Subscribe to our weekly International update on Health Policies
The weekly IHP newsletter offers a digest of key global health (policy, governance, research) reads.
Select a newsletter issue or browse the topics in the current issue.
Dear Colleagues,
Like me, you’re probably delighted that the (Chinese) ‘Year of the Ox’ is upon us, in fact it just started. While preparing for this intro, I read a bit on Oxes’ personality ( it can’t always be Horton’s Offline 😊) “Having an honest nature, Oxes are known for diligence, dependability, strength and determination.“ Joe Biden seems to have a fair amount of Ox traits, certainly compared to his predecessor – a Dog😊 (Mad one, I’d add). Let’s hope Joe ( a Horse, actually) keeps it up in that insane country of his. And that some more “Oxes” pop up at the helm of (rogue) countries in the years to come. I can think of a few.
Over to our dire Covid times then. As others have flagged, there’s a global race between vaccines & mutations ongoing. And it’s a nasty one, even if so far the so called ‘Belgian variant’ (thriving on a diet of chocolate, beer & fries), the Canadian ( bent on ‘double-dipping’ ) nor the ‘Dutch’ one (recalcitrant nature & hoping for tax benefits, while trying to infect you) haven’t popped up. As mentioned in the FT, in the race between vaccines & mutations, “…Which comes out on top will determine when — or if — the virus can truly be tamed. And the race will not be properly won unless it is won all around the world.” Unfortunately, for the time being, “… our species is not yet winning”. In fact, more and more voices are saying the illness Is probably here to stay. As in: “Endemic”. I tend to side with them, rather than with the ‘Yes to No Covid’ fans. But would be happy to be proven wrong in the months and years to come.
In Wuhan, the Joint WHO/China investigative mission didn’t come up with much news (nor quick answers), although we learnt the ‘Chinese variant’ seems to particularly enjoy frozen food 😊.
On 15 Feb, WTO’s General Council will hold a special meeting to consider the appointment of the next Director-General. Most probably, that’ll be Ngozi Okonjo-Iweala. ‘Gutsy’ is the word often used to describe her. The world (as well as global vaccine equity) can certainly use a gutsy leader at the helm of WTO now, to ‘boldly go beyond’ ACT-A among others. ( #growthepie ! ) On the latter, there was some good news this week, at the fourth ACT-A Facilitation Council meeting, with the US now also on board. Yet, grave threats and challenges remain, as dr. Tedros argued.
Finally, in the climate crisis, we do hope you take a very good look at the latest Lancet Planetary Health issue, which focuses on upcoming climate negotiations (Glasgow COP) and links with health. Hoping for Ox Time in Glasgow as well.
Enjoy your reading.
Kristof Decoster
https://www.theguardian.com/environment/2021/feb/09/fossil-fuels-pollution-deaths-research
“Pollution from power plants, vehicles and other sources accounted for one in five of all deaths that year, more detailed analysis reveals.”
“Air pollution caused by the burning of fossil fuels such as coal and oil was responsible for 8.7m deaths globally in 2018, a staggering one in five of all people who died that year, new research has found. … … Countries with the most prodigious consumption of fossil fuels to power factories, homes and vehicles are suffering the highest death tolls, with the study finding more than one in 10 deaths in both the US and Europe were caused by the resulting pollution, along with nearly a third of deaths in eastern Asia, which includes China. Death rates in South America and Africa were significantly lower….”
“…. The new estimate of deaths, published in the journal Environmental Research, is higher than other previous attempts to quantify the mortal cost of fossil fuels…”
https://www.thelancet.com/journals/lanplh/issue/vol5no2/PIIS2542-5196(21)X0002-2
Very cool new Lancet Planetary Health issue!
· Start with the Editorial - Giving the climate policy ratchet a healthy turn introducing and with the overview of the issue:
“…But this time with the ongoing pandemic and the politics of a post COVID-19 recovery hanging over proceedings. In this issue we focus on the upcoming climate negotiations and links with health.” Obviously, looking ahead to the upcoming Glasgow climate summit (COP 26, November, 2021). “…. this is expected to be a key moment in this cycle because it is the first-time countries are being asked to increase their level of ambition. Given the small time window we have left to keep climate warming well below 2°C, a failure to significantly ratchet up collective GHG mitigation commitments will make keeping climate change within relatively safe limits increasingly unlikely. If there is a need for a deadline to motivate action, we have it and it's November, 2021.”
“…. A modelling study in this issue by Ian Hamilton and colleagues explores the potential GHG and population health effects that would be likely to result in 2040 from the NDCs in place at the end of 2020 (current pathway scenario) and for two more ambitious scenarios.
· Cfr press release on the modelling study: The public health implications of the Paris Agreement: a modelling study
“The Lancet Planetary Health: Millions of lives saved annually by 2040 if countries raise their climate ambitions to meet Paris Agreement targets, modelling study suggests. Adopting policies that are consistent with achieving the Paris Agreement and prioritise health, could save 6.4 million lives due to better diet, 1.6 million lives due to cleaner air, and 2.1 million lives due to increased exercise, per year, across nine countries.. …. “New research from The Lancet Countdown on Health and Climate Change published in a special issue of The Lancet Planetary Health journal highlights the benefits to health if countries adopt climate plans - Nationally Determined Contributions (NDCs) – that are consistent with the Paris Agreement aim of limiting warming to “well below 2°C”. The countries considered in the study represent 50% of the world’s population and 70% of the world’s emissions - Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK and the US. ….”
· (still via the Editorial): “…In a related Article in this issue Niheer Dasandi and colleagues use content analysis and natural language processing methods to examine the diverse ways in which public health is incorporated in NDCs. They find that high income countries tend not to mention health in their NDCs, while relatively greater engagement with health was found in LMICs and small island developing states. There was also an association between NDC health coverage and population exposure to temperature change and air pollution. This follows broader patterns of global inequalities. …”
Make sure you also read:
* Comment A MacNeill - Planetary health care: a framework for sustainable health systems
“…we present a framework for constructing environmentally sustainable health systems. …. In summary, the race to net zero health-care emissions is not simply a climate change mitigation strategy, but rather the capstone of a societal transition towards health and wellbeing for all….”
* Comment Margaret Chan - Accelerating towards net zero emissions: the most important global health intervention
Finally, a link:
Blog Ann Pettifor - What's so zero about Net Zero? Good to read ahead COP 26. She explains how net zero emissions differ from zero emissions. “What net zero really does is buy predatory capitalism more time. It is capitalism’s dirty little secret.”
“The COVID-19 pandemic remains a severe health emergency that has caused great suffering and hardship across the African continent and globally. The African Union however is committed to ensure all its member states benefit are part of, and benefit from the continental efforts to prevent and contain the pandemic especially with the rollout of the vaccination programme. The Assembly of Heads of State and Government during the opening of its 34th Ordinary Session held virtually on 6 February 2021, committed to strengthen the collective response to the crisis, marshalling resources for the benefit of all, and striving to ensure that no country is left behind….”
https://www.newtimes.co.rw/news/kagame-calls-au-prioritize-domestic-health-financing
“President Paul Kagame has called on African Union member states to prioritize domestic health financing especially in light of the Covid-19 pandemic to improve health outcomes and resilience. Kagame was speaking at the 34th Ordinary Session of the African Union Assembly which was held virtually, where he presented a progress report on the Institutional Reform of the African Union as well as an update on domestic health financing. Kagame said that without strong national health systems, the continent will remain vulnerable to pandemics. … Among the steps that Kagame said ought to be actualized to improve health outcomes include strengthening of Africa Centres for Disease Control (CDC) to allow its autonomy and effectiveness. The President proposed that the assembly considers adjustments that will drive countries’ improvement with regard to domestic health financing. The proposals include the presentation of the data in the annual scorecard being updated to rank countries according to the World Health Organization Service Coverage Index, rather than exclusively in terms of per capita spending. This adjustment, he noted, will allow for more accurate benchmarking of the efficiency of health spending across different contexts, while at the same tracking progress toward universal health coverage. … … … President Kagame also proposed that the African Union Development Agency, NEPAD be assigned the responsibility for working with partners to create regional platforms to support Member States in increasing domestic health financing….”
“We’re not asking for charity, but fairness – instead of the hoarding and protectionism currently in play.” “…… Africa is not sitting back and waiting for charity. We have learned our lessons from the past. All we ask for is transparency and fairness in vaccine access, not the protectionism currently in play….”
The right message. Not sure by the right messenger, though. But judging from the frantic pace of tweeting and retweeting, nobody seemed to care much.
And a link, on Joe Biden’s announcement of a closer (US) relationship/partnership with Africa.
“The U.S. gave its formal backing to Ngozi Okonjo-Iweala to lead the World Trade Organization, removing the final obstacle to her bid to be the first woman and the first African to run the Geneva-based trade body….”
“… The decision comes amid hopes from many countries that the new Biden administration would keep its election pledge to re-establish Washington’s support for multilateral institutions….”
See also Bloomberg - Meet the Nigerian Corruption Cop Lagarde Expects Will ‘Rock’ the WTO
“… The WTO badly needs to be shaken up. All three pillars of the Geneva-based trade body’s work are under threat. … The organization has struggled to produce meaningful multilateral agreements, its trade-monitoring function consistently underperforms and former U.S. President Donald Trump neutralized the WTO appellate body in late 2019. …” “… The WTO plans to hold a meeting in the coming days where its members will consider a final decision on Okonjo-Iweala’s candidacy. If none of the WTO’s 164 members oppose her, she will be appointed for a four-year term, with a possible four-year extension in 2025….”
“… Until recently, Okonjo-Iweala served as the board chair at the Global Alliance for Vaccines and Immunization, an experience that could help the WTO navigate the health and economic implications of the Covid-19 pandemic….”
PS: it remains to be seen, though, to what extent her GAVI (& ACT-A) bonds will also influence her position on the TRIPS waiver proposal….
PS: The WTO’s General Council will hold a special meeting on 15 February at 15:00 Geneva time to consider the appointment of the next Director-General.
https://www.devex.com/news/uk-s-aid-budget-cuts-undermine-g-7-global-health-agenda-experts-say-99060
“The U.K. government’s decision to cut the aid budget has undermined its G-7 global health security agenda, according to experts.”
Excerpts: “… The government's first policy priority for its presidency of the group of leading industrial nations is to “build back better” from COVID-19 by “leading the global recovery from coronavirus while strengthening our resilience against future pandemics.” … … Hancock’s “emphasis on global solidarity was really at odds with the aid cuts,” said Tom Hart, research fellow at the Overseas Development Institute. He described this as “the real weakness” of the United Kingdom’s G-7 health agenda. … …. The health secretary’s announcement consisted of four pillars: health security “for all,” including the launch of a New Variant Assessment Platform to analyze genetic viral mutations; improving the coordination and standardization of clinical trials and information sharing; fighting antimicrobial resistance; and developing digital health care.”
“These objectives appear to put U.K. needs ahead of those of lower-income countries, according to Pete Baker, a policy fellow on the Center for Global Development’s global health policy team. He said the focus on a New Variant Assessment Platform and digital health care, “in combination with [aid] cuts … worries me.” Along with the New Variant Assessment Platform, Baker said his “main worry” is that “it looks like a U.K.-focused, high-tech approach to global health security, almost like they started with what is interesting and useful for the U.K. and then rolling it out to the world, rather than … starting with the priorities of the security of low-income countries and supporting them.”
“… Implementation was also a key point for Ilona Kickbusch, a global health consultant, who said the G-7 needs to home in on the “health security for all” pillar of its platform. “What’s really critical is: What is the political message the G-7 is going to send on global health at this point in time?” she told Devex. “The G-7 had better show how it is a responsible global actor.”
L Regan et al ; https://www.cgdev.org/blog/can-uk-cut-bilateral-aid-health-50-percent-and-protect-health-systems#.YCFBHTzrfZ4.twitter
“Following the UK government’s decision to cut aid from 0.7 to 0.5 percent of GNI, recent announcements have shown that bilateral aid is likely to receive the biggest hit, all while in the midst of a global pandemic. In this blog, we look at what the reduction could mean for health services in lower-income countries and find that UK aid supports important health services that are already under stress due to COVID, and which are unlikely to find alternative funding sources. We conclude with some advice for Ambassadors and officials on implementation….”
https://www.devex.com/news/in-brief-former-dfid-secretary-calls-for-big-tech-tax-to-fund-aid-99119
“A former international development secretary has called for a tax on large technology companies to help pay for the United Kingdom’s international aid budget, which is being cut from 0.7% to 0.5% of gross national income. Andrew Mitchell, a senior backbench Conservative member of Parliament and vehement defender of development, has been critical of the government’s decision to reduce the budget by around £4.5 billion this year, which is expected to significantly impact bilateral aid spending. “Why not let Amazon pay fair tax and not balance the books in this way on the backs of the poorest people in the world?” asked the former head of the Department for International Development, urging the government to take a second look at what he called a “pernicious and shabby cut.” “…. Mitchell is understood to be backing a parliamentary rebellion against forthcoming government legislation to change the aid spending target. An exact date for that discussion is still unknown, but Mitchell recently told Devex that “leaders of the rebellion are quietly confident that the government will have to change its mind.”
