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Against the backdrop of, increasingly, “two pandemics” – “As we ease up, virus sweeps the world’s poor” (Guardian) some have called this month of May perhaps “the most important month for global health ever”. From that point of view, the great news on Wednesday that the U.S. would back the proposal to waive intellectual property rights (at least for vaccines) seems like a good start, even if the WTO negotiations on this still don’t look like a shoe-in. More encouraging news, with the G7 summit coming up in June, it seems at last “a package to speed up the supply of vaccines to LMICs by making commitments to export surplus vaccines and by ramping up production” might see the light. According to a draft seen by Reuters, some “real money” could also come via the G20, it appears. And as ‘icing on the cake’, even the Gates Foundation changed its stance on the issue of a temporary Trips Waiver on Thursday. Not a bad start for this month of May 😊.
Still, we shouldn’t forget what rich countries in the West understood under ‘global solidarity’ and ‘access to vaccines as a Global Public Good’ in April 2020. By now it’s clear they meant: “We will (1) vaccinate our own adults first, all of them (including the not very vulnerable young adults), and only then, we’ll help facilitate global vaccine supply, while (2) continuing to treat our own pharmaceutical companies with soft gloves.” That certainly goes for European leaders (+ UK & Switzerland). As you know, till recently, in the US, with the previous “president”, the situation was even worse. Also for the Biden Administration, the first point remains more than valid, while for the second only now the gloves seem to come off – to some extent, at least.
Let’s just look at the situation on Wednesday evening, before the – gamechanging – news broke on the new US stance and global health policy twitter was set on fire (while I was, unsuspecting, watching a rubbish Real Madrid team). It still looked (and looks) like Covax would only in the second half of the year really get going, which was perhaps always to be expected given the above ( even if it’s fair to say the not really anticipated fierce second wave in India didn’t help Covax ). This week also saw additional (whopping) fundraising estimates for ACT-A (incl Covax) in the coming years going in the tens of billions while Pfizer upgraded its full-year expectations for revenue from the jabs to $26bn (from $15b). (Yeah, you’re not the only one wondering whether there’s a correlation, but as a half-baked scientist, I refrain from commenting 😊) (PS: In my country, Pfizer is largely seen as the ‘good guy’, as we have a company in Puurs, a Belgian town, and Pfizer has been rather reliable in terms of deliveries in the EU (unlike AZ). As is well known by now, Ursula VdL clearly also considers André Bourla a ‘good guy’ )
But frankly, it’s not just our leaders. For most citizens in Europe (don’t know about the US) this seemed all just fine. Even with the horror in India ongoing, public opinion indignation was just not high enough to put sufficient pressure on our leaders. Too many of us saw the coverage on India, empathizing, sure, but also thinking, ‘what can “we” do about it?’, “Seems like Modi has screwed up like Bolsonaro (not exactly wrong)” etc. And then, a few days later, the India tragedy already became ‘content’ for our newspapers (including very sensationalist headlines to draw attention), on 1-2 pages max, and our citizens began to feel about it like they do about the dodgy role of the EU at its borders and drowning migrants, or our role in the climate crisis, considering all of these as almost “natural calamities” in which we have no role of our own. Yes, we might not like Big Pharma’s IP protected profits but too few of us challenged our leaders’ rigid positions. Plus, it’s “somebody else’s problem”, and “will probably last our time”. And hey, can we now finally get our beer on a terrace in the sun, and watch Kevin de Bruyne together with our pals like in the old days?
Fortunately, while there are no doubt many reasons behind the Biden administration’s new stance, one of them must surely be this one: the assessment that Ellen ‘t Hoen was indeed damned right, when she concluded her ruthless debunking of all trademark Big Pharma arguments against sharing Covid-19 related IP with this quote: “Rejecting both the TRIPS waiver and the WHO’s C-TAP pool is not a tenable position. Something will have to give. Humanity’s future depends on it. “ I have a hunch the Biden administration also understands better (than Team Europe et al) the high symbolic value of a temporary TRIPS waiver, especially given the omnipresent rhetoric since the very beginning of this pandemic that “no one will be safe until we’re all safe”.
