concerning increases in hospitalizations, with intensive care units (ICUs) at capacity in some places. He said he understands that fatigue from pandemic measures is real, but he said countries must not give up. "Leaders must balance the disruption to lives and livelihoods with the need to protect health workers and health systems as intensive care fills up…”
See also Stat News - WHO warns giving up on efforts to control Covid-19 would be ‘dangerous’
Reuters - Europe needs 'serious acceleration' in fight against coronavirus: WHO
Cidrap News - Surges in Europe, US push exponential COVID-19 rise
HPW - Europe Becomes ‘Epicentre’ For COVID-19 As Spain Declares State Of Emergency & US Cases Rise Officially also a ‘third wave’ in the US now.
PS: “In a press conference on Monday, Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, noted that some 184 countries have by now joined the COVAX Facility vaccine initiative, calling it a “positive development” against trends of vaccine nationalism.”
VOA - WHO Reports Record 3 Million New COVID-19 Cases in a Week
https://news.un.org/en/story/2020/10/1076052
(from last Friday): “Facing another critical juncture in the COVID-19 pandemic, the World Health Organization (WHO) chief told reporters on Friday that a “very tough” few months lie ahead with too many nations seeing an exponential increase in cases. Tedros Adhanom Ghebreyesus said some countries were now on a “dangerous track” and the worrying rise was leading to hospitals and ICUs “running close or above capacity – and we’re still only in October.” … Turning to the need to share all resources in the COVID fight equitably, Tedros noted that a heavy toll was being taken on the world’s supplies of clinical oxygen, so crucial for those patients who need to be intubated, and many countries simply do not have enough. The “global oxygen gap” is particularly acute in some of the poorest nations, where some have only five to 20 per cent of what they need for patient care. …”
Do check out what WHO is doing to help with this global oxygen gap.
“David Nabarro says ‘circuit breakers’ should be reserve rather than primary measure.”
“Building a robust test, trace and isolate system must remain the priority for all governments, said Nabarro, “with lockdown still the reserve that you use to take the heat out of the system when things are really bad”….”
“People in most of 25 countries around the world think governments and leaders failed to respond either well or fast enough to the coronavirus crisis, a new global survey shows….”
Stat;
Focus on the US in this piece, but perhaps true for many more countries.
“…the ambitious drive to produce Covid-19 vaccine at warp speed seems to be running up against reality. We all probably need to reset our expectations about how quickly we’re going to be able to be vaccinated. Pauses in clinical trials to investigate potential safety issues, a slower-than-expected rate of infections among participants in at least one of the trials, and signals that an expert panel advising the Food and Drug Administration may not be comfortable recommending use of vaccines on very limited safety and efficacy data appear to be adding up to a slippage in the estimates of when vaccine will be ready to be deployed. Asked Wednesday about when he expects the FDA will greenlight use of the first vaccines, Anthony Fauci moved the administration’s stated goalpost….”
““Could be January, could be later. We don’t know,” (Fauci) (in interview in JAMA)…”
T Bollyky et al ; https://www.washingtonpost.com/outlook/2020/10/27/coronavirus-vaccine-distribution-plan/
Focus on the US in this piece, but basically a valid question for everywhere. “If we don’t plan carefully now, the people who need the vaccine the most won’t get it first.”
“For months, experts in public health and medical ethics, from the National Academy of Medicine to the World Health Organization and scholars at Johns Hopkins and other universities, have been debating which groups should receive the earliest covid-19 vaccines first — and last. Paradoxically, while a considerable amount of energy is being spent on recommending who should receive the vaccine first, almost no attention is being devoted to how to distribute it.
… If that “how” question is not answered until a vaccine is in hand, it will be far too late. Once FDA authorizes a vaccine, there will be enormous pressure for distribution to begin immediately. If the infrastructure is not established to distribute early vaccine doses to the vulnerable and disadvantaged people who stand to benefit most, those supplies will go instead wherever it is politically and logistically expedient — which is what has happened in the past.
Well worth a read, this week’s issue. With focus on Covax, considered by Gavin Yamey as the ‘compromise solution’ in the current world. “This week we’re looking at the challenges of equitable vaccine distribution.”
Make sure you read the section “Inside the Covax plan”.
“Vaccine nationalism could cost the global economy up to $1.2 trillion dollars, new analysis has found, amid concerns that lower income countries may miss out on crucial vaccines. The study, put together by the not-for-profit research organisation Rand Europe, builds on previous research that has estimated the death toll from Covid-19 could be twice as high if the first two billion vaccine doses are not equitably distributed. In the latest report, Rand analysed a series of ‘what if’ scenarios to understand the various consequences unequal distribution of immunisations may have on global prosperity. In the most extreme example, the analysis found that the world would lose $1.2 trillion dollars a year in GDP-terms if vaccine manufacturing countries, such as the United States, EU, UK, China, Russia and India, maintained a monopoly over the supply….”
“…However, if these high-income countries invested in efforts to ensure under-resourced countries also had equal access to the first round of vaccines, the return in investment would be four-fold: for every $1 spent, high-income countries would get back about $4.80. “A globally coordinated multilateral effort to fight the pandemic is key, not only from a public health perspective but also an economic one,” said Marco Hafner, the study’s lead author and senior economist at Rand Europe. “Our findings suggest that there are real economic incentives for the higher income countries to drive vaccine development and distribution to ensure that the rest of the world has access to vaccines as soon as possible.”…”
https://news.un.org/en/story/2020/10/1076292
“The heads of three UN agencies joined forces on Tuesday to appeal for a global push towards “open science”, citing the value of cooperation in the response to COVID-19 and the dangers of treating evidence-based knowledge as an exclusive asset, or simple matter of opinion. Audrey Azoulay, the Director-General of the UN Educational, Scientific and Cultural Organization (UNESCO), Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) and Michelle Bachelet, UN human rights chief (OHCHR), said it was time to ensure the benefits of science could be shared by all. …”
“Drugmakers Sanofi and GlaxoSmithKline have agreed to provide 200 million doses of their potential COVID-19 vaccine to the COVAX Facility, a collaboration designed to give countries around the world equal access to coronavirus vaccines. The Sanofi-GSK vaccine candidate is in early stage trials, with results expected in early December. The drugmakers said Wednesday that they plan to begin phase three trial by the end of the year and request regulatory approval of the vaccine in the first half of 2021….”
“Activists called on pharmaceutical companies on Thursday to be transparent about the costs and terms of providing COVID-19 vaccines, saying they must be available and affordable for all. French drugmaker Sanofi and Britain’s GlaxoSmithKline said on Wednesday they would supply 200 million doses of their COVID-19 candidate vaccine to the global COVAX vaccine facility backed by the World Health Organization (WHO) and the GAVI vaccine alliance. Medecins Sans Frontieres (Doctors Without Borders) demanded the two companies provide details around price, supply and distribution of any vaccine proven safe and effective. “Pharmaceutical corporations Sanofi and GSK must sell their vaccines at-cost and open their books to show the public exactly how much it costs to make the vaccine,” said Kate Elder, senior vaccines policy adviser at MSF’s Access Campaign….”
https://www.hrw.org/news/2020/10/29/rights-transparency-central-covid-19-vaccines
“Governments should maximize Covid-19 vaccine access and affordability for people worldwide, and those funding vaccines with public money should be transparent about the terms and conditions attached, Human Rights Watch said in a report released today. Governments should support India and South Africa’s proposal to waive some aspects of global intellectual property (IP) rules to enable large-scale manufacturing and make vaccines affordable for all. The 77-page report, “‘Whoever Finds the Vaccine Must Share It’: Strengthening Human Rights and Transparency around Covid-19 Vaccines,” examines three significant barriers to universal and equitable access to any vaccine that is found to be safe and effective – transparency, supply, and pricing….”