N Maani et al ; https://gh.bmj.com/content/6/2/e004950
“… This year the WHO Foundation has been launched as a way to broaden the WHO donor pool. We describe a lack of clarity about the applicability of Framework of Engagement with Non-State Actors (FENSA) norms and practices to this new entity. The risks regarding undue corporate influence at the expense of independence were at the core of the protected negotiations underpinning the development of the FENSA that guides the WHO itself, but do not appear to be reflected in the Foundations’ governance structures. Considering past failed initiatives, and how many global health challenges, including non-communicable diseases and climate change, are driven by powerful transnational companies, the WHO cannot afford to be seen to sacrifice independence or impartiality to the commercial determinants of health in pursuit of funding.”
J Kates et al ; https://www.kff.org/global-health-policy/issue-brief/what-will-be-the-contours-of-the-biden-administrations-global-health-agenda/
“The Biden administration brings a starkly different vision for U.S. international engagement, including global health, compared to the “America First” foreign policy doctrine of its predecessor. At the top of the agenda is addressing COVID-19, re-engaging with the global community more broadly, and pursuing a stepped-up emphasis on global health security. The administration has already taken several actions including: releasing a National Strategy on COVID-19 and Pandemic Preparedness; issuing a National Security Memorandum and Executive Order on U.S. global leadership on COVID-19 and global health security; restoring funding for and membership in WHO; joining COVAX; and rescinding the Mexico City Policy. It has also proposed several other actions, including some that require Congressional support. Yet the extent to which the administration will seek to champion core global health programs beyond COVID-19 and preparedness remains unknown, as does the level of support from Congress, given the pressures of COVID-19 and economic strain at home. The stakes are even higher now, given the emergence of new COVID-19 variants and the slow roll-out of vaccines.
Among the many key policy issues and outstanding questions ahead are the following:
How the U.S. will be received on the global stage; How best to balance COVID-19 needs at home and abroad; How robust will U.S. support for global COVID-19 vaccine access be; Whether global health security will become a dominant frame for U.S. global health engagement; How much room there will be to address the unfinished business of global health, including the effects of COVID-19 on core programs; The balance between bilateral and multilateral U.S. health investments; How the U.S. will approach WHO reform; How far will the administration go in its support for global family planning and reproductive health and how will it withstand partisan push back in Congress; and Whether the bipartisan consensus regarding global health funding can be maintained.”
M Kavanagh, N Erondu, M Pillinger; https://www.thinkglobalhealth.org/article/united-states-needs-new-approach-fight-pandemics-new-era
“The new administration should adopt a new approach to global health, characterized by solidarity rather than leadership.” Recommended read. Also for Joe Biden himself 😊.
“On the two-year anniversary of the establishment of the African Medicines Agency (AMA) Treaty, over 40 patient and civil society organizations, health and pharmaceutical industries, and product development partnerships called upon African Union member states to ratify the Treaty. Rapidly ratifying the Treaty, which was created to provide a unified approach to the approval of new medicines and vaccines, is a “matter of priority” and the failure to so undermines patients’ access to effective therapies and vaccines, according to the numerous stakeholders representing patients, researchers and industry leaders. The Treaty was adopted at the 32nd African Union Assembly to enhance regulatory oversight across the continent’s 55 countries. It has been signed by 19 countries but only ratified by eight out of the required 15. …”
ILO joined the GAP. “The 12 signatory agencies to the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) warmly welcome the International Labour Organization (ILO) as a new member of the partnership between health, development and humanitarian agencies working to better support countries to accelerate progress towards the health-related Sustainable Development Goals (SDGs ….”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00364-0/fulltext
“The Davos Alzheimer's Collaborative aims to build a diverse patient cohort for study, coordinate clinical trials, and improve care. Nayanah Siva reports. A new international initiative to collectively tackle the challenges of Alzheimer's disease has been launched by the World Economic Forum and the Global CEO Initiative on Alzheimer's Disease. Aiming to accelerate the discovery, testing, and delivery of precision interventions for Alzheimer's disease, the initiative, called the Davos Alzheimer's Collaborative (DAC), will include governments, academics, private sector leaders, and non-governmental organisations. …. … DAC has prioritised three main goals: first, global development of the science on Alzheimer's disease by collecting diverse population data on a global scale; second, building and coordinating an international platform for clinical trials to reduce the time taken to bring new treatments to global markets; and third, facilitating health-care system preparedness and implementation of potential new innovations, diagnosis, and care.”…”
And a link via G2H2: EU-led Draft Resolution on Strengthening WHO Preparedness and Response to Health Emergencies
Opening speech dr. Tedros - WHO Director-General's introductory remarks - ACT Accelerator 4th Facilitation Council
In which he listed three major threats to the success of the ACT Accelerator and COVAX, which need our urgent attention.
“In her first major public statement since the United States signaled that it would approve her candidacy for Director-General of the World Trade Organization (WTO), Ngozi Okonjo-Iweala highlighted the need for rich countries to step up their financial contributions to ensure equitable access to COVID-19 tools. Okonjo-Iweala was the keynote speaker on Tuesday at the fourth meeting of the Access to COVID-19 Tools (ACT) Accelerator Facilitation Council, where a new burden sharing agreement to recruit more funds from donor countries to fill a $27 billion funding gap was announced….” “… Ngozi Okonjo-Iweala is currently the WHO Special Envoy for the ACT Accelerator…”
Gutsy speech. But nothing – yet? – on the TRIPS waiver proposal. Hope that comes after she’s appointed.
As already mentioned, the US joined ACT-A. (Including the ACT-A Facilitation Council on 9 Feb).
“The World Health Organization’s head on Tuesday welcomed the United States’ move to join a WHO-backed programme to accelerate tools to fight COVID-19, as U.S. President Joseph Biden reverses the Trump Administration’s course. The programme, formally called Access to COVID-19 Tools (ACT) Accelerator, is raising money to develop vaccines, diagnostics and treatments to tackle the pandemic, but still faces a roughly $27 billion funding gap, WHO director general Tedros Adhanom Ghebreyesus said…”
See also Reuters - U.S., changing course, joins WHO programme aimed at boosting COVID-19 fight
On the burden sharing framework: “ The virtual WHO Facilitation Council aims to help fill a $27 billion funding gap for ACT-A … Washington, the top donor to the WHO, has already pledged $4 billion for the global pandemic response. WHO's Special Envoy for the ACT Accelerator, Andrew Witty, a former GlaxoSmithKline CEO, said talks on further U.S. contributions were ongoing. A meeting document gave preliminary total estimates for how much major economies would be expected to give, showing between $6-$9 billion for the United States and about $2-$4 billion for Japan and Germany. "There was general support for the burden-sharing framework," Dag Inge Ulstein, Norway's minister of international development who co-chaired the meeting, told Reuters….”
See also A Financial Framework for ACT Accelerator (9 Feb)
“The German Parliament’s budget committee approved €1.5 billion ($1.8 billion) in additional funding for the Access to COVID-19 Tools Accelerator, a global coalition launched in April to speed up the development of COVID-19 tools and treatments and to ensure their equitable distribution, particularly in low- and middle-income countries. Much of that funding appears earmarked for vaccine distribution and development through the ACT-Accelerator’s COVAX Facility, according to initial committee reports…. … Sweden is also channeling additional money directly into COVAX. Per Olsson Fridh, the country’s new minister for international development cooperation, confirmed a $12 million increase in funding for the facility, doubling Sweden’s COVAX support.”
With focus on key global trends, and main WHO messages.
The worrying news about the effectiveness of the AstraZeneca vaccine vs the South-African variant dominated a big part of the week, together with the joint WHO/China investigation debriefing.
“… In other global developments, the WHO said in a weekly update that overall cases and deaths show more signs of decline, a promising development, though cases are rising in some nations and more countries are reporting the detection of variant SARS-CoV-2 viruses. … In its weekly report on global COVID-19 patterns, the WHO said yesterday that cases declined again last week, with illnesses down 17% and deaths down by 10%, which it said is promising, though numbers are on the rise in some countries, such as Iran, the Philippines, and some parts of the Americas. The WHO's Pan American Health Organization (PAHO) said today at a briefing that Caribbean countries such as the Dominican Republic and Cuba are reporting significant rises in cases, as are other parts of the region, including parts of Honduras, El Salvador, Guatemala, and the Amazon region along the border between Brazil, Colombia, and Peru. Overall, the WHO noted that much of the drop in global cases is from declines in some of the highest burden countries, including the United Kingdom and the United States….”
Via HPW : “… African health facilities have been overwhelmed by the pandemic’s second wave, said WHO’s Regional Director Matshidiso Moeti, speaking at the briefing. According to a recent WHO survey of 21 countries, 66% reported inadequate critical care capacity; 71% were reporting shortages of vital oxygen supplies, and 24% reported health worker burnout. …”
See also Cidrap News - COVID deaths spike in Africa “… the head of the WHO's African regional office, Matshidiso Moeti, MBBS, said that deaths in Africa were up by 40% last month and that its second surge seems to have peaked on Jan 6 and had grown much faster and was far more lethal than the first surge. "The increasing deaths from COVID-19 we are seeing are tragic, but are also disturbing warning signs that health workers and health systems in Africa are dangerously overstretched," she said, noting that early information from 21 countries found 66% have inadequate critical care capacity, and 15 have inadequate oxygen production….” “Regarding the variants, she said B1351 has been found in eight African countries, and the B117 variant, first identified in the United Kingdom, has been found in six….”
https://news.un.org/en/story/2021/02/1084142
“The emergence of new coronavirus variants has raised major questions around whether currently available vaccines will be effective against them, the head of the World Health Organization (WHO) said on Monday.”
https://news.un.org/en/story/2021/02/1084462
“Briefing UN Member States on Thursday, WHO chief Tedros Adhanom Ghebreyesus drew attention to a $27 billion financing gap in the ACT Accelerator, which supports the development and equitable distribution of coronavirus tests, treatments and vaccines globally. “The longer this gap goes unmet, the harder it becomes to understand why, given this is a tiny fraction of the trillions of dollars that have been mobilized for stimulus packages in G20 countries”, he said. Secondly, noting some bilateral deals, he called on all States “to respect COVAX contracts and not compete with them”. And third, Tedros underscored the need for “an urgent scale-up in manufacturing to increase the volume of vaccines” with “innovative partnerships” to include tech transfer, licensing and “other mechanisms to address production bottlenecks”….”
https://healthpolicy-watch.news/82258-2/
“The World Health Organization (WHO)’s expert group on immunisations remains confident in the Oxford/ AstraZeneca vaccine’s efficacy against severe SARS-CoV2 disease – despite the enormous worldwide concerns triggered by a small South African study that showed it had little effect in stemming mild disease from the B.1.351 variant first identified in that country….”
“… COVAX Suppliers Need To Be Prepared to Adjust Products To Viral Evolution Meanwhile, Dr Seth Berkley, CEO of the vaccine alliance, GAVI, stressed that pharma manufacturers supplying vaccines to the global COVAX facility “must be prepared to adjust to COVID-19’s viral evolution, including potentially providing future booster shots and or adaptive vaccines, if found to be scientifically necessary”.”
See also COVAX Statement on New Variants of SARS-CoV-2
https://www.ft.com/content/be33aa38-5eff-4069-b104-ba7bdb735c72
On Wednesday: “The World Health Organization has recommended the Oxford/AstraZeneca coronavirus vaccine for use worldwide by all adults, in a boost for the jab after a series of setbacks. The WHO’s Strategic Advisory Group of Experts on Immunization said the vaccine can be used by all people over the age of 18 and recommended extending the time between the first and second dose to improve efficacy. “In light of the observation that two-dose efficacy and immunogenicity increase with a longer interdose interval, WHO recommends an interval of 8 to 12 weeks between the doses,” it said on Wednesday….”
“…The WHO is likely to follow the recommendation by issuing an emergency use listing for the vaccine as early as Monday, according to people familiar with the matter. Soumya Swaminathan, its chief scientist, said the processes were “independent, but co-ordinated”. She said the emergency use listing looked at the manufacturing process, among other things. Although authorisation by the WHO is not required by national governments to use the jab, it is needed for the WHO-led Covax vaccine programme to begin distribution of the shot to participating countries. Many countries, especially poorer nations, have banked on the jab, which will be sold at cost during the pandemic and is easy to store…”
“The sweeping WHO recommendation by its “Strategic Advisory Group of Experts” (SAGE) marks what WHO Chief Scientist Soumya Swaminathan described as an “important milestone” in the plan for the global “COVAX” facility to rollout vaccines more equitably around the world. .. WHO Also Recommended For Use in Older People & In Countries With South African Variant. …”
Some links re AstraZeneca & SA variant:
· HPW - AstraZeneca’s Failure in South Africa Has Serious Implications for COVAX and AU
“The failure of the Oxford/ AstraZeneca SARS-COV2 vaccine to protect against the COVID-19 variant identified in South Africa has serious implications for massive African vaccine rollouts planned by both the WHO co-sponsored COVAX vaccine facility as well as the African Union’s dedicated African Vaccine Acquisition Task Team (AVATT). The bulk of Africa’s COVAX allocations and a significant proportion of the AVATT acquisitions are for the AstraZeneca vaccine produced by the Serum Institute of India (SII). Yet most southern African countries neighboring South Africa are almost certain to be dominated by the B.1.351 variant (also called 501Y-V2) which was first identified in South Africa. The variant has already appeared in Malawi, eSwatini, Lesotho, Mozambique, Zambia and Zimbabwe, experts say, and it could have already spread to East Africa….”