No doubt, there are also some higher ‘geopolitical’/diplomatic reasons for at last doing something substantial. See this telling quote in The Guardian: “Diplomats concerned by the scenes in India and the high-profile supply of vaccines by China to Africa seem belatedly to be waking up to the damaging impression that could be left for western democracies if they are seen to be hoarding vaccines while the poor die.” Still, I’m not cynical enough to think this was the main reason for the Biden administration. In this Trips waiver debate, it was never going to come from Emmanuel, Boris, Ursula/Charles, it had to be Biden, who gives the impression to be of Gordon Brown material so far (and if he isn’t, there are enough good people around him to “nudge” him in that direction 😊). Anyway, with the pandemic accelerating again in many LMICs in South Asia, the carnage in India, Brazil and other South-American countries, and leaders in Africa also worrying about the possibility of an Indian horror scenario, this comes not a day too soon.
Dr Tedros reiterated it once again, this week, like a broken record: “If we cannot use an IP waiver now, then when?” Provision of waiver was meant for unprecedented emergencies. The emergency is now. In interest of each and every country in the world. “With variants popping up around the world, it is not a charity issue.” Truth is, it never was a charity issue. But most European leaders (and citizens) treated it as such, for far too long. It took a new US president to come with some real “moral leadership and wisdom” – in the words of Tedros again. Joe did the right thing, even if there’s certainly still room for improvement.
Enjoy your reading.
No prizes to be won here, and no, it’s not the divorce of the Gateses 😊. See also the intro. (PS: more on the Trips waiver discussions also later in this newsletter).
“The United States has swung its weight behind a hotly-debated proposal by India and South Africa to suspend intellectual property rights on COVID-19 vaccines for the duration of the pandemic. The dramatic turnabout in the US position, announced Wednesday evening by US Trade Representative Katherine Tai, signals a sea change in the balance of powers around the debate over the IP waiver – which until now had been supported primarily by low- and middle-income countries. … While lauding the US move, medicines access advocates immediately called out the fact that the statement of US support for the WTO waiver proposal referred only to “COVID-19 vaccines” and not treatments or tests – signalling the long road that still remains to reach consensus in the WTO….”
“The announcement came on the heels of a WTO General Council meeting where WTO members seemed to be inching towards more granular, and text-based negotiations over the proposal by South Africa and India to temporarily suspend intellectual property rights for needed COVID-19 treatments, tests and vaccines. But at the same time, the two co-sponsors had also signaled that they would be open to modifying the original proposal – and would table a new draft of the proposed resolution later this month in a bid to reconcile positions between the LMIC bloc of supporters and the primarily high-income opponents. Now, with the US administration of President Joe Biden behind the waiver concept – albeit only for vaccines – the revisions required to eventually reach consensus may become less daunting….”
“…With the new US position, It can be expected that a revised proposal, might seek to expand existing TRIPS flexibilities on vaccines, per se, while still stopping short of the kind of blanket waiver that was proposed in October on all COVID tests, treatments and equipments. But a new proposal could also address some of the deeper structural problems that exist in current trade rules – particularly the barriers that countries face when producing vital COVID health products under a “compulsory license” – to exporting those products to third country partners. The revised proposal may also tackle some of the broader supply chain, tech transfer and capacity building issues that everyone agrees remain obstacles….
“…Tai also warned that any upcoming negotiations on the waiver proposal “will take time, given the consensus nature of the institution [WTO] and the complexity of the issues involved.” … In preparation for a debate over a revised draft, the South African and Indian delegations proposed that the TRIPS Council hold a special meeting open to all WTO members in the second half of May. That would be followed by a formal TRIPS Council meeting in early June.”
PS: as for WTO boss Ngozi, she stressed WTO needs a “Sense of Urgency”, and in terms of addressing the most immediate pandemic needs, Iweala stressed to WTO members that countries need to step up the sharing of vacines as part of a four-point plan to move forward.