From late last week. “The United States Food and Drug Administration decision Thursday to approve Gilead Science’s Remdesivir as a COVID-19 treatment failed to consider the results of the recent WHO “Solidarity Trial” – which found no measurable benefits for the drug’s use – because the pharma company failed to include the study in its FDA submission for approval, WHO’s Chief Scientist said on Friday. “
See also Reuters - WHO: Nations mulling Gilead's COVID drug should consider trial flop, too
“… The WHO also said on Friday that its formal guidelines on use of remdesivir for COVID-19 should be ready for release in three to four weeks, after a separate group within the United Nations health agency reviews data from the study. .. … An independent WHO panel will convene next week to look at all evidence of the effectiveness of Gilead’s drug, Janet Diaz, the WHO’s top official for clinical care responses, said….”
“October was a good month for Gilead Sciences, the giant manufacturer of antivirals headquartered in Foster City, California. On 8 October, the company inked an agreement to supply the European Union with its drug remdesivir as a treatment for COVID-19—a deal potentially worth more than $1 billion. Two weeks later, on 22 October, the U.S. Food and Drug Administration (FDA) approved remdesivir for use against the pandemic coronavirus SARS-CoV-2 in the United States—the first drug to receive that status. The EU and U.S. decisions pave the way for Gilead’s drug into two major markets, both with soaring COVID-19 cases. But both decisions baffled scientists who have closely watched the clinical trials of remdesivir unfold over the past 6 months—and who have many questions about remdesivir's worth. … … … Science has learned that both FDA’s decision and the EU deal came about under unusual circumstances that gave the company important advantages….”
“…two major studies of vaccines against Covid-19, both paused because of potential safety concerns, are set to restart, the companies running them said [last week on ] Friday….”
https://ca.reuters.com/article/us-health-coronavirus-astrazeneca-vaccin-idCAKBN2782WC
“AstraZeneca Plc AZN.L said on Friday its coronavirus vaccine deal with Oxford University will allow it to add up to 20% of manufacturing costs to cover additional expenses required to be incurred by the British drugmaker. “In addition to the manufacturing costs, the company is incurring costs in excess of $1 billion globally that include clinical development, regulatory, distribution, pharmacovigilance and other expenses”, an AstraZeneca spokesman said in a statement. “To cover these additional expenses, the company will add an amount equivalent to a maximum of 20% of the manufacturing costs to ensure there is no material impact on its finances this year while continuing efforts to provide the vaccine at no profit during the pandemic,” the statement added….”
Cfr a tweet Ilona Kickbusch: « You can’t call it “the Chinese virus” and then tell Americans they ought to take a Chinese vaccine. So the Trump administration has made no serious effort to make a vaccine-sharing deal with China. #COVID19 #vaccine »
A nice re-cap of the WTO meeting of 20 October (on the TRIPS waiver proposal).
“The practical impact of the Agreement on Trade-Related Aspects of Intellectual Property Rights and its flexibilities on access to medicines has sparked intense debate both within the trade community, as well as among public health experts, civil society groups, and intergovernmental agencies. Ahead of the meeting of the WTO’s TRIPS Council on 20 October, India and South Africa submitted a communication proposing a waiver from certain TRIPS provisions for “the prevention, containment, and treatment of COVID-19”. The proposed waiver was reportedly opposed by the EU and the US, as well as a mix of developed and developing economies, while others sought further time to consider its feasibility and wider impact, beyond the immediate pandemic needs….”
M Chinazzi et al ; https://www.mobs-lab.org/uploads/6/7/8/7/6787877/global_vax.pdf
“We use a global metapopulation transmission model to study the effect of different COVID-19 vaccine allocation strategies across countries of the world. In the two scenarios considered, 3 billion doses are distributed worldwide. In the uncooperative allocation scenario, the first 2 billion doses are co-opted by a list of high-income countries, while the third billion is distributed equally around the world. In the cooperative allocation scenario, all the 3 billion doses are distributed to all countries proportionally to their population. To avoid uncontrolled assumptions and unknowns about the future course of the COVID-19 pandemic, we consider a counterfactual scenario analyzing what would have happened if the vaccine had been available on March 16th, 2020. The model considers a single dose vaccine that is effective two weeks after administration. We find that the cooperative and uncooperative strategy would have averted 61% and 33% of the deaths globally through September 1st, 2020, respectively, when the vaccine is 80% effective, and 57% and 30% deaths when the vaccine is 65% effective.”
Cfr tweet David Legge: “If rich countries monopolize Covid-19 vaccines it could cause twice as many deaths as distributing them equally.”
https://healthpolicy-watch.news/78089-2/
“Rapid diagnostic tests (RDTs) could play a critical role in decentralising testing and reaching remote communities as WHO launches an Africa roll-out, but a recent study has found that only two of the six RDTs making it to the final round of testing met WHO accuracy standards….”
And some links:
Stat - No news on Pfizer’s Covid-19 vaccine is good news — and bad news
Reuters - Russia applies for WHO emergency use tag for its COVID-19 vaccine
https://www.ft.com/content/bd73a115-1988-43aa-8b2b-40a449da1235
“The biggest bilateral lender to Africa this century is hesitant on debt relief as crisis reveals fragmented nature of loans.”
Excerpts: “Over the past two decades, China has emerged as the biggest bilateral lender to Africa, transferring nearly $150bn to governments and state-owned companies as it sought to secure commodity supplies and develop its global network of infrastructure projects, the Belt and Road Initiative. But, as Zambia heads for Africa’s first sovereign default in a decade and pressure mounts on other debt-burdened countries during the coronavirus pandemic, the crisis has revealed the fragmented nature of Chinese lending as well as Beijing’s reluctance to fully align with global debt relief plans. China’s share of bilateral debt owed by the world’s poorest countries to members of the G20 has risen from 45 per cent in 2015 to 63 per cent last year, according to the World Bank. For many countries in sub-Saharan Africa, China’s share of bilateral debt is larger still. Chinese lenders have lent money to almost every country on the continent and eight have borrowed more than $5bn apiece this century. But Beijing’s involvement in a debt service suspension initiative from the G20 group of the world’s largest economies has been slow….”
… “It’s frustrating,” said David Malpass, president of the World Bank, this month. “Some of the biggest creditors from China are still not participating and that creates a major drain on the poorest countries . . . if you look at the [Chinese] contracts, in many cases they have high interest rates and very little transparency.” … … China is so far the biggest single contributor to the DSSI, suspending at least $1.9bn in repayments due this year according to an internal G20 document seen by the Financial Times, out of roughly $5.3bn suspended by G20 members for 44 debtor countries. … But the extent of China’s commitment is unclear. … However, those figures do not include about $6.7bn of repayments that the IMF has said are under negotiation between Angola and three major creditors, which analysts believe to be China Development Bank, China Export-Import Bank and ICBC, another Chinese lender…. …. … Angola’s borrowings illustrate one of the debt initiative’s major problems — China has lent to African states through a variety of organisations, meaning that information about who owes what to whom is partial and fragmented. Ethiopia has also been one of the top borrowers, borrowing at least $13.7bn between 2002 and 2018 for everything from roads, to sugar factories, to a railway line to Djibouti. … Chinese lending should be understood as a product of “fragmented authoritarianism”, said Deborah Brautigam, director of the China Africa Research Initiative…”
PS: … With the DSSI making clear the difficulty of getting all creditors working together, the G20 is preparing a “common framework” on debt restructuring. G20 officials hope this will ensure bilateral lenders share the burden equally and make relief conditional on borrowers seeking the same treatment from banks and bondholders. “It will be a proxy for China joining the Paris Club,” said one official involved in negotiations, referring to the informal group of bilateral lenders born of the debt crises of the late 20th century.”