· FT - South Africa forced to overhaul vaccine plan over variant fears
“Concerns over AstraZeneca efficacy against mutation prompt about-turn with global repercussions.”
“…South Africa has temporarily halted the rollout of the Oxford/AstraZeneca vaccine after a Witwatersrand university study appeared to show that it offered little protection against mild and moderate disease caused by the 501. V2 viral variant first identified in South Africa. The study has yet to be peer reviewed and did not assess severe disease. That study, first reported in the Financial Times, has left scientists scrambling to figure out its implications for the likely effectiveness of the Oxford/AstraZeneca vaccine, and other jabs, as the virus mutates. “ ….… “If it is confirmed that the vaccine doesn’t protect against severe disease and death caused by the South African variant, we have a massive problem,” said Peter Piot, director of the London School of Hygiene and Tropical Medicine. … “ “Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said Pretoria was right to halt use of the Oxford/AstraZeneca vaccine while it investigated further. “The key word is ‘temporary’,” he said. “They should step back and take a look. It’s not a disaster, it is a cautionary measure.” But, Nkengasong said the study was of concern not only for South Africa but for the rest of the continent where the Oxford/AstraZeneca vaccine formed what he called “the backbone” of the immunisation strategy. Some 500m doses have been ordered through the African Union and several hundred million doses more through Covax. …. The World Health Organization said that it had identified cases of the variant in Botswana, Ghana, Kenya, Comoros and Zambia, as well as in 24 non-African nations. However, many African countries lack the capacity to detect the new strain on a systemic basis, said Nkengasong, adding that the continent needed to dramatically ramp up its genomic testing ability…..”
· Guardian - Vaccine strategy needs rethink after resistant variants emerge, say scientists
“... South Africa’s health minister, Zweli Mkhize, said in comments reported by Reuters on Sunday that the country would suspend use of the Oxford jab in its vaccination programme while scientists advised on the best way to proceed. …. … “These findings recalibrate thinking about how to approach the pandemic virus and shift the focus from the goal of herd immunity against transmission to the protection of all at-risk individuals in the population against severe disease,” he said….”
“The African Union (AU) will not be “walking away” from AstraZeneca’s COVID-19 vaccine but will target its use in countries that have not reported cases of the variant dominant in South Africa, the head of its disease control body said on Thursday. …African countries are due to receive 100 million doses of the AstraZeneca vaccine this year under an AU vaccine plan…. (in addition to via Covax)
But see FT - African countries unsure whether to use Oxford/AstraZeneca jab
“Countries where the Covid-19 variant first identified in South Africa is dominant are receiving conflicting advice about whether to roll out the Oxford/AstraZeneca vaccine in a sign of the complex challenge facing public health officials. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said preliminary evidence that the Oxford/AstraZeneca jab might not stop mild and moderate disease linked to the 501.V2 variant meant countries where it was circulating widely should seek alternatives. “If you have evidence that the 501.V2 variant is dominant . . . in your country, then we recommend that it should not be deployed for the obvious reason that it will have reduced activities in neutralising antibodies,” Nkengasong said at a briefing on Thursday. The advice appeared to conflict with recommendations from the World Health Organization, which endorsed the Oxford/AstraZeneca shot on Wednesday for use in all countries, including those where 501.V2 was present. Dr Matshidiso Moeti, the WHO regional director for Africa, echoed the advice on Thursday. “If this virus [variant] is not circulating very widely — and even if it is — we are recommending the use of the vaccine with an understanding that it may not be able to stop some cases, particularly mild cases, but it is able to stop severe cases.” Moeti described the seeming difference in recommendations between the WHO and Africa CDC as small…”
“… According to WHO, the variant has now spread to eight African countries — Botswana, Ghana, Kenya, Comoros, Mozambique, South Africa, Zambia and Tanzania. The Tanzanian variant cases, identified among travelers arriving from the United Kingdom, are significant as it suggests the steady creep of the variant northward. …”
Via HPW : John Nkengasong also argued for local manufacturing capacity:
“… Going forward, he said the African Union is vastly in support of a long term plan to enable the manufacturing of COVID-19 vaccines in the country considering there may be the need for periodic vaccination to boost the immune systems of their recipients. This he said is part of the reasons why the center is supporting the decision of the heads of governments in Africa to put their political weights behind calls for the transfer of technology especially in the area of vaccine production. “We know that we won’t be in this race for vaccines for long, and for several reasons. We truly are dealing with a new virus, we don’t know for how long when people receive vaccines their protection will last. And if, it so happens, this is hypothetical, that the vaccine will require that we do periodic vaccinations, you also require that Africa is well positioned and equipped to be able to manufacture vaccines locally so that the continent can at least meet the demand for a continent of 1.2 billion people,” he said….”
https://news.un.org/en/story/2021/02/1084002
On Tedros’ media briefing last week on Friday: “The number of people who have received a COVID-19 vaccination now exceeds those reportedly infected, the head of the UN’s health agency said on Friday, while warning that after inoculating their own health workers and older people, countries must share doses with others, to eradicate the deadly coronavirus.”
https://healthpolicy-watch.news/who-china-team-visits-lab-at-centre-of-conspiracies/
Still on last week Friday’s media briefing: “… Tedros again underscored the need for nations to share doses. “But we also need a massive scale-up in production”, he said. Drawing attention to French pharmaceutical giant Sanofi’s announcement last week to make its manufacturing infrastructure available to produce the Pfizer/BioNTech vaccine, he called on other companies to follow their example. “Companies can also issue non-exclusive licenses to allow other producers to manufacture their vaccine – a mechanism that has been used before to expand access to treatments for HIV and hepatitis C”, said the WHO chief. Having received substantial public funding, he stressed that “manufacturers can do more”. “We encourage all manufacturers to share their data and technology to ensure global equitable access to vaccines”, Tedros said. The WHO chief also called on companies to “share their dossiers” with the UN health agency faster and more fully than they have been doing, “so we can review them for emergency use listing”….”
See also Development Discourse - Companies Can Issue Voluntary Licenses to Speed Up Manufacture, Says Tedros
… …Companies can also issue non-exclusive licences to allow other producers to manufacture their vaccine, a mechanism that has been used before to expand access to treatments for HIV and hepatitis C. The COVID-19 technology access pool or C-TAP enables the voluntary licencing of technologies in a non-exclusive, and transparent way by providing a platform for developers to share knowledge, intellectual property and data,” said Tedros, stressing that this would help to build additional manufacturing capacity in Africa, Asia and Latin America.;..”
See also Reuters - WHO chief says drug firms should share vaccine-making capacity
More than worth a read. “…STAT caught up with Ryan over the weekend to get his read on where things stand with the vaccine rollout, when he thinks life may get closer to something that approximates normalcy, and what that might look like. (Sooner than we expect, different than we might imagine, in his view.)
“… What I see emerging ultimately is a Covid-19 control program, hopefully integrated into our influenza control program, so we have a much better way of dealing with respiratory viruses as ongoing threats. Because for me, respiratory viruses have shown again their potential to rip us asunder. …. I was asked the other day on Facebook: “When can we get back to our old lives, the old normal?” And I said: “I don’t want to go back there. It wasn’t a safe place — for our planet, or for social justice or for extremism or for human health. I want to go forward to something new that’s better. More sustainable. Fairer. More alert.’’ That’s the moment we’re in right now….”
The WHO team debriefed on Tuesday: “A month-long investigation into the origins of COVID-19 has dismissed suggestions that it could have been introduced to humans through a laboratory leak, finding it was most likely to have been transmitted through an intermediate animal host and may have been spread through frozen food. The World Health Organisation and Chinese investigators on Tuesday announced several key findings including that the virus was likely to have been active outside the Wuhan market for weeks before cases were first detected. The team raised the possibility that the virus could have been present in other regions or countries before the first cases were reported in Wuhan. … But the zoonotic origin of the virus remains a mystery, with investigators finding no clear link to bats, pangolins or other wild animals, while calling for more samples to be taken from felines and other species….”
· See also the Guardian - WHO team says theory Covid began in Wuhan lab ‘extremely unlikely’
“In a lengthy press conference on Tuesday, representatives of the joint WHO/China investigative mission delivered a summary of findings from two weeks in the field. They said the team’s work did not dramatically change the picture they had before they began, but had added important details to the story….”
“ The team said they had examined four main hypotheses for the introduction of the virus into the human population…..” “….While the findings were delivered jointly, there were key differences in emphasis….” (by resp. Liang & Embarek)
· And HPW - WHO Experts Unable to Find ‘Missing Link’ in SARS-CoV2 Transmission in China
Pretty extensive overview also of the findings.
· The NYT take: China Scores a Public Relations Win After W.H.O. Mission to Wuhan
“Experts with the global health agency endorsed critical parts of Beijing’s narrative, even some parts that independent scientists question.”
· Scmp - US will not accept World Health Organization findings out of Wuhan without independently verifying
· And Devex on Next steps :
“…The team members looked at all possible pathways for the virus’s introduction into humans and identified four hypotheses, Embarek said. Among them was the theory that it escaped from a lab, but they are no longer pursuing that idea, given the conclusions they’ve arrived at. The three other hypotheses, however, are still on the table and will be the focus of further work. One is the possibility that the virus was directly transmitted from an animal species to humans. The second is that the virus was spread via an intermediary host or animal species that is closer to humans. The third is that the virus was introduced in the food chain, such as frozen food products. “Our initial findings suggest that the introduction through an intermediary host species is the most likely pathway ... and one that will require more studies and more specific, targeted research,” Embarek said. The mission’s report lists key recommendations for future studies, he said, such as continuing to analyze materials from the early days of the outbreak. These materials include blood samples from blood banks within China as well as in other countries where there were initial reports indicating the virus was present. The team also wants to survey other animal species that could have served as a reservoir for the virus and conduct more sampling and studies of bat populations outside China. “We should also look further back in tracing the source … of the animal products, in particular, that were in Huanan market in December 2019 and go back and see if we can find products that were produced at that time and that are still available to also look at the suppliers to these vendors in the market, see if we can go further back in terms of identify interesting clues in the farming environments in the species being raised in these farms and where they were potentially coming from before that,” Embarek said….”
PS: not everybody is convinced, though. See for example Ian Birrell - The WHO’s Covid shame
“Their investigation into the pandemic was little more than an appeasement of Beijing.” Focusing on the ‘leak’-hypothesis.
Finally, some links:
· Guardian Analysis - WHO investigation into Covid-19 origins offers no quick answers
“…In the end the significance may be in the relative insignificance of the briefing, pointing to a forensic and ongoing process.”
· Reuters - Understanding COVID-19 origins will take years, says WHO team member
“ A member of the World Health Organization-led team visiting the central Chinese city of Wuhan said he has been surprised by the complexity of getting to the origins of the COVID-19 pandemic and that years of research lay ahead….”
· Reuters - WHO's Wuhan probe ends, U.S.-China bickering over COVID continues
Ahum 😊. “China called on the United States on Wednesday to invite the World Health Organization to investigate origins of the COVID-19 outbreak there, as sparring over the pandemic continued after the WHO wrapped up its field work in the Chinese city of Wuhan….”
“About 90 people were hospitalized with Covid-19-like symptoms in central China in the two months before the disease was first identified in Wuhan in late 2019, according to World Health Organization investigators, who said they pressed Beijing to allow further testing to determine whether the new virus was spreading earlier than previously known….”
https://www.bmj.com/content/372/bmj.n405
“The World Health Organization has urged countries to prioritise rehabilitation for the medium and long term consequences of covid-19 and to gather information on “long covid” more systematically….”
https://apnews.com/article/coronavirus-new-variants-b4d472f3d61c62a57aa68c4aa7c85012
“Evidence is mounting that having COVID-19 may not protect against getting infected again with some of the new variants. People also can get second infections with earlier versions of the coronavirus if they mounted a weak defense the first time, new research suggests….”
See also a resource: COVID-19 reinfection tracker (one of the many Covid related trackers you don’t want to end up in)
https://www.ft.com/content/e17f18a5-25e8-451c-abdd-a2f65ec3da92
“Jeremy Farrar says further virus mutations that reduce jab efficacy should be expected.”