“This is a global health crisis, and the extraordinary circumstances of the Covid-19 pandemic call for extraordinary measures. The administration believes strongly in intellectual property protections, but in service of ending this pandemic, supports the waiver of those protections for Covid-19 vaccines,” said U.S. Trade Representative Katherine Tai in a statement. She added the administration will “actively participate in text-based negotiations at the World Trade Organization needed to make that happen,” but cautioned that “those negotiations will take time.” … …. As Tai noted, however, there is no assurance the proposal will pass the WTO. The U.S. was not the only wealthy nation to have objected — other wealthy nations that have resisted the measure include the U.K., Japan, and Switzerland, as well as the European Union. So it remains to be seen whether the Biden administration can persuade others. A decision on granting the waiver is not expected until next month. …”
· Dr. Tedros - WHO chief hails ‘monumental moment’ in COVID fight, as US throws support behind vaccine patent waiver Obviously, a happy Tedros (and WHO). Other global health leaders supporting the People’s Vaccine (like Winnie Byanyama) were also very happy, while pointing out the road still ahead.
“Drugmakers argue waiver of intellectual property rights for Covid vaccines will harm innovation.” No surprises there.
Biden’s “ administration’s decision to support a temporary waiver of Covid-19 vaccine patents prompted instant outrage in the pharma sector, which argues that the move rides roughshod over their intellectual property rights and will discourage US innovation while sending jobs abroad…. … the pharmaceutical industry did not expect it; the US has tended to fiercely protect domestic companies’ intellectual property rights in trade disputes. Industry leaders described the decision as a heavy blow for innovation that would do little to boost global production because there is a shortage of manufacturing facilities and skilled employees. … … Sven Borho, a managing partner at OrbiMed Advisors, a healthcare investment firm, said pharma executives feared the administration’s move set a precedent that would make it easier to suspend patents in the future. “They are worried in the long term that this is a foot in the door — ‘OK, we did it with Covid-19, let’s do it with the next crisis, and the next one’,” he said. “And then suddenly it’s a cancer drug patent that needs to be invalidated. They fear it is a mechanism that sets the stage for actions in the future.” Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, said there was a potential trade-off that pitted the imminent need to contain the pandemic against the risk that drugmakers would be more cautious when investing in pioneering therapies in the future….”
“The International Federation of Pharmaceutical Manufacturers and Associations said on Wednesday that U.S. President Joe Biden's support for waiving patents of COVID-19 vaccines was "the wrong answer" to a complex problem and called for more technology transfer agreements.” Zzzz.
· WIPO via Reuters - UN's IP agency says must maintain "right incentives" for vaccine research
“The U.N.'s World Intellectual Property Organization supports efforts to find ways to ramp up COVID-19 vaccine production while ensuring "the right incentives" exist to enable continued investment in innovation, a spokesperson told Reuters on Thursday.”
· Via Politico:
“In a signal that both the EU and U.K. were open to negotiations, Commission President Ursula von der Leyen and U.K. Trade Secretary Liz Truss both said Thursday that they were ready to hold talks on the U.S. position. “The European Union is also ready to discuss any proposal that address the crisis in an effective and pragmatic manner,” said von der Leyen during a speech on the state of the union at the European University Institute. “And that’s why we are ready to discuss how the U.S. proposal for a waiver on intellectual property protection for COVID vaccines could help achieve that objective.”…”
As for Germany, see Reuters - Germany rejects U.S. proposal to waive patents on COVID-19 vaccines
“The US government’s decision to support a temporary waiver on intellectual property related to COVID-19 vaccine patents & other knowhow in the World Trade Organization is a positive development, said key stakeholders in Africa’s health ecosystem on Thursday. While US President Joe Biden’s reversal of the previous US position against the waiver will not result in an overnight supply of more vaccines, it will likely advance Africa’s local vaccine manufacturing agenda, said John Nkengasong, Director of the Africa CDC during a press briefing….”
“… At the briefing, WHO’s Africa Regional Direcctor, Matshidiso Moeti, also praised the bold announcement by US Trade Representative Katherine Tai, calling it a potential a game changer for Africa that could unlock millions of vaccine doses and save more lives on the continent. … … And even if it is finally approved by the WTO, even a temporary waiver on COVID-19 vaccines will however not be enough to jump-start local vaccine production, Moeti said: “For local production to really take off, investments will be needed in technology transfer capacity building and quality assurance, backed by strong regulatory systems, and private sector partnerships.” …. With the right support and proper financing local vaccine production could start as early as the first quarter of 2022 at the Pasteur Institute of Senegal, according to Nkengasong….”