“Efforts to control the pandemic in low and middle income countries received a $60 million boost on Monday, but experts said more is needed to help tackle Covid-19 via one underfunded but effective element of the response: testing. Australia, Germany and Saudi Arabia pledged $60m to the Foundation for Innovative New Diagnostics (FIND) to increase universal access to rapid and reliable coronavirus tests in under-resourced countries.;..”
O Williams; https://covid19healthdiaries.com/diary?did=378
Gloomy assessment by Owain Williams, after the IMF/WB annual meetings. Probably not far from the truth, though. Must-read!!
D Wilson et al ; https://blogs.worldbank.org/health/what-health-emergencies-and-disaster-risk-recovery-efforts-have-common
“…. The World Bank’s massive COVID-19 response is currently helping more than 100 countries. In addition, new mechanisms have been developed to help countries build back more inclusively, in ways that will improve the world’s resilience to the next pandemic or other natural disasters.
“One of these new mechanisms is the World Bank’s new Health Emergency Preparedness and Response Trust Fund (HEPRTF) to help developing countries respond to the current crisis and to improve their preparedness for future health emergencies. The HEPRTF provides financing to low-income countries and to countries with low health emergency preparedness and response scores. Funding will also be available for countries not eligible for World Bank financing because they are in arrears with their payments to the International Development Association (IDA), and to countries supporting Syrian refugees. The fund aims to provide upstream catalytic funding to countries that would kick in before they can access other sources of funding or their own domestic funding, or for countries for which such funding is not sufficient. To ensure complementarity with other funding efforts, this Trust Fund is closely coordinated with the IDA Crisis Response Window, with Japan’s Policy and Human Resources Developing Fund grants, and with the World Bank’s COVID-19 response financing….”
P Krause et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32259-5/fulltext
On behalf of the WHO Ad Hoc Clinical Trial Expert Group.
“No one disputes the urgent need for safe and effective COVID-19 vaccines. But confidentiality within the processes of vaccine development is also essential. Ensuring rapid availability of COVID-19 vaccines will depend on rigorous evidence of their safety and efficacy. That rigour is threatened if emerging data from trials of candidate COVID-19 vaccines are disclosed in ways that allow them to influence the design or conduct of trials and potentially bias the results. It is widely recognised that emerging data by intervention group from clinical trials must be kept confidential—ie, accessible only to the trial Data Monitoring Committee (DMC). However, less well recognised are the risks to trial integrity from the release of data pooled across vaccine and placebo groups….”
“Scientists have warned that early adoption of a Covid vaccine with only moderate effectiveness could disrupt efforts to test and create improved versions. Immunising against the disease is not going to be a simple business of turning off the virus once the first vaccine appears, they say. In fact, there could be considerable confusion as researchers struggle to pinpoint the best versions for different vulnerable groups, such as the elderly….”
https://www.nature.com/articles/d41586-020-02965-3
“Injections of antibodies might prevent mild COVID-19 from becoming severe, but the treatments are expensive and difficult to make.”
https://www.nature.com/articles/d41586-020-02972-4
“It’s too soon to say whether COVID is seasonal like the flu — but where clusters aren’t under control, infections will continue to swell.”
“One of the world’s leading COVID-19 experimental vaccines produces an immune response in both young and old adults, raising hopes of a path out of the gloom and economic destruction wrought by the novel coronavirus….”
And another encouraging link on this Oxford vaccine: Oxford coronavirus vaccine is to get approval ahead of Christmas so it can be used for medics and the elderly BEFORE final trials are finished, says professor who is leading the project
“People recovering from COVID-19 may suffer significant brain function impacts, with the worst cases of the infection linked to mental decline equivalent to the brain ageing by 10 years, researchers warned on Tuesday….”
“Long-term exposure to air pollution may be linked to 15 percent of COVID-19 deaths globally, according to a new study. Published in the journal Cardiovascular Research on Tuesday, the research from German and Cypriot experts analysed health and disease data from the United States and China relating to air pollution, COVID-19 and SARS – a respiratory illness similar to the new coronavirus disease. … In East Asia, which has some of the highest levels of harmful pollution on the planet, the authors found that 27 percent of COVID-19 deaths could be attributed to the health effects of poor air quality. The proportion was 19 percent in Europe, and 17 percent in North America. The authors said the deaths linked to COVID-19 and air pollution represented a “potentially avoidable, excess mortality” and that exposure to particulate matter in air likely aggravated “co-morbidities that lead to fatal outcomes” of infection by SARS-CoV-2, the virus that causes COVID-19…
“…Two new studies demonstrate how severity of disease is predictive of longer-lasting antibody production and detail how immunity wanes over time but may exist for up to 7 months….”
https://www.ft.com/content/2782655a-0441-4d38-bb03-5c4e67ead110
“Genetic mutation that originated in Spain transmitted by returning holidaymakers, researchers find.”
“…A coronavirus variant that originated in Spanish farm workers has spread rapidly through much of Europe since the summer, and now accounts for the majority of new Covid-19 cases in several countries — and more than 80 per cent in the UK. An international team of scientists that has been tracking the virus through its genetic mutations has described the extraordinary spread of the variant, called 20A.EU1, in a research paper to be published on Thursday. Their work suggests that people returning from holiday in Spain played a key role in transmitting the virus across Europe, raising questions about whether the second wave that is sweeping the continent could have been reduced by improved screening at airports and other transport hubs.”
https://www.nature.com/articles/d41586-020-02973-3
“Young children are unlikely to spread the virus — but older kids are more at risk, say researchers.”
“The production of infectious aerosols can vary wildly between individuals—and experts are exploring why in the COVID-19 era.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32262-5/fulltext
R Horton brings in Foucault in today’s Offline.
“COVID-19 is about the politics of the body. In a series of lectures and essays in the 1970s and early 1980s, Michel Foucault (who died in 1984) argued that the discipline of public health emerged with the birth of capitalism in the 18th century. The body came to be understood as an instrument of economic production, of labour power, and so became a subject of significant political interest. Medicine and public health were endorsed as tools to enhance these productive forces, to ensure that people were fit for work. …”
“Why is Foucault important for understanding COVID-19? The reasons lie in the sinister way in which approaches to this syndemic are evolving. It is seen as acceptable to argue that older citizens at risk of COVID-19 are somehow less valuable to society than younger people. It is suggested that young people should be allowed to risk their health in order to protect economies. And governments have enacted extraordinary measures to control and constrain the behaviours of their populations. COVID-19 has evolved to become a debate about the distribution of power in society—central government versus local government, young versus old, rich versus poor, white versus black, health versus the economy. Those most at risk of COVID-19 are some of the least powerful in our society. Those working in public health do not see themselves as instruments of capitalist states. On the contrary, they view health to be of such intrinsic value that it must be fought for and defended. But we need to be clear-sighted about our alliance with government to address this syndemic. Medicine and public health are being co-opted into a political programme of population control to protect the power of the modern neoliberal state. …”
F Tediozi et al ; https://gh.bmj.com/content/5/10/e004020
“The need for a systemic approach to complex challenges and for better understanding the relationship between population health and its economic consequences have been recognised for years as the basis towards sustainable solutions in global health. The emergence of a movement promoting Universal Health Coverage (UHC) as the ultimate means to ensuring equitable access to health for all people, raised the attention to the importance of re-imagining health systems. The COVID-19 pandemic further highlighted the importance of UHC that should be promoted with better governance and linkages to social protection systems.”
Conclusion: “Moving towards and sustaining UHC, as expressed in SDG 3, is critically important to build resilient health systems and to promote more inclusive and fairer societies. Yet it will be hard to make substantial progress towards UHC without promoting simultaneously universal social protection that will contribute to realise SDG 1 targets of alleviating poverty, and stronger governance structures as indicated by SDG 16. UHC policies should, thus, be coordinated with social protection systems providing social safety nets, and coordinated governance is required across health and social sectors. This is a major challenge that requires system-wide social and health policies breaking the boundaries of traditionally fragmented welfare systems and global health programmes.”