“…One of the UK government’s top scientific advisers has warned that early signs the Oxford/AstraZeneca vaccine is less effective at stopping mild and moderate cases of the South African coronavirus variant are a “worrying harbinger” for 2021. Sir Jeremy Farrar, director of the Wellcome Trust medical charity and a member of the government’s Sage advisory committee, told the Financial Times that this year was “very unpredictable” as new viral variants less susceptible to current control methods were likely to undermine efforts to contain the virus. … … Farrar warned that the question of vaccine efficacy was “not just a problem for South Africa”. Biological and immunological pressure would “undoubtedly” lead to more variants around the world this year that could have higher transmission rates, higher fatality rates and be more difficult to prevent, he said. “The more people infected, the more virus there is,” Farrar said, adding that Sars-Cov-2 was now mutating in different ways in response to growing levels of immunity in the population owing to vaccination or prior infection. “We’ve had biological evolution and now we’ve got immunological evolution.” He urged “Covax, the World Health Organization’s vaccine procurement programme, to begin exploring second and third-generation jabs that could be adapted to new variants and elicit a broader immune response. In the meantime, he said, existing vaccines, including the Oxford/AstraZeneca shot, should be used where they are known to be effective — including in the UK — alongside other methods to drive down transmission….”
“Scientists are working on a shot that could protect against Covid-19, its variants, certain seasonal colds — and the next coronavirus pandemic.”
“… Dr. Modjarrad is one of many scientists who for years have been calling for a different kind of vaccine: one that could work against all coronaviruses. Those calls went largely ignored until Covid-19 demonstrated just how disastrous coronaviruses can be. Now researchers are starting to develop prototypes of a so-called pancoronavirus vaccine, with some promising, if early, results from experiments on animals. Dr. Eric Topol, a professor of molecular medicine at the Scripps Research Institute in San Diego, thinks scientists should join together in another large-scale vaccine-creation project immediately. “We have to get a real work force to accelerate this, so we can have it this year,” he said. Dr. Topol and Dennis Burton, a Scripps immunologist, called for this project on broad coronavirus vaccines on Monday in the journal Nature….” (see below)
D Burton & E Topol ; https://www.nature.com/articles/d41586-021-00340-4
“COVID’s evolution signals the importance of rational vaccine design based on broadly neutralizing antibodies.”
“Drug makers are increasingly turning to monoclonal antibodies to protect the millions of people who can't use vaccines. But questions swirl about their cost and long-term viability.”
Philip Schellekens; https://pandem-ic.com/slow-quick-slow-the-viral-spread-in-the-developing-world/
“The spread of the coronavirus in developing countries is likely to follow a slow-quick-slow pattern explained by external connectivity, urban density and urbanization.”
Tweet: “Latin America is 80% urbanized. Sub-Saharan Africa 40%. Could this have slowed the viral spread in Africa?”
https://www.nytimes.com/2021/02/05/health/covid-variants-genome-recombination.html
“New studies underscore how coronaviruses frequently mix their genetic components — which could contribute to the rise of dangerous variants.”
“… A flurry of new studies suggests that recombination may allow the virus to shapeshift in dangerous ways. But in the long term, this biological machinery may offer a silver lining, helping researchers find drugs to stop the virus in its tracks. … “ “… Scientists worry that recombination might allow for different variants of the coronavirus to combine into more dangerous versions inside of a person’s body….”
“Tocilizumab, antibody also used for rheumatoid arthritis, saves patients’ lives by dampening the immune system.”
Links:
Reuters - J&J CEO says people may need annual COVID-19 vaccine shots for next several years - CNBC
Reuters - UK says COVID-19 booster and annual vaccinations very probable
FT - Britain risks becoming virus ‘melting pot’ as mutations spread
FT - Oxford/AstraZeneca jab fails to prevent mild and moderate Covid from S African strain, study shows
Guardian - AstraZeneca says vaccine against new Covid variants may take six months
Stat - Arthritis drug cuts deaths in hospitalized Covid-19 patients, major study shows
Guardian - Pfizer vaccine found to give strong immune response to new Covid variants
https://drive.google.com/file/d/1KCLoJDR4YrJzHDrcq7C2sPWeGJllTb_9/view
Global civil society is calling for the equitable rollout of #COVID19 Vaccines. Call to Action calling for urgent action from governments, donors, companies and multilateral agencies.
By GAVI CSO constituency in collaboration with the ACT-A Vaccine pillar CSO representatives. And many other CSOs. Calling for a mix of support for Covax (and ACT-A), C-TAP, tech transfers, …
PS: some in global civil society would have liked it to be more ambitious (Trips waiver proposal…).
“…. Other nations are getting impatient too. Unlike past disease outbreaks, where less wealthy countries have generally waited for vaccines to be delivered by the U.N. and other organizations, many are now taking matters into their own hands. Experts are increasingly concerned that these go-it-alone efforts could undermine a U.N.-backed program to get COVID-19 shots to the neediest people worldwide. … …. Countries including Serbia, Bangladesh and Mexico recently began vaccinating citizens through donations or commercial deals — an approach that could leave even fewer vaccines for the program known as COVAX, since rich countries have already snapped up the majority of this year’s supply….”
“…Kate Elder, senior vaccines policy adviser at Doctors Without Borders, said developing countries should not be criticized for securing private vaccine deals since that is precisely what rich countries did last year…..”
Good helicopter view (6 Feb).
Excerpt: “Covax has a target of delivering 2bn doses globally, including at least 1.3bn for 92 low- and middle-income countries, by the end of 2021. This would be enough to inoculate 20% of each countries’ population – prioritising health workers, the elderly and those with underlying medical conditions – although that target has been criticised as inadequate to deal with the pandemic. It has negotiated advance deals for these 2bn doses. However, Duke University analysts believe that the doses can only be delivered this year as planned if the Serum Institute can make all 900m doses ordered as “options”, which they judge unlikely given the company’s publicly stated capacity and extant orders. The analysts estimate instead Covax will provide between 650-950m doses, split between 145 nations – including some of those with enough confirmed deals for vaccines to inoculate their citizens several times over….”
Joint statement by UNICEF Executive Director Henrietta Fore and WHO Director-General Dr. Tedros Adhanom Ghebreyesus.
“Of the 128 million vaccine doses administered so far, more than three quarters of those vaccinations are in just 10 countries that account for 60% of global GDP. As of today, almost 130 countries, with 2.5 billion people, are yet to administer a single dose. This self-defeating strategy will cost lives and livelihoods, give the virus further opportunity to mutate and evade vaccines and will undermine a global economic recovery. Today, UNICEF and WHO – partners for more than 70 years – call on leaders to look beyond their borders and employ a vaccine strategy that can actually end the pandemic and limit variants.” “…. COVAX participating countries are preparing to receive and use vaccines. Health workers have been trained, cold chain systems primed. What’s missing is the equitable supply of vaccines. To ensure that vaccine rollouts begin in all countries in the first 100 days of 2021, it is imperative that:
Governments that have vaccinated their own health workers and populations at highest risk of severe disease share vaccines through COVAX so other countries can do the same. The Access to COVID-19 Tools (ACT) Accelerator, and its vaccines pillar COVAX, is fully funded so that financing and technical support is available to lower- and middle-income countries for deploying and administering vaccines. … Vaccine manufacturers allocate the limited vaccine supply equitably; share safety, efficacy and manufacturing data as a priority with WHO for regulatory and policy review; step up and maximize production; and transfer technology to other manufacturers who can help scale the global supply….”
https://www.twn.my/title2/health.info/2021/hi210202.htm
“A large majority of developing countries at the World Trade Organization (WTO) have joined forces to demand text-based negotiations on the proposed TRIPS waiver to combat the COVID-19 pandemic expeditiously, participants told the SUNS. … … Despite a groundswell of support from international civil society organizations and pressure groups across the world, the so-called “protectors” of the exploitive international IPR (intellectual property rights) regime – the United States, the European Union, Japan, Switzerland, and Canada among others – have blocked the demand for text-based negotiations on the waiver, said participants, who asked not to be quoted. Adopting “diversionary” tactics by raising somewhat extraneous and irrational arguments, the US, the EU, Japan, Switzerland, and Canada among others said that they will not enter into text-based negotiations on the waiver on grounds that the TRIPS flexibilities and the COVAX facility being implemented by the Geneva-based GAVI (The Vaccine Alliance) can address the concerns raised by the proponents, said participants….”
P Patnaik; Geneva Health Files;
More analysis of last week’s WTO TRIPS Council informal meeting.
“… Vaccine production woes and internal EU squabbles on accessing vaccines might have opened up a new frontier that could help proponents of the TRIPS waiver proposal. “
“…Although some countries continued to oppose the proposal and refused to engage in text-based discussions, diplomatic sources in Geneva say that there has been a perceptible shift in the position of many countries. Less opposition may not mean more support, but it opens up spaces for discussions particularly at the bilateral level…”
PS: “…. There have been efforts to get the Italian Presidency of the G20 to extend support to the TRIPS waiver proposal. Both India and South Africa, proponents of the proposal are members of the G20. Civil society groups are advocating the Italian presidency at the G20 to support the proposal, she added….”
And: the “Next TRIPS Council formal meeting will be on 23rd February to work on a draft report for the General Council that meets in early March. Countries are expected to meet in smaller groups for bilateral discussions in the coming days… “
https://healthpolicy-watch.news/us-rejoining-covax-should-involve-more-resources-says-fauci/
“The US decision to join COVAX “is likely to mean resources” to be able to get vaccines for people, Dr Tony Fauci, US President Joe Biden’s Chief Medical Advisor, told the International AIDS Society’s COVID-19 conference this week. … Fauci expressed concern that, while modifying vaccines to address variants “immediately attacks the problem at hand.. the downside is that you don’t want to be chasing mutations over the next couple of months and making an upgrade, upgrade. “So the long game of what we want to do is to get a universal coronavirus [vaccine] that is specific for SARS-COV2 so that we don’t have to keep chasing every time there’s a relevant mutation.”
And Berkley on the TRIPS waiver proposal: “… …. Earlier on Tuesday, Dr Seth Berkley, CEO of the vaccine alliance GAVI, said that while he agreed with activists on the urgent need to get everyone vaccinated, he was not sure that the tactic trying to get intellectual property rights waived on COVID-19 related products at the World Trade Organisation would work for vaccines. “For drugs and diagnostics, getting rid of the TRIPS arrangements and having patents freely available may be the solution. But the critical issue for vaccines is know how.” “AstraZeneca had enabled the Serum Institute of India to make its vaccine via a tech transfer and actually we want to pay for those tech transfers to other companies.” Waiving intellectual property rights may prevent cooperation, whereas with tech transfers meant that, “as problems in manufacturing have occurred, these have been discussed on a daily basis across the different manufacturers moving forward”….”
Must-read. “… The current controversy around intellectual property rights has focused on the role of intellectual property in the current Covid-19 vaccine shortage. But the present situation should not be understood as a manifestation of an exceptional legal event. Rather, it is a reflection of the legal normal that has been in place for the last twenty-five years since the 1995 TRIPS Agreement that forms the legal transnational structure for intellectual property-driven knowledge capitalism.
Tweet Els Torreele: “The entangled issue of public vaccine subsidy, ensuing distribution, and private intellectual property right raises the fundamental question of a government’s duty to the publics and who these publics include and exclude.”
Quotes: “… If there is any novelty in the present pandemic situation, it is that the Covid-19 pandemic does not only hit Africans, Asians and South Americans. The wealthy countries’ population might have become used to seeing others as pandemic subjects that are at the mercy of their charity. In the present pandemic, however, even the wealthy cannot pay their way out of it so easily, as Canada and the European Union member states are finding out. …. … ….”
A Prabhala et al ; https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html?auth=login-email&login=email
« They, too, work, and they can help fill shortages everywhere. »
From another angle, see also NYT - The Newest Diplomatic Currency: Covid-19 Vaccines
“India, China, the U.A.E. and others dole out donations in countries where they seek sway. In some cases, they are sending doses despite pressing needs at home.”
“External Affairs Minister S Jaishankar said some poor countries are being supplied the vaccine on a grant basis while some nations wanted it on par with the price that the Indian Government pays to the vaccine makers….” “India has so far supplied COVID-19 vaccine to 15 countries and another 25 nations are in the queue at different levels for the shots, External Affairs Minister S Jaishankar said on Saturday. He said there are three categories of countries which are keen to get the vaccine from India- poor, price sensitive nations and other countries which directly deal with pharmaceutical companies that make the antidote….”
See also Reuters – Vaccine diplomacy: India seeks to rival China with broad shipments
“India has approved the shipment of COVID-19 vaccine to Cambodia and plans to supply Mongolia and Pacific Island states, officials said on Sunday, as supplies arrived in Afghanistan - all part of the country’s widening vaccine diplomacy.;..”
“The supply of safe and effective vaccines for all is being artificially rationed because of the protection of exclusive rights and monopolies of pharmaceutical corporations, the People’s Vaccine Alliance said [today].”