See also FT – Africa celebrates suspension of Covid vaccine patents
“African Union officials hope that at least three countries — South Africa, Senegal and Rwanda — will develop the capacity to produce vaccines for the continent, including the mRNA-type vaccines that emerged as an innovative technology against Covid-19….” Though doubts it will be in time for this pandemic.
“ Mark Suzman, CEO at the Bill & Melinda Gates Foundation, announced Thursday that the foundation is supportive of temporarily lifting coronavirus vaccine patent protections….” Well well.
“the foundation has reconsidered its position, due in part to the COVID-19 surges in India and Brazil, as well as the lack of vaccines across African countries, which Suzman said made clear that more needed to be done….”
“Necessary but not sufficient. “ Also with the views of James Love, and L Gostin, among others.
“…Experts suggested the earliest the world could expect to see additional capacity flowing from the waiver — if it’s approved at the World Trade Organization — would be in 2022… “. And the waiver needs to be part of a larger package.
Great analysis also, on how activists will take this forward now (and try to improve on it), how the current sponsors of the waiver proposal might use the new US stance in their adjusted proposal, on what the EU parliament might do to change the EC’s view, etc.
Must-read on the (high-level) diplomacy now ongoing. “Macron’s support for the US move marked a shift for France, which had previously argued that a patent waiver would discourage innovation…. The Gavi vaccine alliance welcomed Biden’s support for waiving intellectual property (IP) rights and also urged Washington to help manufacturers transfer knowhow to boost global production…. … Many observers said the US decision had to be seen primarily as a lever to force the pharmaceutical firms to end any obstruction to voluntary knowledge transfer agreements….”
“The US announcement, brewing inside the Biden administration for days, came hours after G7 foreign ministers had hammered out an elaborate compromise in its joint communique on how to distribute vaccines to the world’s poorest. It made no mention of enforced loss of intellectual property, but instead favoured voluntary sharing. The communique promised to “support, on voluntary and mutually agreed terms, licensing, technology transfer, contract manufacturing and public-private costs and risk sharing”.
PS: for more on the G7 meeting from this week, see below.
· Guardian (Sarah Boseley) - US support for Covid vaccine patent waivers puts pressure on EU and UK Neat analysis as well.
“ U.S. support for waiving intellectual property rights on COVID-19 vaccines could be a tactic to convince drugmakers to back less drastic steps like sharing technology and expanding joint ventures to quickly boost global production, lawyers said on Thursday.”
· And for a critical take (on the use of a temporary waiver), see Amanda Glassman (CGD) - Big Pharma Is Not the Tobacco Industry
“Fully investing in midwives by 2035 would avert roughly two-thirds of maternal, newborn deaths and stillbirths, saving 4.3 million lives per year. Millions of lives of women and newborns are lost, and millions more experience ill health or injury, because the needs of pregnant women and skills of midwives are not recognized or prioritized. The world is currently facing a shortage of 900 000 midwives, which represents a third of the required global midwifery workforce. The COVID-19 crisis has only exacerbated these problems, with the health needs of women and newborns being overshadowed, midwifery services being disrupted and midwives being deployed to other health services. These are some of the key takeaways from the 2021 State of World’s Midwifery report by UNFPA, WHO, International Confederation of Midwives (ICM) and partners, which evaluates the midwifery workforce and related health resources in 194 countries….”
“Joe Biden is being urged to clarify a longstanding US law restricting overseas aid that has been misinterpreted by successive administrations as an outright ban on funding abortion for any reason. As the US president marked his first 100 days in office on Friday, more than 140 human rights and global health organisations, including Human Rights Watch, US and the Global Justice Center, signed a letter asking him to confirm that US aid can be used for abortion care in cases of rape, incest and when the woman’s life is in danger. The calls on the president to back , introduced in Congress last year, to permanently repeal the 1973 Helms amendment, which has been wrongly interpreted as a ban on US money being used for abortion in any circumstances….”