J Feffer; …https://sevenstories.com/books/4292-the-pandemic-pivot
“Experts from the frontlines of global policy tackle the implications of Covid-19.”
“Both a sobering analysis of the present moment and a hopeful cry on behalf of the power inherent in a global, people-oriented response to the pandemic and the societal breakdown that led to it, The Pandemic Pivot offers insight and an actionable framework for what Cindy Wiesner calls "a just transition to a regenerative, anti-racist, feminist economy."…”
See John Feffer (Open Democracy) - What COVID-19 is trying to tell us ““COVID-19’s message is clear: we need to move forward, quickly, into a very different future.””
https://www.bmj.com/content/371/bmj.m4082
“French patient associations are angry that politicians have called on scientists but ignored civil society in devising strategy for the pandemic. But France is not the only country guilty of this, writes Barbara Casassus.”
Excerpt: “… The exclusion of patient groups from official crisis management policy is mirrored across the globe, says Kawaldip Sehmi, chief executive officer of the International Association of Patients’ Organizations (IAPO). If policy makers in other countries had sought IAPO’s advice about shielding programmes, the measures would have been much less severe for the general public, claims Sehmi. “We would have advocated test, trace, and treat and isolating high risk people from the start,” he says. “If the authorities had contacted their country’s rare diseases association, it would have put out the word immediately, and I am 100% sure that the public would have signed up to it.” Most governments and health authorities have dismissed patient associations’ calls for emergency measures to protect people with chronic health conditions by allowing and facilitating treatment for non-covid cases. The problem is particularly acute in countries with no or weak social welfare systems, says Sehmi. “Like in wartime, some patients feel guilty for seeking non-urgent medical care, as they see it as drawing resources away from the front line.” IAPO has repeatedly asked the World Health Organization to urge member countries to involve patient associations in this pandemic and maintain the policy for the future. The BMJ contacted WHO for comment but has yet to receive a response….”
C Kenyon; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32219-4/fulltext
By my colleague Chris Kenyon. “Richard Horton argued persuasively that COVID-19 should be addressed as a syndemic of biological and social interactions. When planning the “national revival” he calls for, I consider it crucial that this syndemic approach includes an ecological dimension. Studies have found that widespread anthropogenic ecosystem degradation has played a crucial role in explaining why the rate of emergence of zoonoses has been increasing over the past 40 years….”
Vox;
“Doctors can now save many more lives from Covid-19 — until hospitals reach capacity.”
“…we may be approaching the tipping point at which the progress in saving lives can’t be sustained. “Each hospital’s overwhelmed point is different now than it was in April but there is a point that’s too much for any hospital …”
From Spring to Summer, both in Europe & US, even after controlling for differences in patient populations, mortality improvements appeared to hold.
“…The ominous implication of the winter spike in cases and hospitalizations, Mateen said, is that “we risk seeing what we saw at the beginning of the first wave, with a creeping up mortality rate.”” Due to overwhelmed hospitals, to a great extent.
D Mishtra et al; https://www.cgdev.org/blog/we-must-stop-flying-blind-building-existing-systems-low-and-middle-income-countries-improve
“COVID- 19 has brought a sense of urgency to decision-making that typically would have taken many months and years of deliberation. Central to this uncertainty is the glaring lack of knowledge on just how big the burden of COVID-19 truly is. The pandemic has highlighted concerning gaps in data and weaknesses in surveillance systems that have long hampered public health systems globally, especially in low- and middle- income countries (LMIC)….”
M Leach et al; https://www.sciencedirect.com/science/article/pii/S0305750X20303600
“COVID-19, an unprecedented health and development crisis, has exposed major faultlines and fragilities in current systems. A novel conceptual framework grounded in a decade of research on epidemics and development emphasises a structural-unruly duality in the conditions and processes of emergence, progression and impact. Mainstream development thinking and practice are part of the problem; post-pandemic futures require radical transformations in science-policy under uncertainty; economies, and citizen-state relations. Post-COVID-19 development must fully embrace resilience, diversity, care and solidarity, and egalitarian, inclusive knowledge and politics.”
A Broadbent et al; https://www.cgdev.org/blog/how-should-we-evaluate-lockdowns-disentangling-effectiveness-context-and-politics
“This blog outlines some recent evidence from Africa, and we present some thoughts on how lockdowns can be evaluated, using some of the Bradford Hill “criteria.””
“… The AU Commission’s joint meetings of African Ministers of Health and of Finance build on the African Leadership Meeting Declaration (ALM), in which governments committed to both increasing domestic investment in health and improving the efficiency and effectiveness of health spending. … To inform these discussions, ODI and the Global Fund to Fight AIDS, Tuberculosis and Malaria have brought together perspectives from eminent leaders from Africa and from the global health community on the key priorities for African governments in responding to Covid-19 and investing in health. The contributions highlight three critical areas that have been central to discussions: (1) They recognise the decisive policy response to the pandemic across the continent and the ongoing importance of strong leadership and robust governance at national, regional and global levels. (2) Reforms are important not just to mobilise more resources but also to drive efficiency gains. Creative responses to Covid-19 have led to innovations that can be scaled up to improve the productivity, resilience and sustainability of health systems. (3) As Africa faces its sharpest economic contraction since the Great Depression, equity must be considered. This creates an imperative to rethink and redesign the social safety net to protect those with the fewest resources. This requires a focus on primary health care, addressing socioeconomic determinants of health and strengthening financial risk protection to ensure that out-of-pocket expenditures on health do not perpetuate inequity and create an additional ‘tax on the sick’….”
With the takes of Donald Kaberuka, Ngozi Okonjo-Iweala, M Pate, Peter Sands, Tedros & many others.
M Boyd et al ; https://gh.bmj.com/content/5/10/e003276
The authors aimed to validate the GHSI against a range of external metrics to assess how it could be utilised by countries.
“High levels of air pollution bring an added worry to the region – it comes in the middle of the coronavirus pandemic.”
https://www.bmj.com/content/371/bmj.m4039
“Alfred Moore and Michael K MacKenzie argue that greater openness about disagreement among diverse types of experts makes it harder for political leaders to politicise expertise.”
“…While many have rightly focused on the ethos and duties of experts in political contexts, we focus on the role that political institutions can play in helping to manage the politics of expertise more effectively and legitimately. Drawing on findings from behaviour research, we identify two principles to guide the institutionalisation of expert advice. The first involves ensuring that diverse perspectives—both disciplinary and social—are adequately represented when expert advice is given and consulted. The second has to do with protecting, promoting, and normalising disagreement among diverse sets of experts.”
“… Data tracking people’s attitudes during the pandemic reveal a more nuanced picture. It turns out that lots of young adults are doing their part to follow social distancing rules and that they’re closer in alignment with their elders than is commonly assumed….”
https://blogs.bmj.com/bmj/2020/10/26/a-safer-world-starts-with-strong-primary-healthcare/
“The covid-19 pandemic has reminded us of the critical role that primary healthcare has in keeping our communities safe and healthy, say Orin Levine, Atul Gawande, Gina Lagomarsino, Edward Kelley, Lu Wei Pearson, and Muhammad Ali Pate.” (PS: Orin Levine is the director of global delivery programs at the Bill & Melinda Gates Foundation )
https://www.wsj.com/articles/epidemiologists-stray-from-the-covid-herd-11603477330
“Great Barrington Declaration co-authors Martin Kuldorff and Jay Bhattacharya on the costs of lockdown, the science of immunity, and the politicization of the coronavirus pandemic.”
They don’t convince me, but perhaps worth a read nevertheless.