“…The alliance warned that the three biggest vaccine companies in the world are largely sitting on the sidelines – they currently plan to produce enough COVID-19 vaccines for only 1.5 per cent of the global population in 2021. A number of other large manufacturers are not yet producing any of the successful, proven COVID-19 vaccines. At the same time, the producers of approved vaccines, Pfizer/ BioNTech, Moderna and AstraZeneca, aim to produce enough doses to vaccinate around a third the global population. But because rich countries have bought multiple doses of these vaccines the actual figure of humanity covered is a lot less. …”
“… The three biggest global vaccine producing pharmaceutical corporations by market value are GlaxoSmithKline (GSK), Merck and Sanofi and between them they have only pledged to produce 225 million vaccines this year. … It is also likely that potential capacity in developing countries is being overlooked. The Serum Institute of India is already producing hundreds of millions of vaccines for COVID-19 on behalf of AstraZeneca and Novovax as well as developing their own, but there are at least 20 more vaccine manufacturers in India… “
“… The People’s Vaccine Alliance is calling on US President Joe Biden and the governments of the UK and EU to use their emergency powers and to leverage their massive public funding to put pressure on Pfizer/ BioNTech, Astra Zeneca, Moderna and other subsequently successful vaccine producers, to openly share their vaccine science and technology, to waive their patents and insist that all other major vaccine producers get involved in production. …”
“… Jordan is one of the few countries to have begun vaccinating refugees as innoculation programs begin. Millions of others have been excluded from their host countries’ national vaccine programs or face added barriers to access. That could ultimately leave everyone at risk. Of 133 countries which UNHCR, the United Nation’s refugee agency, has information on, 81 have finalized their vaccination strategies and only 54 have included explicit provisions to cover populations of concern such as refugees, asylum seekers and stateless and internally displaced people. Refugee advocates warn that failing to include these vulnerable populations, many of which live in crowded and impoverished conditions, ultimately undermines a nation’s efforts to stop the coronavirus. International law makes host countries responsible for the health care of refugees and asylum seekers within their borders, but that norm has clashed with demands by some who say citizens should be prioritized….”
“… Covax, the World Health Organization’s global vaccine program for ensuring a more equitable distribution, said it is working to craft an “emergency buffer” that would set aside about 5 percent of available doses for humanitarian and emergency use. Low- and middle-income countries host most refugees, according to UNHCR. “The principle is that buffer will supply vaccine to countries where humanitarian affected populations, including refugees, asylum seekers, stateless, remain excluded from national rollouts to ensure they are reached,” Kathryn Mahoney, a UNHCR spokeswoman, said in an email….”
https://www.devex.com/news/meps-probe-europe-s-global-vaccine-strategy-99069
With the view of Jutta Urpilainen, EC commissioner for international partnerships.
Quote: “… In recent weeks, the commission has also floated the idea of a new “vaccine-sharing mechanism” to allow EU countries to donate doses to health workers and others in low-income countries. Urpilainen said Thursday that the mechanism would take place “hopefully through COVAX,” though details remain scarce. COVAX did not respond to a request for comment Thursday on how the mooted EU mechanism would work. And EU officials admit privately that the politics of asking national governments to send shots abroad while their own citizens are still waiting to be vaccinated can be tricky.
S Kiernan et al; https://www.thinkglobalhealth.org/article/vaccine-spheres-influence-tracker
“Tracking COVID-19 vaccine administration and access around the world.”
“Eight weeks after the first coronavirus vaccination campaigns began, many people—especially those living in low- and middle-income countries—are still wondering when their turn to get a shot will come and which vaccine they will receive. Based on government websites and statements, publications or contracts by vaccine manufacturers, and major local or international news media, Think Global Health has assembled that information. A table with detailed information and links to those sources, as of February 3, 2021, is included below and will be regularly updated. The vaccine that countries are able to procure and administer is a form of influence for the sponsor of that vaccine and the nations that funded the vaccine's development….”
Nice resource (with a world map). “…Devex maps out the projected vaccine allocations, including the type of vaccine each country will receive, and the percentage of its population the doses are expected to reach….”
S Kiernan et al; https://www.thinkglobalhealth.org/article/middle-income-nation-squeeze
“…By comparing cumulative reported cases and early COVID-19 vaccine administration, it is clear that countries that have been disfavored the most in the vaccine rollout to date are middle-income nations, as defined by the World Bank. Middle-income nations represent nearly half of the global burden of coronavirus cases, but a little more than one third of vaccine doses administered….”
“…The disparity grows larger when China, classified as an upper-middle-income nation, is excluded….”
D-I Ullstein & J-A Rottingen; https://www.weforum.org/agenda/2021/02/4-principles-pharma-action-combat-covid19/
“Collaboration is needed between pharmaceutical companies and governments to combat the spread of COVID-19 and accelerate access to tests, treatments and vaccines. Norway, which co-chairs the Facilitation Council of the ACT-Accelerator, is committed to ensuring the global vaccination effort is managed effectively. Here are four principles which could ensure equitable access to COVID-19 tools and health products, particularly for low and middle-income countries….”
They are: File for registration rapidly, widely and on the basis of the most rigorous standards; Price health technologies fairly; Expand production and supply capacity; transparency.
“ Teva Pharmaceutical Industries is in talks with COVID-19 vaccine makers to co-produce some shots, chief executive Kare Schultz told Reuters on Wednesday. Schultz said Teva, the world’s largest generics drugmaker, both approached and was approached by vaccine makers. It declined to name the companies with which it was in discussions….”
https://www.ft.com/content/29b6aa58-b6e1-4398-8d94-1dc8b004891f
“Sharing resources is an attractive concept, but it is difficult for a sector where competition is hard-wired.”
“Purchased through a private sector partnership by the corporate group that imports materials to process locally, the vaccine will be the first available to Nigerians.”
“One of Africa’s largest conglomerates, the BUA Group, has paid for one million doses of AstraZeneca Covid-19 vaccines for Nigeria through the African Export Import Bank (Afrexim) Vaccine programme. The purchase was made in partnership with the Coalition Against Covid-19 (CACOVID), a private sector task force collaborating with the Nigerian government, the Nigeria Centre for Disease Control and the World Health Organization (WHO) to combat Covid in Nigeria. These doses of the vaccine, which should be delivered by next week, will be the first delivery of vaccines to Nigeria since the Covid-19 shots became available. According to BUA, the vaccines will be distributed free to Nigerians at no cost…..”
https://www.voanews.com/covid-19-pandemic/zimbabwe-appeals-vaccine-funding-amid-surge-covid-19-cases
“Zimbabwe’s government is asking for help from the country’s corporate sector, citizens and other well-wishers to fund the import of COVID-19 vaccines….”
https://healthpolicy-watch.news/little-vials-big-crime-criminals-primed/
“Weak medicine regulators in Africa mean the continent is vulnerable to falsified COVID vaccines being circulated. Sources at international anti-crime agencies argue that Africa’s strong trade routes with China and India are going to allow criminals to introduce shipments of falsified vaccines into supply chains….”
“The World Bank approved today an additional financing of $5 million from the International Development Association (IDA) to provide the small island nation of Cabo Verde with affordable and equitable access to COVID-19 vaccines. This is the first World Bank-financed operation in Africa to support a country’s COVID-19 immunization plan and help with the purchase and distribution of vaccine in alignment with the COVID-19 Vaccines Global Access (COVAX) Facility….”
Links:
To sell or swap? South Africa weighs options for AstraZeneca shots ahead of J&J rollout
Reuters - Merck in talks with governments, other drugmakers to produce COVID-19 shots
See also the extra Covid section (scroll down).
https://www.economist.com/leaders/2021/02/13/how-well-will-vaccines-work
“Governments need to start thinking about how to cope” “…governments need to start planning for covid-19 as an endemic disease. Today they treat it as an emergency that will pass. … Across the world governments will have to work out when and how to switch from emergency measures to policies that are economically and socially sustainable indefinitely. …”
“Ease of transmission, new strains, limits of vaccination programs all mean Covid-19 will be around for years—and a big business.”
“Vaccination drives hold out the promise of curbing Covid-19, but governments and businesses are increasingly accepting what epidemiologists have long warned: The pathogen will circulate for years, or even decades, leaving society to coexist with Covid-19 much as it does with other endemic diseases like flu, measles, and HIV. The ease with which the coronavirus spreads, the emergence of new strains and poor access to vaccines in large parts of the world mean Covid-19 could shift from a pandemic disease to an endemic one, implying lasting modifications to personal and societal behavior, epidemiologists say….”
As well as big business.
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00360-3/fulltext
Horton asks a rather important question this week.
“…. Lifting lockdowns and risking the virus surging back will put a proportion of those still to be vaccinated in danger. This moment will mark the transfer of power from scientists back to politicians. It will be at this point that a serious public conversation will have to take place. Do we continue physical distancing, with persistent disruptions to schools, universities, workplaces, and leisure activities, until about three-quarters of the population are immunised (achieving herd immunity) or do we agree that a finite number of deaths must be accepted if we are to return to relatively normal lives? Our society has normalised deaths from many diseases. Why should COVID-19 be any different? In England, deaths from influenza vary from several thousand to as many as 30 000 per year. The question politicians will have to answer is this: what number of COVID-19 deaths are they willing to accept? And will the public trust their answer?”
J Kazibwe, P Baker et al ; https://www.cgdev.org/blog/we-can-stop-preventable-covid-deaths-urgently-prioritising-medical-oxygen-and-essential
“…We examine some of the likely causes of oxygen shortages in LMICs and suggest policy solutions. These include improving dialogue between the multilateral development banks and countries on oxygen needs and demands; establishing national task forces; and building partnership between countries, the World Bank, and other ACT-Accelerator (ACT-A) agencies to improve financing, contracting, regulation, infrastructure, and clinical use of oxygen….”
P Barlow et al; https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30291-6/fulltext
“The scale of the COVID-19 pandemic is a consequence of international trade and globalisation, with the virus spreading along established trade and travel routes. However, the pandemic also affects international trade through reductions in both supply and demand. In this Viewpoint we describe the many implications for health and propose ways to mitigate them. Problems include reduced access to medical supplies (in particular, personal protective equipment and tests), budgetary shortfalls as a result of reduced tariffs and taxes, and a general decline in economic activity—leading, in many cases, to recessions, threats to social safety nets, and to increased precariousness of income, employment, and food security. However, in exceptional cases, the pandemic has also brought some transient benefits, including to the environment. Looking ahead, there will be great pressure to further liberalise rules on trade to encourage economic recovery, but it is essential that trade policy be informed by its many consequences for health to ensure that the benefits are maximised and threats are minimised through active identification and mitigation.”
Labonté’s background paper for the PMAC conference. “A global pandemic could prove a windfall for investors suing governments over public health measures. Really? Yes, so it seems….”
“Bilateral investment treaties (BITs) and trade treaties with investment provisions (TIPs) are collectively referred to as international investment agreements (IIAs). This paper reviews how IIAs could be used by foreign investors to challenge measures used by governments of states that are parties to these agreements in their responses to the COVID-19 pandemic (SARS-CoV2). Part 1 of this paper describes the rationale for such investment treaties, their key provisions, the scale and outcomes of past investor-state disputes, controversies in dispute settlement procedures, and obligations that could potentially trigger a COVID-19 Investor-State Dispute Settlement (ISDS) claim. Part 2 identifies the range of government pandemic responses that could be open to such claims. Part 3 discusses government defensive arguments in response to ISDS pandemic-related challenges. Part 4 concludes with an overview of different preventative measures governments have taken, or could take, to minimize future ISDS risks.”
NPR;
Informative analysis. “ … The World Health Organization sparked the efforts in Feb. 2020 in the early days of the coronavirus crisis. The U.N. agency teamed up with over 40 tech companies to help disseminate facts, minimize the spread of false information and remove misleading posts. But there's one big question that's tough to answer: Is it working? Have any of these efforts actually changed people's behavior in the pandemic — or encouraged them to turn to more credible sources? Health messaging experts and misinformation specialists interviewed for this story praise WHO's efforts to reach billions of people through these tech industry partnerships. But they say the actions taken by the companies have not been enough — and may even be problematic….”
PS: this week Facebook said it will expand a list of false health claims it bans from the platform to include debunked claims about vaccines in general.
See also Devex - Facebook ramps up fight against COVID-19 vaccine misinformation
I Kickbusch & M Mayer; https://www.thinkglobalhealth.org/article/no-covid-germany-launching-policy-debate-complex-political-environment
“This new strategy proposal adheres to the principle that every infection is one too many.”
I still don’t see it, to be honest… but will be happy if proven wrong in the months ahead.
https://www.bloomberg.com/news/features/2021-02-01/the-most-interesting-u-s-city-hall-designs
Pathogen surveillance; repairing and augmenting WHO; genetic sequencing; developing more vaccines, faster; ironing out distribution and logistics.
But see also this related tweet Amanda Glassman: “The Five Things to Get Right Before the Next #Pandemic - a great list but missing global perspective - low-income countries aren’t yet counting all deaths or meeting basic health needs, no one safe until all safe.”
David Malpass https://blogs.worldbank.org/voices/covid-crisis-fueling-food-price-rises-worlds-poorest?cid=ECR_FB_worldbank_EN_EXT
On the importance of investing in social protection systems- given the impact of COVID on food prices.
“In an interview with Devex, Clarke (WHO) discussed the challenges countries face with private sector engagement amid COVID-19, how the new strategy might help, and how WHO itself is leveraging the private sector in pandemic response efforts….”