We flag some analyses here on the possible ramifications of the divorce for the BMGF.
“Memos insist ‘business as usual’ at philanthropic organisation despite founders heading for divorce.”
“…The Bill & Melinda Gates Foundation, which disburses over $5bn a year, notably to health and development projects, moved swiftly to quash concerns of disruption their divorce might entail. “Bill and Melinda will remain co-chairs and trustees,” it said. “No changes to their roles or the organisation are planned. They will continue to work together to shape and approve foundation strategies, advocate for the foundation’s issues, and set the organisation’s overall direction.”…”
“…What are the broader implications for the foundation’s governance? The foundation’s future endowment will depend on the size of continued contributions from their separate fortunes, as well as the extent of further gifts from their longstanding friend and fellow trustee Warren Buffett. The 90-year-old investor has made substantial donations and promised to hand over 85 per cent of his $100bn remaining fortune…. ”
Andrew Jack (FT) also explores what might happen to their activities outside the foundation.
(Gated) “The couple have not donated the majority of their fortune to the foundation and could choose other mechanisms for grants and investments.”
And via Devex: “The Gates have asked for privacy, but there are real public implications. Much of the Gates’ estimated $130 billion fortune has not been donated to the foundation, meaning the two could still put those assets elsewhere, especially if they’re finding it difficult to co-chair the organization, or if their interests diverge….”
Linsey McGoey; https://www.lrb.co.uk/blog/2021/may/the-people-v.-bill-gates
You know you have to read this analysis.
“Even before the divorce, public opinion was shifting. … The growing distrust of Gates may signal a shift in public attitudes to the dangers of so much wealth and power being concentrated in unelected hands….”
“The couple, who jointly run the Bill and Melinda Gates Foundation, a huge funder of global health and disease prevention initiatives, including the fight against coronavirus, said they would continue to run the foundation together. … The pair “will continue to work together to shape and approve foundation strategies, advocate for the foundation’s issues and set the organization’s overall direction,” the Gates Foundation said in a statement….”
… At least one critic of billionaire benefactors cited the Gates’ split as a cautionary tale in the wisdom of concentrating so much sway over global humanitarian issues under the control of super-wealthy individuals. “The Gates divorce will do more than upend a family’s life. It will ramify into the worlds of business, education, public health, civil society, philanthropy, and beyond,” Anand Giridharadas, author of the book Winners Take All told Reuters. …”
“ The announcement raises questions about the fate of their fortune. The couple helped create the Giving Pledge, but much of his Microsoft money has not yet been donated.”
“Even so, the divorce will create new questions about the fate of the Gates fortune, much of which has not yet been donated to the Gates Foundation. Mr. Gates, 65, who co-founded Microsoft, is one of the richest people in the world, worth an estimated $124 billion, according to Forbes. … “The Gates Foundation is the most important and influential philanthropic entity in the world today,” said Rob Reich, a professor of political science at Stanford University. “The divorce may have huge repercussions for the foundation and for its work across the globe.”…”
“A former member of the staff who worked with both Gateses said people in the foundation’s orbit were texting and emailing one another after hearing the news, trying to figure out what had happened and what it might mean for the foundation. The consensus was that it would be fine for the time being, the former staff member said, but there were questions about what the effect would be — depending on how amicable the divorce is and how they work together going forward — the next time it came time to review strategies and future plans. … “You could imagine Melinda Gates being a much more progressive giver on her own,” Mr. Callahan said. “She’s going to be a major force in philanthropy for decades to come. …”
“Leaders of G20 nations are to commit for the first time to fully fund a World Health Organization scheme to distribute COVID-19 vaccines and drugs to poorer nations, the draft conclusions of a summit show, in a move that would unblock nearly $20 billion. … The document, subject to changes before a global health summit to be held in Rome on May 21, also says that leaders of the world’s 20 largest economies are committed to urgent action this year to boost manufacturing capacity for anti-COVID technologies, but omits mention of vaccine patent waivers. According to the draft, leaders will for the first time express an explicit commitment “to fair and full financing of the Access to COVID-19 Tools Accelerator (ACT-A) strategy”, which is the WHO’s scheme to make COVID-19 vaccines, drugs and tests available to everybody in the world.