“In the midst of this terrible time, Signs wanted to reach out to a group of scholars to think through – with a feminist lens – the parameters of the pandemic and the social ills and inequities it has both revealed and amplified. It is a clear testament to where feminism is now that all these essays range widely, locating this pandemic in a robustly intersectional feminist framework, where the various sites of oppression and inequality literally spill over into each other, and where borders (intellectual, political, embodied) are revealed as porous and contested. When a masculinity that is literally toxic infects the world stage, our need for feminist leadership (Jacinda Ardern, Black Lives Matter, and the list goes on) is ever more pressing. ….” Check out the essays.
B Palafox et al ; https://onlinelibrary.wiley.com/doi/full/10.1111/tmi.13498?campaign=wolearlyview
“Community health workers in low‐ and middle‐income country primary health care systems are well suited to perform essential functions on the frontlines of Covid‐19 pandemic responses. However, clear and coordinated guidance, updated infection control training, and reliable access to personal protective equipment must be ensured in order to deploy them safely and effectively. With these additional responsibilities, community health workers must also be supported to ensure that hard‐fought gains in population health, including progress on non‐communicable diseases, are sustained throughout the pandemic.”
A Acharaya et al ; https://gh.bmj.com/content/5/10/e004222
Study focusing on 3 countries: UK, India, US. « While we cannot precisely determine the mechanisms at work, the null findings contained in this study suggest that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. »
Nevertheless, we’re about to find out. On November 3 😊.
T Bollyky et al; https://www.foreignaffairs.com/articles/united-states/2020-10-23/coronavirus-fighting-requires-trust
« … trust in government has played a significant role in determining how different countries have performed in containing and responding to the COVID-19 pandemic, especially in those countries that had not recently experienced deadly outbreaks of other coronaviruses or emerging infections. Better appreciating the role of government trust can help countries prepare for and respond to not only the current pandemic but also those still to come. … … if no one factor explains the success stories, there is a factor that is clearly associated with nearly all the countries that have suffered the most deaths, even accounting for differences in population age structure and size and the timing of the pandemic: low government trust, as defined by the World Values Survey (see Figure 2). A recent 23-country study, currently under peer review, accords with this conclusion, finding that those in countries with higher trust in government were significantly likelier to wash their hands, avoid crowded places, and make personal sacrifices to stop the spread of the virus … … … Fortunately, trust is something that governments can earn in a crisis. A public that trusts its government is likelier to accept that the risks the government identifies are real and to follow its guidance; the government builds and maintains that trust by issuing advice and assessing risk in a manner that is timely, honest, and based on science. Such a positive feedback loop is essential for sustaining people’s compliance with public health measures. »
M S Jalali, D Sridhar et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30447-2/fulltext
“Scientific models have a crucial role in mitigating harm from the pandemic, by estimating the spread of outbreaks of the virus and analysing the effects of public health policies. The context-sensitive and time-sensitive measures provided by COVID-19 models offer real population health impacts and are of great importance. However, these models must be completely transparent before policies and insights are enacted. … … We assessed whether COVID-19 modellers adhere to best practices in reporting and documentation; we did not evaluate whether a model's projections are correct….”
And perhaps more in poor ones. Read why.
“…For the world to fully recover from the far-reaching effects of the pandemic, we must first address the biases that are underlining COVID-19's damage to older adults. A new report from the World Economic Forum's Global Future Council on Longevity, "COVID and Longer Lives: Combating ageism and creating solutions," outlines the importance of ensuring that responses to the pandemic are informed, inclusive and targeted to protect the rights and dignity of older adults….”
As a reminder: “The policy brief issued by the UN Secretary-General highlights the necessity of universal health coverage, both to address the COVID-19 pandemic and to prepare for future crises. The brief that cautions the effects of the COVID-19 pandemic could “seriously impair or reverse" progress towards the SDGs….”
“The brief presents five major recommendations: (1) Urgently control COVID-19 transmission, including with stronger public health measures to reduce local transmission to zero, facilitate universal provision for COVID-19 testing, isolating, and contract tracing, and ensure access to care for COVID-19 patients to reduce deaths; (2) Protect delivery of other essential services; (3) Massively expand access to new rapid diagnostics and treatments, and ensure future COVID-19 vaccines are a global public good with equitable access for everyone, everywhere, including through fully funding the Access to COVID-19 Tools Accelerator (ACT-Accelerator) and urgently addressing the spread of misinformation about vaccine safety; (4) Achieve UHC by investing in core health systems functions that are fundamental to protecting and promoting health and well-being, and suspending user fees for COVID-19 and other essential health care; and (5) Strengthen national and global pandemic preparedness and aim for healthy societies.”
https://www.nytimes.com/2020/10/29/health/covid-remdesivir-gilead.html?smid=tw-nythealth&smtyp=cur
“Gilead Sciences said Wednesday that remdesivir, which has been authorized for emergency use since the spring, brought in $873 million in revenues so far this year.”
https://www.thinkglobalhealth.org/article/holding-incumbents-accountable-covid-19-ballot-box
“Lessons from elections during the pandemic in Dominican Republic, New Zealand, Poland, Singapore, and South Korea.”
Conclusion: “At this point, one cannot say whether a government’s pandemic response will determine its electoral results. Evidence from these five countries suggests that parties and politicians who were successful at combating COVID-19 and centered their campaigns around the pandemic may see gains in national elections. However, these examples also highlight that while voters care about how their government has handled the pandemic, other issues still matter and may even matter more….”
And a link:
The resilience of two professionalized departmental health insurance units during the COVID-19 pandemic in Senegal. (by N B Mbow et al)
“Two large-scale professionalized health insurance in Senegal were able to maintain their performance after the departure of donors and despite the COVID-19 pandemic.”
M Kavanagh et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003324
“… With evidence that TB programs are hampered by the legal environment, we analyze the degree to which law reform is needed to align with promises at the United National High Level Meeting on Tuberculosis to promote human rights and dignity in the TB response. Exploring the laws at key points of vulnerability to TB in 20 high TB-burden countries (HBCs) shows that internationally recognized rights related to medical isolation, privacy, home inspection, and medical examination are insufficiently protected in the laws of most of these countries. Exploration of the legal environment for migration shows that restrictions or bans on travel and immigration for those with TB is the norm, along with limitations on access to medical care, in contravention of international standards. Fundamental human rights, expected in other areas of public life, are often missing for people with TB. This is likely contributing to reluctance among people with TB to engage with health systems. Law reform is urgently needed to align national laws with global human rights agreements and public health standards and help close major gaps in TB diagnosis and treatment.”
https://www.nature.com/articles/d41586-020-03045-2
“A vaccine against a type of polio that is spreading in the Southern Hemisphere is expected to receive emergency approval before the end of the year. If it does, it will be the first time the World Health Organization has steered an unlicensed vaccine or drug through its emergency listing process….”
“… a version of the virus that arose naturally from the weakened polio virus used in vaccination is increasing, What is called circulating vaccine-derived polio-virus (cVDPV), is increasing in both Afghanistan and Pakistan, as well as in the Philippines, Malaysia, Yemen and 19 African countries — with Chad, the Democratic Republic of the Congo and Côte d’Ivoire the worst affected in Africa.”
“…Independent scientific advisers to the World Health Organization (WHO) have been assessing a vaccine that is designed specifically to protect against cVDPV. This vaccine, a decade in the making, has been tested for safety and efficacy, but is not yet licensed and still has to undergo further trials. The WHO is in the last stages of considering whether to approve it more quickly, under what is called an emergency-use listing — a procedure that was created during the 2014–16 Ebola outbreak in West Africa, and which the agency is also preparing to use for coronavirus vaccines.”
J Bernhardt et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31313-1/fulltext
Part of a Stroke series in the Lancet. “The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.”