Quote: “A lack of strategy, tools, and know-how about working with the private sector is impacting countries’ responses to COVID-19 and universal health coverage efforts, according to David Clarke, team leader for UHC and health systems law at the World Health Organization. The private sector could be playing a critical role in providing maternal health and other essential health services, especially when the public sector is so overwhelmed, he said, but many countries don’t have the necessary governance know-how or infrastructure in place to allow this to happen. “This is a really important issue because now more than ever, countries need a whole-of-government, whole-of-society approach if they're going to tackle COVID-19,” Clarke said, adding that many countries have large and growing private sectors that are major sources of services but that historically they have been weakly governed and poorly coordinated….”
Yi-Ling Chi, A Glassman et al; https://www.cgdev.org/section/opinions/blogs
“Prior to the pandemic, many low-and middle-income countries (LMICs)–Bangladesh, Ethiopia, Senegal, Uganda, and Zambia to name a few—were on track to expand their Universal Health Coverage (UHC) arrangements. To what extent can LMICs still make real progress towards UHC as their economies enter some of the most severe recessions in centuries?...”
“…The pandemic is likely to exacerbate the constraints on public health financing in LMICs through the following channels: (i) decline in GDP translating into a decline in government revenues, (ii) decline in external support, and (ii) additional direct health costs from the COVID response….”
The authors also put forward several considerations for existing and future efforts, to build back better (with a view on UHC).
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00202-6/fulltext
“Richard Horton proposed the importance of Foucault's biopolitics as a concept for understanding COVID-19. While praising his commentary, we would add that in countries like Brazil, COVID-19 is not only about the politics of the body, but about the politics of death….”. “… Achille Mbembe's Necropolitics explains what is happening in Brazil…”
https://www.one.org/africa/issues/covid-19-tracker/#newsletter
The ONE Africa COVID-19 Tracker contains the latest reliable data from global institutions, governments, and universities on questions like:
“How many hospital beds do African countries currently have? What social protection measures are governments undertaking? How many people have insufficient food? Which governments are receiving debt relief?”
With also a weekly newsletter.
“Case near city of Butembo comes nearly three months after the end of an outbreak in the western province of Équateur, which killed 55… … The announcement potentially marks the start of Congo’s twelfth Ebola outbreak since the virus was discovered near the Ebola River in 1976, more than double any other country….”
See also WHO Afro - Resurgence of Ebola in North Kivu in the Democratic Republic of the Congo
Update: Reuters - Democratic Republic of Congo confirms two Ebola cases in resurgence of major outbreak “Two people have contracted Ebola and died this week in Democratic Republic of Congo’s North Kivu province, the World Health Organization (WHO) and the health ministry said in a statement….”
Telegraph - Second person dies of Ebola in DRC as experts fear new outbreak
P Soentjens et al ; https://gh.bmj.com/content/6/2/e004074
“Rabies, a fully preventable viral encephalitis, still claims at least 59 000 victims per year. Pre-exposure prophylaxis (PrEP) increases the probability of survival in bitten individuals but is hardly available to high-risk groups—like children—in endemic settings. The availability of simplified PrEP schedules and new modes of administration with a focus on specific risk groups should be seen as game-changers for PrEP feasibility in low-income and middle-income countries. We contend that there is a moral imperative to change the current paradigm where PrEP is available for international travellers to endemic regions but not to local individuals at risk. We call for a global effort to make simplified rabies PrEP available and affordable to those in need.”
https://www.ft.com/reports/future-antibiotics
Well worth a read, the new article in the series below:
FT - Push and pull: funding drugs to be used only sparingly
“New models are emerging to allow pharma companies to turn a profit regardless of how much new antibiotics are used.”
Excerpts:
“Approaches so far have focused on so-called “push” strategies, which aim to take drugs beyond what [Kevin] Outterson calls the “magic line” of regulatory approval, whether that be from the US Food and Drug Administration, the European Medicines Agency, or UK, Canadian or Japanese regulators. But there are also “pull” incentives, with which “you’re pulling from the market after approval”, says Outterson …. Both aim to make research and development of effective antibiotics palatable to companies and investors. … .. “Push incentives reduce the cost of research and development,” adds Outterson. “And pull incentives replace an ineffective market.” They reward successful development by increasing future revenue, he explains. One promising initiative is de-linkage, a “Netflix-type” subscription model in which sales are not dependent on the drugs being used, an approach Outterson describes as “outstanding”. … …. Pull incentives, according to a European Observatory on Health and Policy Systems paper, could include prizes for bringing drugs to market or hitting certain goals, and governments buying patents off drugmakers….”
Thomas Cueni “ ….says the AMR Action Fund, a $1bn backer of research created by pharma companies, is “one example of how investors can help in the short-term by supporting the failing pipeline. In the longer term governments have to step in to help create a viable market for new antibiotics”. The fund includes heavyweights such as Novartis and aims to make two to four novel antibiotics available to patients by 2030. … …. … “The entire US sales [volume] for the past 12 months of all patented antibiotics was $750m,” says Outterson. Considering that remdesivir sold nearly three times as much, “that’s indicative of a problem in how we pay for antibiotics.””
“Critics say the US$30m cost should have been invested in African institutions. A United States-funded programme to help African countries use their malaria-fighting resources more effectively has been slammed by critics who say it reinforces colonial structures and merely reproduces Africa-led efforts. The US President’s Malaria Initiative launched a five-year, US$30 million operational research and programme evaluation project on 26 January. It is led by Path, a Seattle-based public health nonprofit with a global footprint, in collaboration with seven other organisations based in the US, the United Kingdom, and Australia. …”
“… several public health experts have criticised the project. “This is scientific colonialism,” says Ngozi Erondu, a United Kingdom-based infectious disease epidemiologist who specialises in health policy in Africa. She asks why none of the eight organisations making up the consortium running the project are Africa-based….”
“… as need outstrips funding, experts are making the case for overhauling ‘old-fashioned’ donor-recipient narratives…”
Quote: “…Sara Pantuliano, chief executive of the Overseas Development Institute (ODI), believes we are witnessing a “serious crisis of legitimacy” of aid structures….”
T A Deivanayagham et al ; https://gh.bmj.com/content/6/2/e004582
« Policing is a public health concern because it is a tool of racist and discriminatory power structures, actively harming the physical, mental, social and emotional health and well-being of populations, particularly Black and people of colour, and other minoritised populations. Policing is a matter of public health because criminalisation and punitive responses to social problems reproduce the social and economic conditions that result in criminalised behaviours, undermining healthy communities. A fundamental tenet of abolitionist public health is developing and implementing interventions that tackle the interpersonal, social, economic and political determinants of health at the root of societal problems, thus making policing obsolete. Defunding the police and reallocating public funds to primary and secondary preventative policies aligned with the social determination of health are essential steps towards abolition….”
Pai’s interview with Dr Paul Farmer on his new book on Ebola, Covid-19 & why global health should also focus on inequities within high-income countries.
Quote: “…The first is about continuities and discontinuities in what’s termed “global health.” If we recognize that global health has colonial origins—and that colonial practices have been sustained well into the postcolonial era—we must also appreciate our own agency in rolling out new paradigms that are rooted in care, solidarity, and social justice. Do we want global health, as is practiced from universities across the globe, to be radically different from colonial health or tropical medicine? If so, then let’s stop referring to it as “global public health” or “global health security” and start calling it “global health equity.” This could mark a radical departure from the colonial-era policies that deemed caregiving too expensive or trivial for the “natives.”…
K Burgess-Jackson https://medwinpublishers.com/PhIJ/why-i-publish-in-predatory-journals-and-why-you-should-too.pdf
“This article has two purposes. The first is to explain why, after 38 years of publishing in “reputable” academic journals, I have decided to publish exclusively in what critics call “predatory” journals. The adjective “predatory” is singularly inapt in this context, for the true predators (i.e., exploiters, oppressors, plunderers) are wealthy multinational publishing corporations who treat researchers and authors as slave laborers. The second purpose is to advocate that other academics (especially those in my own discipline of philosophy) follow my lead.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00024-6/fulltext
“…We provide key recommendations (panel) and a detailed checklist (appendix) for applying a feminist approach that takes into account ethical, gender, and decolonisation considerations when collecting data in forced displacement settings….”
And a link:
· Lancet Digital Health (Comment) - Challenging racism in the use of health data (H Knight et al)
“… In this Comment, we examine how structural inequalities, biases, and racism in society are easily encoded in datasets and in the application of data science, and how this practice can reinforce existing social injustices and health inequalities. Approaching the problem from the perspective of data scientists, we follow the stages in an analytical pipeline to consider how and where things can go wrong. We then outline the essential role of data scientists in tackling racism and discrimination….”
https://news.trust.org/item/20210205062335-6fenp/
“From Kenya, Somalia and Tanzania in the east to Liberia, Sierra Leone and Nigeria in the west, the COVID-19 pandemic has led to a surge in reports of girls across Africa undergoing female genital mutilation (FGM), say women's rights groups. … FGM, which involves partial or total removal of the female genitalia, threatens 4 million girls annually. On Saturday, International Day of Zero Tolerance for Female Genital Mutilation aims to focus minds on the practice and bolster efforts to raise funds and awareness to stamp it out. More than 200 million girls and women globally have undergone FGM. It is practiced in more than 30 countries - largely in Africa, but also in parts of Asia and the Middle East, and by diaspora communities in the West….”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32545-9/fulltext
“….This report by the Lancet Commission on Public Policy and Health in the Trump Era assesses the repercussions of President Donald Trump's health-related policies and examines the failures and social schisms that enabled his election….” Focus on the US impact, but also some parts on the global impact (like on SRHR, climate, …)
For some coverage and a good summary, see The Guardian:
“…. In a wide-ranging assessment published on Thursday, the commission said Trump “brought misfortune to the USA and the planet” during his four years in office. The stinging critique not only blamed Trump, but also tied his actions to the historical conditions which made his presidency possible. … … … A line is drawn from neoliberal policies pushed in the past 40 years, such as those that intensified the drug war and resulted in mass incarceration, to health inequities Trump exacerbated while in office. Many of the connections date back even further, to the colonization of the Americas and the persistence of white supremacy in society….”
“The Global Coalition for Social Protection Floors calls on the G20 to launch an initiative to establish a Global Fund for Social Protection.”
KFF;
“A new KFF analysis finds that across 46 PEPFAR countries and among six different indicators of progress, the majority (40) has met at least one target, 17 countries have met at least half of the targets, and one country has met five targets. No country has met all targets and six have not met any target. The analysis is part of a dashboard that provides a detailed look at progress being made to address the HIV/AIDS epidemic in countries where PEPFAR operates and will be updated over time. It examines six different indicators of progress, including PEPFAR’s epidemic control target (the point at which the total number of new HIV infections falls below the total number of deaths from all causes among HIV-infected individuals), UNAIDS global “90-90-90” targets (90% of people living with HIV know their status, 90% of people who know their status are accessing treatment, and 90% of people on treatment have suppressed viral loads), and two other HIV incidence-based targets….”IISD;
“The Sustainable Development Goals Center for Africa and the Sustainable Development Solutions Network published the 2020 edition of the Africa SDG Index and dashboards report. The goals facing the greatest challenges in the region are SDG 3 (good health and wellbeing), SDG 9 (industry, innovation and infrastructure), and SDG 16 (peace, justice and strong institutions). The 2020 edition introduces a new index on the 2030 Agenda’s overarching ambition of leaving no one behind, and assesses the impacts of COVID-19 on SDG achievement in African countries….”
https://www.devex.com/news/experts-criticize-new-dna-project-designed-to-track-sex-offenders-98924
“Critics are raising concerns about the ethics and potential effectiveness of a new project aimed at tackling sexual abuse and harassment in the aid sector.”
“… The project — the brainchild of Andrew MacLeod, a campaigner against child sexual abuse in the aid sector — would see DNA samples taken from children in West and Central African countries whose suspected fathers are foreign aid workers. King's College London has provided £44,000 ($60,000) to MacLeod’s team to expand on a proof-of-concept project carried out in the Philippines with six people, which identified four fathers and gained some child support … … In an email to Devex about the project, MacLeod wrote that “This technology, dealing with a tiny subset of victims … will highlight the scale of the problem and put pressure back on the aid industry to make real change in how they stop abuse — not just empty words and platitudes like ‘zero tolerance.’””
“But while experts in the field of sexual abuse and exploitation acknowledged the sector’s failure to tackle the issue, they also voiced objections over what they saw as the questionable ethics and likely ineffectiveness of the DNA project, with some saying it could undermine wider safeguarding efforts. “This is just not humanitarian work; it's a deeply moralistic agenda coming out of the global north,” said Kristin Sandvik, a research professor at the Peace Research Institute Oslo who described the project as “extremely problematic.” “Should the humanitarians become the police?” she asked….”