“…G20 leaders also commit in the draft “to global sharing of surplus vaccine doses”, but the document does not clarify whether excess vaccines bought by wealthy nations would be shared through the WHO scheme for vaccines, known as COVAX, or through bilateral deals or regional mechanisms such as one set up by the European Union, which critics say may hamper COVAX’s efforts for a fair distribution of shots….”
“Professor Mariana Mazzucato will Chair the new WHO Council made up of eleven leading figures in economics, health and development. The Council will focus on strategies to build healthy societies that are just, inclusive, equitable and sustainable. … In addition to Professor Mariana Mazzucato, as Chair, the inaugural members of the council are Professor Senait Fiesseha, Professor Jayati Ghosh, Vanessa Huang, Professor Stephanie Kelton, Professor Ilona Kickbusch, Linah Kelebogile Mohohlo, Dr Zélia Maria Profeta da Luz, Kate Raworth and Dame Marilyn Waring. Additional members may be appointed. Dr Vera Songwe will join as a special guest. When asked why all members are women, both Professor Mazzucato and Dr.Tedros answered, "Why not?!"…”
“The Council [will] hold its inaugural meeting on 6 May, which will kickstart a robust and wide-ranging process to gather insights and develop actionable plans and forward looking practices built on real-world examples and lessons learned from the COVID-19 pandemic.”
See also this WHO press release - Global experts of new WHO Council on the Economics of Health For All announced
“ Council’s focus is on new strategies to shape economies and financial systems with the objective of building healthy societies that are just, inclusive, equitable and sustainable. It will incorporate lessons learned during the COVID-19 pandemic….”
“…The WHO Council aims to reframe health for all, as a global objective, and ensure that national and global economies and finance are structured in such a way to deliver on this ambitious goal. This includes advice on what can be done and practical tools in four important areas: new ways to measure and value health for all, build up public sector capacity to drive transformative change and innovate towards achieving population health goals, and, to ensure financial systems invest in creating health. This requires a transformation in financing for health, not as a cost but a long-term investment for a “healthy society,” grounded in the fundamental truth that health and the economy are interdependent.”
For early warning.
“The WHO Hub for Pandemic and Epidemic Intelligence will be a global platform for pandemic and epidemic intelligence, creating shared and networked access to vital multi-sectoral data, driving innovations in data analytics and building the communities of practice needed to predict, prevent, detect, prepare for and respond to worldwide health threats; The WHO Hub will be a new global collaboration of countries and partners worldwide, driving innovations to increase availability and linkage of diverse data; develop tools and predictive models for risk analysis; and to monitor disease control measures and infodemics. The WHO Hub will enable partners from around the world to collaborate and co-create the tools and data access that all countries need to prepare, detect and respond to pandemic and epidemic risks.
“…The WHO Hub for Pandemic and Epidemic Intelligence is part of WHO’s Health Emergencies Programme and will be a new collaboration of countries and partners worldwide, driving innovations to increase availability and linkage of diverse data; develop tools and predictive models for risk analysis; and to monitor disease control measures, community acceptance and infodemics. …”
See also HPW - WHO Global Data Hub To Help Fight Future Pandemics
“… The hub, to be launched in Berlin later this year, would bring together scientists, data experts and other know-how from governments, international organizations and the private sector, in new, and more flexible forms of collaboration, WHO’s Director of Health Emergencies, Mike Ryan, said at a press briefing on Wednesday. Launch of the hub is being supported by €30 million in seed funds from the German government, said officials at the briefing, addressed by German Chancellor Angela Merkel and Health Minister Jens Spahn…”
“Ryan said that WHO envisages the platform as functioning similar to CERN, the European Organization for Nuclear Research – an iconic Geneva-area institution that brings together research fellows, visiting scholars and other experts for brief stints, where they can share and apply their knowledge and skills. Germany has offered a seed fund of €30 million annually as a startup for the hub, with WHO still working on further details of the budget, he added. Appeals for further funding are being discussed with various potential donors at the G7 level, said Ryan….”