For another paper in the series, see Stroke systems of care in low-income and middle-income countries: challenges and opportunities.
Shakira Choonara et al ; https://blogs.bmj.com/bmjgh/2020/10/26/wheels-of-the-bus-go-round-and-round-racism-in-womens-health-organizations/
“First it was the claims of Women Deliver being a White Faux Feminism agency, now it’s the International Women’s Health Coalition (IWHC). Recently, the President of IWHC resigned after a report found a work culture of fear and intimidation experienced by junior staff and people of colour. October is the month dedicated to mental health; looking at the experiences of working in the development space and the fact that mental health issues arise in toxic work environments is shocking. A space that professes to fight for justice, is for some of its workers one of injustice, especially the overt and not-so-overt undercurrents of racism and power….”
Cfr a tweet by the first author: “The action we take will be important in tackling racism within our global health space, it's unacceptable”
SRHR
https://news.trust.org/item/20201027162217-wlabw
‘Right-wing U.S. groups have put more than $280 million into campaigns against LGBT+ rights and abortion worldwide since 2007, almost $90 million of which focused on Europe, according to a report on Tuesday. Many of the 28 groups - most of which are Christian - have close links with U.S. President Donald Trump, who is campaigning for re-election on Nov. 3, investigative website openDemocracy found, amid the rising popularity of the far-right in Europe. "These findings show how Trump-linked groups have built a frightening global empire," Mary Fitzgerald, openDemocracy's editor-in-chief, told the Thomson Reuters Foundation in emailed comments….”
“…Africa was the second most popular destination for anti-LGBT+ efforts. Several of the groups supported the death penalty for gay sex in Uganda, known as the "Kill The Gays" bill, which was overturned by the country's constitutional court in 2014….”
H Ritchie; https://ourworldindata.org/co2-emissions-from-aviation
Worth a read. Quite illuminating.
“Scientists have found evidence that frozen methane deposits in the Arctic Ocean – known as the “sleeping giants of the carbon cycle” – have started to be released over a large area of the continental slope off the East Siberian coast, the Guardian can reveal. High levels of the potent greenhouse gas have been detected down to a depth of 350 metres in the Laptev Sea near Russia, prompting concern among researchers that a new climate feedback loop may have been triggered that could accelerate the pace of global heating….”
https://www.cgdev.org/blog/aid-and-climate-dont-make-poor-pay-twice
Blog linked to a new paper. “A few months ago, the experts at the OECD who decide what’s in and what’s out when it comes to what counts as official development assistance (ODA) said spending on research towards a Covid vaccine was out. “It contributes to addressing a global challenge and not a disease disproportionately affecting people in developing countries,” they argued. That decision highlighted a long-running debate about the relationship between financing to respond to global challenges and ODA that I try to unpack on a new paper. The discussion covers issues from asteroid defense to vaccine development but, at least in terms of the current size of spending, it is most pressing when it comes to the issue of climate change. And I worry that we’re making the poor pay twice when it comes to ODA and climate finance….”
The paper: Official Development Assistance, Global Public Goods, and Implications for Climate Finance
https://www.healthpostcovid-19.org/
“Our aim is to contribute to international efforts to improve and safeguard the health of populations equitably post COVID-19 by identifying key actions for international, national and local actors that will synergistically: prevent pandemics ; reduce non-communicable diseases ; protect natural environments. »
Check out the team members: https://www.healthpostcovid-19.org/team/
S Friel; https://www.ijhpm.com/article_3940_deebd518a78ea1be2b0ba2a21a9d4a82.pdf
“Corporate control of the global food system has resulted in greater global availability of highly processed, packaged and very palatable unhealthy food and beverages. Environmental harm, including climate change and biodiversity loss, occurs along the supply chains associated with trans-national corporations’ (TNCs’) practices and products. In essence, the corporatization of the global food system has created the conditions that cultivate excess consumption, manufacture disease epidemics and harm the environment. TNCs have used their structural power – their positions in material structures and organizational networks – to establish rules, processes and norms that reinforce and extend the paradigm of the neoliberal corporate food system. As a result, policy and regulatory environments, and societal norms are favourable to TNC’s interests, to the detriment of nutrition, health and environmental outcomes. There is hope, however. Power, of which there is many forms, is held not just by the TNCs but by all actors concerned about and connected to the food system. This paper aims to understand these power dynamics, and identify how structurally weak, public-interest actors can release their agency and work to achieve positive structural change. Such an analysis will help understand how the status quo can be disrupted and healthy and sustainable food systems created. The paper draws from the health governance and social movement literature, examining the Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health, the Framework Convention on Tobacco Control (FCTC), and the Divestment movement. These cases demonstrate the many ‘weapons of the weak’ that can, against all odds recalibrate structural inequities. There is no one approach to transforming the corporate food system to become a healthy and sustainable food system. It involves coalition building; articulation of an ambitious shared vision; strategic use of multi-level institutional processes; social mobilization among like-minded and unusual bedfellows, and organized campaigns; political and policy entrepreneurs, and compelling issue framing.”
Azeb Tesema (EV 2020); https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240984
“In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC….”
Salma Abdalla et al ; https://gh.bmj.com/content/5/10/e002884
« … The majority of global health publications focused on topics prevalent in low-resource settings. Governance, infectious diseases, and maternal and child health were major topics throughout the analysis period. Surveillance and disease outcomes appeared during the 2006–2010 epoch and continued, with increasing complexity, until the 2016–2019 epoch. Malaria, sexual and reproductive health, and research methodology appeared for only one epoch as major topics. We included 11 relevant definitions in this analysis. Definitions of global health were not aligned with the major topics identified in the analysis of articles published in global health journals. These results highlight a lack of alignment between what is published as global health scholarship and global health definitions, which often advocate taking a global perspective to population health. Our analysis suggests that global health has not truly moved beyond its predecessor, international health. There is a need to define the parameters of the discipline and investigate the disconnect between what is published in global health versus how the field is defined.”
https://www.biomedcentral.com/collections/InequitiesinLAC
“This article collection in International Journal for Equity in Health showcases research on inequities in health and health systems in Latin America and the Caribbean. Through it, we seek to contribute to the understanding and development of pro-equity policies that can strengthen national health systems and improve access to quality health services for the under-served on the road to achieving universal health coverage….”
S L Wilson et al; https://gh.bmj.com/content/5/10/e004206
“Understanding the threat posed by anti-vaccination efforts on social media is critically important with the forth coming need for world wide COVID-19 vaccination programs. We globally evaluate the effect of social media and online foreign disinformation campaigns on vaccination rates and attitudes towards vaccine safety….”
Conclusion: “…There is a significant relationship between organisation on social media and public doubts of vaccine safety. In addition, there is a substantial relationship between foreign disinformation campaigns and declining vaccination coverage.”
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003373
“The field of precision public health (PPH) has emerged as a response to the increasing availability of genomics, biobanks, and other sources of big data in healthcare and public health. The field has evolved starting with genomics to include multiple practical applications such as pathogen genomics that address population health. PPH can expand understanding of health disparities, advance strategic public health science, and demonstrate the need for innovation and workforce development. In the coronavirus disease 2019 (COVID-19) era, rapidly evolving scientific innovation can have a long-lasting impact on PPH beyond the pandemic. Further developments in PPH will require global, national, and local leadership and stakeholder engagement.”