S Mondal et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa163/6132076?searchresult=1
« Intersectoral action (ISA) is considered pivotal for achieving health and societal goals but remains difficult to achieve as it requires complex efforts, resources and coordinated responses from multiple sectors and organizations. While ISA in health is often desired, its potential can be better informed by the advanced theory-building and empirical application in real-world contexts from political science, public administration and environmental sciences. Considering the importance and the associated challenges in achieving ISA, we have conducted a meta-narrative review, in the research domains of political science, public administration, environmental and health. The review aims to identify theory, theoretical concepts and empirical applications of ISA in these identified research traditions and draw learning for health. … … Overall, our review reaffirms affirms that ISA has both technical and political dimensions. In addition to technical concerns for strengthening capacities and providing support instruments and mechanisms, future research must carefully consider power and inter-organizational dynamics in order to develop a more fulsome understanding and improve the implementation of intersectoral initiatives, as well as to ensure their sustainability.
https://gh.bmj.com/content/6/2/e004392
By N V Rao, NS Prashanth & P B Hebbar. “”…An adaptive governance framework that relies on shared accountability while reconciling varying levels of flexibility across three dimensions—operational processes, institutional linkages and health system values, is the way to build a resilient health system in India. We identify three reforms as illustrative examples of how a process of continuous consultation, coordination and collaboration across central, state (provincial) and local levels of government, with an underlying adaptive governance logic ought to be driving these reforms….”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00361-5/fulltext
“… The COVID-19 pandemic has highlighted the need to address racial and social inequalities globally, but the same lens is often not applied to prison-related policies. Prison health systems remain a weak link in public health preparedness, racial and social justice, and human rights….”
“Several areas could be prioritised for legal and policy reform to improve prison health….”
https://twn.my/title2/briefing_papers/twn/FiscalSOSfinal.pdf
“…. new TWN Briefing Paper by Bhumika Muchhala and Alexander Kozul-Wright on the urgent need for the issuance of Special Drawing Rights (SDRs), a tool of the International Monetary Fund (IMF), to provide fiscal assistance to developing and least developed countries to tackle COVID-19 and its associated socio-economic crises. … While there is a new momentum with the Biden Administration possibly supporting the issuance of SDRs, many challenges exist that require a global solution that is equitable and does not create another round of debt for the affected countries, as set out by the authors of the Paper.”
B Hensen et al ; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czaa158/6130108?searchresult=1
“… In response to Covid-related measures, many public health researchers are choosing to switch from standard face-to-face data collection methods to remote data collection in support of continued research. Remote data collection is defined here as the collection of data via the phone, online or other virtual platforms, with study participants and researchers physically distanced. The aim of this commentary is to summarize methods, key challenges and opportunities of remote qualitative and quantitative data collection for public health research in low- and middle-income countries (LMIC). The framework we use to structure our discussion is the research process, starting from sampling and culminating in analysis. Within this, we draw out the steps in research most likely to be affected by the pandemic and attendant need to cease face-to-face interactions with research participants. We identify which steps are most affected and what are potential alternatives based on interviews and discussions, held between May and June 2020, with ∼30 researchers from the London School of Hygiene and Tropical Medicine and collaborating partners, representing a range of disciplines. …. These consultations identified the following as the steps in research most likely to require attention: sampling and recruitment; informed consent; response rates; rapport with participants; privacy and safety; and analysis….”
L Naccarella et al ; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00553-8
“The United Nations Children’s Fund (UNICEF) published their Health Systems Strengthening (HSS) approach to meet its strategic goals of ending preventable maternal, newborn and child deaths and promoting the health and development of all children and reducing inequities in health in 2016. UNICEF commissioned the University of Melbourne’s Nossal Institute for Global Health to develop and deliver a pilot blended HSS program, involving 60 hours of online learning and 2 weeks of face-to-face teaching over a 6-month period. To assess the extent to which the HSS program had built the first 83 UNICEF 2017 graduates’ capabilities to apply HSS actions by 2017, UNICEF funded an independent evaluator from the University of Melbourne….” Check out the findings.
https://mayday.leftword.com/catalog/product/view/id/22190
“… Amit Sengupta (1958–2018) believed the job of a doctor was not simply to treat a sick individual, but to build a society in which health is a fundamental right of all citizens. In these times of the Covid-19 pandemic, such a perspective is more relevant than ever. The essays in this book trace how Sengupta's work and politics were integral to the history of the health movement, and how this movement evolved from ‘medicines for all’ to ‘health for all’. Sengupta's work of a lifetime is supplemented and framed by his colleagues in the movement: David Sanders, SP Shukla, Prabir Purkayastha, Satyajit Rath, Sarojini Nadimpally, Indranil, David Legge, Kajal Bharadwaj and many others….”
Z Zeinali et al ; https://www.ijhpm.com/article_4009.html
“This systematized review explored the existing literature around women’s progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis….”
Easily the blog of the week 😊.
On the life journey of the work of an Anganwadi worker in a deprived Karamkode Paniya settlement. Panyia are a tribal group in the state of Kerala.
“China recently released a long-awaited update on its plans for aid reform. From a broader model of development cooperation to greater transparency, Beata Cichocka, Ian Mitchell, and Euan Ritchie review what's changed, what's stayed the same, and where they remain hopeful. “
The 3 shifts: China broadens its model of development cooperation; Encouraging commitments on aid, effectiveness and transparency; Increased volume, more grants, and emphasis on global public goods.
K Bertram; https://pfipartners.org/2021/02/09/partnership-fatigue/
In this blog Katri Bertram discusses what happens when partnerships run out of steam, what the stumbling blocks are, and how partnerships can ensure they stay on track – to deliver impact.
Key points: “Partnership fatigue is a common challenge in many international development partnerships, and hampers impact. Partnership fatigue can be caused by factors such as: an inability to move to implementation, an overstretch of partners in too many or too many similar partnerships, unclear mandates and goals, and/or organisational and staff goals that are not aligned with partnership impact goals. Partnership fatigue can be prevented or overcome by focusing on 5 key areas: governance, a clear strategy for implementation, alignment of incentives, communication, and having an exit plan.”
“The most interesting clue was what @MarionKoopmans explained: That some animals known (rabbits) or suspected (ferret-badgers, bamboo rats) to be susceptible to #SARSCov2 were at Huanan market and came from farms/traders in regions where bats are known to harbor related viruses.”
“What worries me: global health spends last decades saying we need to build capacity in LMICs to improve global health security During #COVID19 HIC health systems crumble much more than LMIC Results in less health system strengthening and UHC efforts + financing in future.”
· Coming up: 16 Feb – (Alliance) Webinar: Co-producing knowledge for stronger health systems
“Numerous voices have called for more effective and innovative ways to bridge the divide between knowledge generation and uptake, including collaborative models to integrate health research into policy and practice. Attention now focuses on collaborations between researchers and end-users of research, including patients and the public, health professionals, health system managers, and policy-makers. Co-production of research is being advocated globally, and across sectors. But there remains uncertainty on what co production of research entails, how to do it, when to do it, and when not to do it. Clarity on these issues is essential for co-production of research to deliver on its promise and avoid wasting time, resources, and the good will of end-users. A new collection in BMJ focuses on these issues and will be launched at this webinar.”
· Some recordings of the PMAC 2021 plenary sessions are now available! Others will follow soon: https://pmac2021.com/program#keynote
“…. Ministers, who are keen to avoid an embarrassing row about Britain’s place in the world, are now expected to postpone changing the legislation until after the Prime Minister has hosted the G7 gathering in Carbis Bay, Cornwall, in June….” Let’s see what the Tory ‘opposition’ to the aid cuts leads to.
“Following high-profile sexual harassment allegations against officials, the U.N. has instituted various reforms over the last few years. But the changes have not dramatically changed workplace culture, former and present U.N. employees say.”
J M Vera et al ; https://brill.com/view/journals/hjd/15/4/article-p624_12.xml
“International non-governmental organisations have, for some time, been operating as diplomacy actors in the national and international public spheres. There has been an increase in their influence in the local areas of intervention of their programmes and in broader spaces where polices about the environment, inequality and other issues are decided. However, their influence has been threatened by the emergence of social movements and a flexible style of individualised activism that promotes their demands, as well as by questions around their independence and legitimacy that some of their actions generate cyclically. COVID-19 has brought into the public sphere some old challenges that international non-governmental organisations (INGO s) have been working on for years: health vulnerability, economic precarity and social emergency. This essay analyses this context, in which new challenges are appearing for INGO s concerning how they can influence the public sphere and policy-making, with the collaboration of new allies and partners.”
And a few links:
· Stat - CDC director says ‘bruises are going to take a long time to heal’ at agency
· Al Jazeera - Amnesty International launches fundraising campaign to counter an ‘anti-human rights agenda’.
“The scale of attacks on rights defenders around the world is gravely concerning, says Amnesty International. The rights group launched its first global emergency fundraising appeal to help protect them. It is now calling on individuals and large donors to expand their support….”
https://newsletter.uhc2030.org/t/t-9CC5AF9BB514FBC12540EF23F30FEDED
Check it out. Most info already flagged in last week’s IHP newsletter.
“The pledges countries made to reduce emissions as part of the 2015 Paris agreement are woefully inadequate, and the world must nearly double its greenhouse gas-cutting goals to avoid the most catastrophic effects of climate change, according to research published Tuesday. “The commitments are not enough,” said Adrian Raftery, a University of Washington statistics professor and co-author of the study, published in Communications Earth & Environment. The study found that even if countries were to meet their existing pledges, the world has only about a 5 percent chance to limit the Earth’s warming to “well below” 2 degrees Celsius (3.6 Fahrenheit) over preindustrial levels — a key aim of the international agreement. Raftery and a colleague calculated that global emissions would need to fall steadily — about 1.8 percent each year on average — to put the world on a more sustainable trajectory. While no two countries are alike, that amounts to overall emissions reductions roughly 80 percent more ambitious than those pledged under the Paris agreement, he said….”
https://www.sciencedaily.com/releases/2021/02/210205085718.htm
“A new study provides evidence of a mechanism by which climate change could have played a direct role in the emergence of SARS-CoV-2, the virus that caused the COVID-19 pandemic.”
“Global greenhouse gas emissions over the last century have made southern China a hotspot for bat-borne coronaviruses, by driving growth of forest habitat favoured by bats….”
“Report says pollution, parasites and fish mortality rates cost an estimated $50bn globally from 2013 to 2019.”
A link:
Science - Bill Gates's guide to avoiding climate catastrophe
Book review of Gates’ new book. “How to Avoid a Climate Disaster: The Solutions We Have and the Breakthroughs We Need” . He offers a pragmatic approach to achieving greenhouse gas targets.
PS: Finally, Mike Bloomberg was appointed UN Special Envoy for Climate Ambition and Solutions.
G Yamey; https://www.bmj.com/content/372/bmj.n373
“Successful development of covid-19 vaccines can provide a blueprint.”
Excerpt: “… A relatively modest increase in funding could reap large rewards for global health. One modelling study found that even an additional $1bn in annual funding for development of vaccines for neglected diseases could greatly increase the odds of launching vaccines against malaria, hepatitis C, and diarrhoeal diseases. Covid-19 vaccine efforts also benefited from innovations in the governance of vaccine development, such as the 2017 launch of the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private partnership that funds epidemic vaccine development. …. Such new forms of governance should now be replicated in the broader vaccine development landscape. In particular, a new mechanism is urgently needed to aggregate public, philanthropic, and private financing for phase III trials of vaccines against neglected disease, the costliest phase of development with the lowest chance of success. Finally, important lessons must be learnt from the successes and failures in supplying covid-19 vaccines globally. Making a vaccine in the laboratory is only the first step: a pathway is also needed to link successful phase III trials with large scale globalised manufacturing, distribution, storage, and delivery…”
https://www.unaids.org/en/resources/documents/2021/EducationPlus_Brochure
“A new advocacy initiative for adolescent girls’ education and empowerment in sub-Saharan Africa, backed by an unstoppable coalition for change led by adolescent girls and young women, is being launched in 2021…..”
H Hurd; http://blogs.biomedcentral.com/bugbitten/2021/02/02/bad-news-for-guinea-worms/
“The prospect of eliminating a parasitic disease afflicting humans took a leap forward in 2020, despite restrictions caused by a global pandemic.”
“In the same week that the latest WHO Neglected Tropical Diseases report was published (featured in our blog last Friday), the Carter Foundation made two very encouraging announcements concerning Guinea Worm eradication. …. The first of two pieces of good news just reported by the Carter Foundation is that, in 2020, the number of human cases fell to just 27 worldwide. This is a drop of 50% since the year before, despite the logistical problems caused by the Covid-19 pandemic. Chad and Ethiopia had the majority of cases, with only one case reported in each of South Sudan, Angola, Mali, and Cameroon. In addition, infections in animals fell by 20%. 1570 cases of animal infections were recorded, with cats and baboons, as well as dogs, infected. Second: Substantial renewed support of $10M for the Carter Center’s Guinea worm eradication programme has been announced by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, following the 30th anniversary of the organization’s partnership with the United Arab Emirates. …”
And a few links:
· Devex - Can new ethical guidelines reshape HIV prevention trials?
“The NCD Alliance (NCDA) and World Diabetes Foundation (WDF) announce a new partnership aimed at promoting sustainable and multisectoral responses to the growing burden from noncommunicable diseases (NCDs), with focus on the critical role of civil society….”
P Barlow et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953621000939
Critical discourse analysis of informal challenges to nutrition labelling polices.
And via a WB blog:
“ The World Bank has a diversified portfolio of health systems and health services investment operations supporting NCDs, totaling roughly US$1.5 billion (2019), which represents about 12% of the Bank’s overall Health, Nutrition, and Population lending. The World Bank provides financial support, policy advice, and technical assistance to reduce key risk factors for NCDs, including cancer. World Bank also helps countries strengthen early detection and screening, promote risk reduction, revamp health systems, and facilitate reforms to shift attention from costly secondary care to primary health. …”
M Schaaf et al ; https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01398-2
“…. In this commentary, we argue that we must include an examination of power in research and evaluation of social accountability in sexual and reproductive health, and suggest ways to do this. The authors are part of a community of practice on measuring social accountability and health outcomes. We share key lessons from our efforts to conduct power sensitive research using different approaches and methods….”
Links:
· BMJ Global Health - Parliaments lead the change for women’s, children’s and adolescents’ health: what have we learnt?
“Leadership, gender, multistakeholder partnerships and social accountability facilitate parliamentary action for improved women’s, children’s and adolescents’ health (WCAH) outcomes. Governments and development partners should increase predictable, long-term and flexible funding to support and enhance parliamentary action for WCAH….”
· Global Health: Science & Practice - Levels, Trends, and Inequalities in Using Institutional Delivery Services in Low- and Middle-Income Countries: A Stratified Analysis by Facility Type
“Despite improvements in the use of institutional delivery services around the world, progress has not been uniform across low- and middle-income countries. Persistent and growing inequalities in the utilization of institutional delivery services warrant the attention of policy makers for further investments and policy reviews.”
“The South African police have arrested six people in the past two weeks for trying to smuggle large quantities of the anti-parasitic medicine, ivermectin, into the country from India as demand for the drug as a treatment for COVID-19 surges internationally. Ivermectin is only registered to treat parasitic infections in animals in the country, although it is used throughout Africa to treat people with river blindness and scabies. However, under pressure from doctors and patients, the South African Health Products Regulatory Authority (SAHPRA) announced late last week that it would allow doctors to apply to use it for COVID-19 patients on “compassionate grounds” via a complicated process….”
“…There is already widespread use of ivermectin as a COVID-19 treatment – not only in South Africa, but throughout Latin America. Both Peru and Bolivia have already granted doctors permission to use it as a COVID-19 treatment. But the head of the South African health minister’s advisory committee on COVID-19, Professor Salim Abdool Karim, said in a weekend media interview that there was “no compelling case” to use ivermectin to treat COVID-19, available studies were “of really poor quality” and that “the amount of drug needed to kill the virus is toxic to humans”….”
W D Odoch et al ; https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czaa189/6132736?redirectedFrom=fulltext
“The WHO Model List of Essential Medicines (MLEM) has since 1977 helped prioritize and ensure availability of medicines especially in low- and middle-income countries. The MLEM consists mainly of generic medicines, though recent trends point towards listing expensive on-patent medicines and increasing global support for medicines against non-communicable diseases. However, the implications of such changes for national essential medicines list (NEML) updates for access to essential medicines has received relatively little attention. This study examined how government agencies and other actors in Kenya, Uganda and Tanzania participate in and influence the NEML update process and subsequent availability of prioritized medicines; and the alignment of these processes to WHO guidance….”
CGD;
“In October 2020, the Center for Global Development—in partnership with African Union Development Agency-NEPAD (AUDA-NEPAD), UN Economic Commission for Africa (UNECA), and the African Leaders Malaria Alliance—hosted a high-level roundtable on regional health product manufacturing in Africa. This blog is based on the authors’ reflections of the roundtable.”
H Perry et al; https://www.ghspjournal.org/content/early/2021/02/04/GHSP-D-20-00459
“National community health worker programs are at the dawn of a new era, given the growing recognition of their importance for achieving global health goals and for controlling the COVID-19 pandemic. Now is the time to provide them with the respect and funding that they need and deserve.”
“…Training more professionalized CHWs with better and longer training, better supervision, improved logistical support, and well-defined career paths, and linking them to lower-level volunteer workers, each serving a small number of households, will help strengthen program effectiveness and improve CHW morale and long-term retention.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00362-7/fulltext
“Government officials have dismissed COVID-19 vaccines and promoted unfounded remedies. Munyaradzi Makoni reports.”
WEF;
“U.N. Women's Phumzile Mlambo-Ngcuka has called for more women in leadership roles to help the COVID-19 recovery. Only 22 countries have an elected woman head of state or government, while 119 nations have never had a woman leader, according to U.N. Women. Data shows that at the current rate, parity would not be reached in national parliaments before 2063, and in ministerial positions before 2077.”
https://advances.sciencemag.org/content/7/6/eabe0997
“Despite numerous journalistic accounts, systematic quantitative evidence on economic conditions during the ongoing COVID-19 pandemic remains scarce for most low- and middle-income countries, partly due to limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. We assemble evidence from over 30,000 respondents in 16 original household surveys from nine countries in Africa (Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone), Asia (Bangladesh, Nepal, Philippines), and Latin America (Colombia). We document declines in employment and income in all settings beginning March 2020. The share of households experiencing an income drop ranges from 8 to 87% (median, 68%). Household coping strategies and government assistance were insufficient to sustain precrisis living standards, resulting in widespread food insecurity and dire economic conditions even 3 months into the crisis. We discuss promising policy responses and speculate about the risk of persistent adverse effects, especially among children and other vulnerable groups.”
WEF;
“Women, younger adults and individuals of lower socioeconomic status are most affected by COVID-19-related anxiety or depression, a study has found. Researchers performed a meta-analysis of 68 studies conducted during the pandemic, that included 288,830 participants from 19 countries. Factors that are associated with psychological distress include living in rural areas; lower education, lower-income, or unemployment….”
(4 Feb) “As the roll out of coronavirus (COVID-19) vaccines begins, this policy brief asks how to ensure vaccines for all. In doing so, it examines the case for multilateral approaches to access and delivery, maps key challenges, and identifies priority actions for policy makers. …. While new collaborative efforts such as ACT Accelerator and its COVAX initiative are helping to bridge current gaps, these are not enough in circumstances where demand far outstrips supply. Based on the current trajectory, mass immunisation efforts for poorer countries could be delayed until 2024 or beyond, prolonging human and economic suffering for all countries. Policy actions to support equitable vaccine access in developing countries include: (i) supporting multilateral frameworks for equitable allocation of vaccines and for crisis response, resilience and prevention; (ii) highlighting the role of development finance; and, (iii) promoting context-driven solutions.”
N Maani & S Galea; https://www.scientificamerican.com/article/what-science-can-and-cannot-do-in-a-time-of-pandemic/
“It can inform policy, but it can’t dictate how to weigh the moral and political nature of policy makers’ decisions.”
“… we argue that honestly communicating on the nature of policy trade-offs, and what’s done to ameliorate them, should be at the heart of decision-making in the post-COVID era, both for the U.S. and the world. …”
https://www.ft.com/content/71e53321-3719-4f10-9406-c614a5ddc1b8
“E484K, the genetic change in the variant first identified in South Africa, is affecting the efficacy of some vaccines.”
Excerpt: …. “As Professor John Edmunds of the London School of Hygiene and Tropical Medicine has said, “[the] immune landscape for the virus is changing as more people are infected and vaccinated against it.” During the first phase of the pandemic in the first half of 2020 Sars-Cov-2 was spreading through a previously unexposed population, so there was little Darwinian pressure on the virus to evolve mutations to evade the attentions of the immune system. This has now changed. Epidemiologists say the moment of maximum danger may come within the next few months when a larger number of people have been infected or vaccinated but many still remain unprotected. Then there would be enough community transmission to generate new variants and enough immunity to create an advantage for variants that can escape it….”
https://www.spectator.co.uk/article/the-value-of-vaccine-diplomacy-
Quote: “… Dr. Peter Hotez, co-director of the Centre for Vaccine Development at Texas Children’s Hospital and a former science envoy in the Obama administration, is the author of a forthcoming book, Preventing the Next Pandemic Vaccine Diplomacy in a Time of Anti-science. We discussed the Chinese, Indian, and Russian vaccine programmes. He told me he viewed India’s approach, ‘as more of a pure expression of true “vaccine diplomacy”’, emphasising India’s track record of mass vaccine production, and longstanding history of working with the World Health Organisation’s (WHO) established regulatory mechanism. He suggested, ‘the likelihood is that India is going to rescue the world in making low-cost high-quality vaccines available and responding quickly to the new variant to adjust their vaccines accordingly.’ Hotez told me that ‘with China it seems to be very much linked to exerting political influence which is not really in the true spirit of “vaccine diplomacy”, it’s more this new term called “vaccine nationalism’”….”
C Kenny; https://www.cgdev.org/blog/release-covid-19-vaccine-contracts
“Drugs created with billions in government support, bought almost exclusively by governments and international agencies are shrouded in secrecy: who is paying how much for delivery of what by when is a matter of guesswork and estimate.” “ It is time for COVID-19 vaccine contract transparency.” “…it's not just price and volume but delivery timing too!...”
https://www.washingtonpost.com/nation/interactive/2021/vaccination-pace-herd-immunity/?tid=ss_tw
“Experts warn that the current pace of vaccinations won’t just prolong coronavirus restrictions. It could also make it more likely that new variants will infect the previously immune.” Focus on the US, but relevant for many other settings.
https://www.ft.com/content/797e3d7b-0091-4bfd-8cae-c0b5be380772
“The spread of new Covid strains has made it even more urgent to launch rapid vaccination programmes in poorer countries.”
Excerpts: “News this week, first reported in the Financial Times, that the Oxford/AstraZeneca vaccine appears to offer no protection against mild and moderate disease caused by the 501.V2 variant first detected in South Africa, increases the urgency of immunising people in poor countries as well as rich ones. If Covid-19 continues to circulate in unprotected populations, experts warn, it will rapidly mutate, possibly finding ways of evading the current crop of vaccines altogether. … …. Yet the South African study, led by the University of the Witwatersrand, also complicates the goal of vaccinating the developing world. The Oxford/AstraZeneca jab, which is being offered at cost during the pandemic and is easy to store and transport, was meant to play a huge part in the initial rollout, particularly in poor countries….”
“… Now that the WHO has recommended the Oxford/AstraZeneca vaccine for worldwide use, those doses will still be valuable in countries where the 501.V2 variant is not circulating, including India, much of Africa and Latin America. Even where the 501.V2 variant has a foothold, the jab could still be a lifesaver by preventing serious disease. …”
“… As more vaccines come on stream, the picture will improve. At the end of January, Novavax, a US vaccine company, and Johnson & Johnson, whose one-shot vaccine is ideal for developing countries, both posted promising Phase 3 data. South Africa studies have also shown that both prevent serious illness from the 501.V2 strain. On February 3, Covax said it had struck a long-term supply agreement with the Serum Institute of India, the world’s largest vaccine manufacturer, for 1.1bn doses of the AstraZeneca and Novavax vaccines at $3 a dose. The day before, Sputnik V, a Russian vaccine made by the Gamaleya Institute, showed 92 per efficacy against symptomatic Covid, according to preliminary data published in the Lancet. …”
… In other African countries, too, governments are desperately trying to secure doses to meet ambitious national plans. This month, Nigeria, a country of more than 200m people, raised its order from the African Union fourfold to 41m doses and said it was exploring the possibility of bilateral vaccine deals with Russia and India. Dr Faisal Shuaib of Nigeria’s National Primary Health Care Development Agency says the government hopes to immunise 40 per cent of people this year and a further 30 per cent in 2022, although some describe that target as wildly hopeful. …”
“ Fortunately, it may not be necessary to reach 70 per cent of the population, says Berkley, the Gavi chief executive. Like many countries in Africa, half of Nigeria’s population is below the age of 18, meaning that a 50 per cent vaccination rate would cover almost the entire adult population. … The competition between countries — particularly India, China and Russia — to supply vaccines to the world is another aspect of the global scramble. There has been heavy demand for both Chinese and Russian vaccines….”
“ … Berkley at Gavi dismisses projections that the developing world will have to wait until 2024 to be properly protected. This year, says Berkley, the main limiting factor is likely to be manufacturing capacity in an industry where it is incredibly difficult to quickly ramp up supply of delicate biologics. South Africa and India have asked the World Trade Organization to suspend intellectual property rights on vaccines, but many experts, including at Covax, say IP is not a significant obstacle to a rapid scale-up. …”
U Alam, J Nkengasong, M Moeti et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30545-3/fulltext
“… we should not mistake COVID-19 as the biggest pandemic of our time. If anything, it is only a dry run, with other epidemics brewing on the horizon. Therefore, if the global community is serious about epidemic preparedness, global health security, and protecting the most vulnerable, we need to redesign health systems for resilience. Africa's lessons from the COVID-19 pandemic, as well as from concurrent outbreaks of cholera, Ebola virus disease, yellow fever, and chikungunya, could provide a roadmap…..”
And a link: Will Tech Save Healthcare?
“Covid-19 is the first pandemic of the digital age”. Interview with I Kickbusch.