H Barroy, Joe Kutzin et al; https://p4h.world/index.php/en/blog-lessons-for-managing-public-finances-from-COVID-19-response
“…. Emerging evidence shows, disparities in the readiness of Public Financial Management (PFM) systems. Some countries have budgeting modalities which allowed them to rapidly reprogramme expenditure toward the emergency health response. In other countries, spending procedures have stymied the rapid release of funds to subnational entities and prevented health service providers from quickly accessing necessary resources. In this blog, we delineate some of the enabling features of PFM systems that engendered an effective health response to COVID-19 (“PFM system readiness”) and some of the challenges and bottlenecks that have required major adjustments to existing systems (“PFM system adjustments”). This work builds on inputs from the WHO Survey on PFM & COVID-19 containing information for 183 countries (updated in September 2020), the World Bank COVID-19 response tracking portal (developed in July 2020), the OECD Joint Network of Senior Budget and Health Officials, and regional and country consultations in 17 low- and middle-income countries… … conducted between June and September 2020 by WHO….”
“… What can we learn from low/middle income countries that have actually managed to reduce inequality … ? The newly formed LSE Inequalities Institute were interested and some research got under way, led by Rebecca Simson. And now, five years on (fanfare!) she and Mike Savage have a paper in Third World Quarterly. … Luckily, Rebecca published a Working Paper (open access) on her work in 2018, which covers the same ground. Here’s the highlights:…”
Excerpt: “This paper identifies 27 developing countries, roughly half of which are in Latin America, that have seen a sustained decline in the gini of more than 3 percentage points in the past two decades. In an additional 47 countries we found no inequality trend or the data proved too unreliable to make an informed judgement. Only 12 countries showed a robust increase in inequality. Through a review of secondary literature, this paper explores some of the proximate drivers of these inequality dynamics in 17 countries where inequality has declined, highlighting both economic and political forces.’ [The paper identifies] ‘four clusters of countries with similar initial conditions or drivers of change….”
Gawain; https://niawag.medium.com/the-death-and-life-of-the-international-ngo-1b4cc8e0cd79
“Forty eight % of [INGOs] may not survive the next two years.” This blog starts a series of blogs on this topic.
“After decades of growth, the international non-governmental organization (INGO) has reached a turning point. The model of a Northern-funded, Northern-led organization operating programs around the world is under pressure and attack from many directions. The question now is whether INGOs can — or should — be reformed for a role in a rapidly changing world.”
Warning: dark satire 😊. But a nice blog to read ahead of the HSR2020 symposium.
(in reaction to this Stat op-ed: Science journal editors shouldn’t contribute to politicizing science )
“Everyone is entitled to their opinion even a fundamentally flawed one that misunderstands the nature of journals in science and medicine. Politics is medicine on a larger scale, said Rudolf Virchow. Speaking truth to power is also a fundamental principle of science journalism.”
“As we sharpen our global response to #COVID19 it is critical to distinguish -the Global Common Goods argument for global and sustained global financing -the equity and development argument calling for more and better development assistance.”
“Global Virome Project headed by Dennis Carroll estimates it would take c. $1.6bn & 10 years to find 75 % of 1.6 m viruses — or, if they can raise the funds, about $3bn to capture 90% of viruses. What are we waiting for? Another Dr Evil moment!” ( tweet re FT article: The next pandemic: where is it coming from and how do we stop it? )
ITM colleague Nandini Sarkar defended her PhD last week, cum laude.
You can download it here: The challenge of equitable quality Mental, Neurological, Substance-use care and coverage: A local health systems analysis in eastern Uganda
https://acmedsci.ac.uk/more/news/securing-a-healthy-future-what-covid-19-taught-the-world
In this article, you already find some key messages.
“As countries around the world experience resurgences of the COVID-19 pandemic, the Academy of Medical Sciences and The Lancet International Health Lecture 2020 will explore what we have learnt so far. Here, the three speakers, Professors Ilona Kickbusch, Gabriel Leung and Robin Shattock FMedSci give us a taste of the talks they will deliver.”
http://g2h2.org/posts/breathe/
Wednesday 4 November (3-5 pm CET).
Ahead of the resumed WHA meeting (9-14 November).
See also: G2H2 - A civil society guide to the resumed session of the 73rd World Health Assembly, 9-14 November 2020
https://www.graduateinstitute.ch/WHA73
Theme: Backsliding or Building beyond Covid-19? An introduction to the resumed 73rd WHA
4-day virtual congress. One full day will be dedicated to the Coronavirus pandemic in collaboration with The Coalition for Epidemic Preparedness Innovations (CEPI).
Stay tuned for the call for abstracts.
“Since the COVID-19 pandemic started, multilateral development banks have committed nearly $100 billion for hundreds of coronavirus-related projects. But are these funds really benefiting those in need? And what’s happening to those who are raising questions around transparency and accountability for these funds? Most banks commit to ensuring high levels of social and environmental safeguards, but it seems nothing more than a box-ticking exercise. Much of the funding is going toward countries with very poor human rights records, such as Zimbabwe, Egypt, and Pakistan, where it might never reach those most vulnerable, and many governments are using the pandemic as a pretext to further restrict dissenting voices. Journalists, bloggers, medical workers, human rights defenders, and all those raising concerns about inadequate responses to the crisis — including emergency support directly funded by development banks — are facing threats, arrests, attacks, and stigmatization….”
https://www.devex.com/news/number-of-un-women-leaders-grew-under-guterres-with-some-caveats-98389
“The number of women appointed to top positions within the United Nations has jumped dramatically during U.N. chief António Guterres’ tenure, but the disproportionate representation of Western Europeans and North Americans has remained relatively high over the last 25 years, according to new data by New York University’s Center for International Cooperation….”
https://www.devex.com/news/ties-between-un-faith-based-groups-poised-to-grow-during-pandemic-98357
“COVID-19 has prompted a realization, some experts say, that the U.N. needs to engage faith-based organizations more systematically to comprehensively reach people with humanitarian and development work.” Read why, and how they can be complementary.
“As part of a strategic exercise called “Over the Horizon,” the agency has sought to analyze the current and projected impacts of the pandemic and translate these findings into an operational response. The recommendations include determining a set of focus countries, where needs due to the pandemic are high and the U.S. has a national security interest. Speaking at the American Enterprise Institute on Wednesday, acting USAID Administrator John Barsa did not reveal which countries would be on the list but alluded to Central America’s Northern Triangle region and to East Africa….”
And a link:
CNBC - Progressive lawmakers call on congressional leaders to prepare for next pandemic
“More than 100 Democrats in the Senate and House of Representatives, largely progressives, are calling on congressional leaders to take steps to prepare the United States for the next pandemic and mitigate racial disparities in U.S. health care. Sen. Elizabeth Warren, D-Mass., and Rep. Ro Khanna, D-Calif., spearheaded a letter sent to the top Democrats and Republicans in the House and Senate calling on them to “lay the groundwork to prevent and mitigate future pandemics.”…”
E Jordi et al ; https://gh.bmj.com/content/5/10/e002992
“Maximising efficiency of resources is critical to progressing towards universal health coverage (UHC) and the sustainable development goal (SDG) for health. This study estimates the technical efficiency of national health spending in progressing towards UHC, and the environmental factors associated with efficient UHC service provision….”
Some of the results: “High-achieving middle-income and low-income countries such as El Salvador, Colombia, Rwanda and Malawi demonstrate that peer-relative efficiency can be attained at all incomes. Governance capacity, income and education are significantly associated with efficiency.”
“The world is in an “era of pandemics” and unless the destruction of the natural world is halted they will emerge more often, spread more rapidly, kill more people and affect the global economy with more devastating impact than ever before, according to a report from some of the world’s leading scientists. The current approach to disease outbreaks is trying to contain them and develop treatments or vaccines, which the scientists say is a “slow and uncertain path”. Instead the root causes must be tackled, including stopping the demolition of forests to produce meat, palm oil, metals and other commodities for richer countries. The costs of such a transformative change would be “trivial”, the experts found, compared with the trillions of dollars of damage caused by the coronavirus pandemic alone. Their proposed solutions include a global surveillance network, taxing damaging meat production and ending taxpayer subsidies that ravage the natural world.
“There is no great mystery about the cause of the Covid-19 pandemic, or of any modern pandemic,” said Peter Daszak, the chair of the group convened by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, (Ipbes) to produce the report. “The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment.”
“… This week’s Bankrolling Extinction report finds that financial institutions provide the capital that is funding over-exploitation of our lands and seas, putting biodiversity in freefall. Last year, the world’s 50 biggest banks provided $2.6tn (£1.9tn) in loans and other credit to sectors with a high impact on biodiversity, such as forestry and agriculture. Bank by bank, the report authors found a cavalier ignorance of – or indifference to – the implications, with the vast majority unaware of their impact on biodiversity. In short, this report is a frightening statement of the status quo. Fortunately, signs are emerging that some governments are – slowly – taking aim at financial backers of the destruction of the natural world. They must now push more forcefully….”
https://news.un.org/en/story/2020/10/1076202
“Used vehicles exported from richer countries are contributing to increased air pollution in developing nations and hindering efforts to mitigate the effects of climate change, according to a report published on Monday by the UN Environment Programme (UNEP). The study – the first-ever of its kind – found that some 14 million used cars, vans and minibuses were exported worldwide from Europe, the United States and Japan between 2015 and 2018. Around 80 per cent, went to low and middle income countries, with more than half going to Africa….”
https://www.bmj.com/content/371/bmj.m3081
“Climate change is emerging as an important driver of disease incidence, and a wait and see approach invites unnecessary risk, write Jeremy Hess and colleagues. Governments, funders, researchers, and practitioners must act now.”
“…The global health response has largely been characterized by scepticism and watchful inaction. The world’s largest global health funders, including the US National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation (BMGF), still lack specific climate and health programming, let alone programming focused on climate change and infectious diseases. Climate change remains a vanishingly small element of the portfolio of funders like the European Commission and the Wellcome Trust that have stepped into the breach. Funding for training, research, and practice related to climate change and infectious disease has been limited accordingly….”
“Green groups say agreement will allow emissions to continue to rise in the next decade.”
http://sdg.iisd.org/news/world-bank-report-maps-strategic-directions-towards-decarbonization/
“The Outlook 2050 recognizes the need for a “bold economic transformation” to realize the vision of the Paris Agreement and make the SDGs “more achievable”. It proposes a “whole-of-economy” approach to decarbonization, which prioritizes four economy-wide strategic directions. The report was launched as part of a series focused on the role of sustainable finance in the COVID-19 recovery to help countries “build back better and stronger”.”
S Mulubale et al ; https://www.tandfonline.com/doi/full/10.1080/09581596.2020.1838445
“This paper examines how, in the midst of changing political times, some characteristics of HIV activism are changing, and suggests the relevance of these shifts for other fields of health activism. Despite the UK achieving UNAIDS’s ‘90–90-90ʹ testing and treatment goals, many in the UK lack up-to-date HIV knowledge and retain stigmatising attitudes, and some areas of testing failure remain. In response, people with HIV and HIV organisations are generating imaginative, collaborative projects that indicate effective contemporary forms of health activism may, as other critical health research suggests, be decentred, participatory, multimodal, affective, and implicit. The paper describes a 2016 HIV NGO-run comedy event directed at HIV awareness which was researched via qualitative pre- and post-measures, and two-month follow-up interviews. Findings pointed to strong effects of comedy, as enjoyment and ‘break’ in HIV thinking, feeling, and action; of a one-off event’s emotionality and particularity; and of performance in generating collectivity and HIV citizenship. The paper discusses the potential transferability of these findings to other health activisms, particularly around stigmatised conditions. It argues that such strategies of emotionality, multi-modality, and solidarity in a performance event can work as implicit activism for changing times, generating social change via a doubled politics of resistance and alterity.”
A Schram et al ; https://www.ijhpm.com/article_3941.html
“Globalised and industrialised food systems contribute to human and planetary health challenges, such as food insecurity, malnutrition, and climate change. International trade and investment can serve as a barrier or enabler to food system transformations that would improve health and environmental outcomes. This article used health impact assessment (HIA) to analyse what we know, what we don’t know, and what we don’t know we don’t know about the role that trade and investment might play in food system transformations to improve human and planetary health….”
S Stock et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32235-2/fulltext
“As co-leads of the new international Perinatal Outcomes in the Pandemic (iPOP) Consortium, we are delighted that the Lancet Small Vulnerable Newborn Series will focus cross-sector attention on the high burden of baby deaths (encompassing miscarriage, stillbirth, and neonatal mortality) and disability (following preterm birth and low birthweight), which remain largely intractable with current siloed approaches….”
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00617-9
“Infertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems….”
“The results of a new clinical trial, published today in the New England Journal of Medicine, show that dexamethasone—a glucocorticoid used to treat many conditions, including rheumatic problems and severe COVID-19— can boost survival of premature babies when given to pregnant women at risk of preterm birth in low-resource settings. The WHO ACTION-I trial resolves an ongoing controversy about the efficacy of antenatal steroids for improving preterm newborn survival in low-income countries. Dexamethasone and similar drugs have long shown to be effective in saving preterm babies lives in high-income countries, where high-quality newborn care is more accessible. This is the first time a clinical trial has proven that the drugs are also effective in low-income settings….”
https://www.nature.com/articles/d41586-020-02959-1
“The arrangement will allow some researchers in Germany to publish openly — but critics say it comes with a high price.”
Cfr a tweet M Pai: “€9,500 (US$11,200) per article, to publish as open-access in a @nature journal? Surest way to exclude researchers from low/middle income countries.”
S Crook; https://www.tandfonline.com/doi/full/10.1080/09612025.2020.1807690
“The Covid-19 pandemic instigated fundamental challenges and changes to parents’ working lives in Britain. This viewpoint article reflects upon the experience of balancing childrearing responsibilities with academic work across the Spring and Summer of 2020. It positions the removal of formal and informal childcare networks within the history of feminist demands around childcare and sets it against the background of the recent history of women and reproduction within Higher Education in Britain. Drawing upon feminist literature, personal experience, academic parents’ testimony and emerging studies of the gendered effects of the crisis, the article explores some of the critical challenges that balancing childcare and academic work presented and offers some preliminary reflections on the experience of the concurrent ‘double shift’ the lockdown engendered….”
J Ioannadis et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30466-6/fulltext
“…The ongoing societal response to COVID-19 offers a precedent for drastic action taken to eliminate the tobacco industry….”
Z Hassan-Smith et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32224-8/fulltext
“…We propose a draft schema for prioritisation of vaccines and preventive medications based on our analysis of at-risk groups…”
Very nice one. “Capitalism will nonetheless survive this crisis as it has done previous ones. The fundamental structures of capitalism typically don’t change fast. But they can change and they do, especially at critical historical junctures, such as in response to wars and economic crises – or, potentially, pandemics….”
On yellow capitalism vs light-black capitalism as possible future scenarios for countries.
And via Cidrap News:
“A report from UNICEF today on the impact of COVID-19 school closures found a bigger impact on children in poor and middle-income countries. One of the main findings is that children in poorer countries lost nearly 4 months of schooling since the pandemic began, compared to an average loss of 6 weeks in higher income countries.”
Sabu K U (EV 2020) - https://blogs.bmj.com/bmjgh/2020/10/27/caught-between-the-virus-and-poverty-impact-of-the-covid-19-lockdown-on-indigenous-communities-in-india/
Sabu K U on the predicament of indigenous communities in Kerala (and elsewhere in India), during the lockdown.
https://www.sciencedirect.com/science/article/pii/S0277953620306699?dgcid=coauthor
Coauthored by Edwin Wouters and A J van Rensburg (EV 2016).
“…This cluster-randomised trial tested an intervention to reduce HIV- and TB-stigma among HCWs….”