The new hub will still fall under WHO’s governance.
“Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, plans to run for a second five-year term as the head of the agency, according to a person familiar with his thinking, setting up a referendum on the WHO’s handling of the Covid-19 pandemic under his leadership. It is unclear at this point whether others will emerge to challenge the 56-year-old from Ethiopia, who made history in 2017 when he became the first African elected to the global health agency’s top job. WHO director-generals may only serve two five-year terms, and must be elected each time….”
“The global health community has reacted with shock to huge cuts to UK funding, including for women's and girl's health, HIV/AIDS, polio, and UNICEF. John Zarocostas reports.”
“Britain has announced it will host a summit in 2022 to raise money for vaccine research and development. It said the summit with the Coalition for Epidemic Preparedness Innovations (CEPI) would support the body's goal of cutting the development time for new vaccines to 100 days in future pandemics…..”
(must-read) Feature story from last Friday focuses on the division within countries on ways to reform the WHO Emergency response, and what this tells us about the pandemic treaty discussions. Apart from the status of the negotiations itself, this story also looks at the underlying process in these negotiations and how this can impact the discussions towards the pandemic treaty.
A few quotes, perhaps:
“The virtual nature of the discussions, in addition to countries firefighting the pandemic has impacted negotiations. …”
“Diplomatic sources who spoke on the condition of anonymity told us that fundamentally, countries continued to remain divided on whether a WHO resolution such as the currently negotiated one, can “reform” the International Health Regulations. There are concerns that parts of the resolution seek to introduce new roles for the WHO, those that have not been negotiated under the IHR. The rules first adopted in 1969 and revised in 2005, do not empower WHO “to investigate outbreaks areas for example”, one source said.
It is not clear whether countries are keen on “opening up” the IHR, but some do believe that it should be a separate process. …. Countries are also wary of how such a treaty might become an instrument for channelling financing for WHO exclusively for emergencies work, diverting it away from WHO’s core mandate of health systems strengthening which is crucial for the developing world, an expert suggested.
…Sources indicated that a number of large developing countries do not seem to be in favor of a treaty. It has also emerged that the U.S. is not in favor of a pandemic treaty. … The position of the US, could depend on where and how the pandemic treaty will be administered, a global health expert suggested.
After a first into paragraph on PEPFAR, Amanda makes the case for PEPPPR, linking it also to ACT-A and Covax.
“This May, as the world surpasses 3.5 million now preventable COVID-19 deaths, it is time for the United States to step up once again. … A global plan with a global response is needed, and the US can and should lead such an endeavor. This is not business-as-usual; the response to COVID-19 is the global issue that matters most in the next several years – a health, humanitarian, and economic catastrophe. … … A President’s Emergency Plan for Pandemic Preparedness and Response (PEPPPR) could save lives around the world while protecting Americans from the emergence of COVID-19 variants and other pandemic-potential pathogens that could put hard-won US gains at risk. A dedicated bilateral initiative…”
K Wilson, D Fidler, R Labonté et al ; https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.20.270116.pdf?sfvrsn=24d68ea2_5
Review. “…The IHR require States Parties to designate or establish national IHR focal points to facilitate information sharing about disease events with WHO, which makes these focal points critical in the effective implementation of the IHR within and between countries. On behalf of the State Party concerned, national focal points are responsible for timely notification to WHO of relevant health events, responding to WHO Secretariat requests for event-related information, and ensuring that messages and advice from WHO are disseminated to the relevant sectors within the country. A review of the 2013–2016 Ebola virus disease outbreak in West Africa found deficiencies in the functioning of national focal points. Published studies have also identified technical and political challenges to the notification of events by focal points to WHO. At the request of WHO, we evaluated the ability of focal points to carry out their IHR functions through 25 in-depth interviews and 105 online quantitative surveys. Here we present summary findings and recommendations emerging from our study; survey methods and results have been previously published….
“… To help middle-income countries manage their transitions to domestically funded health systems, in recent years, various transition readiness assessment tools (TRAs) have been developed. TRAs can be used to determine: (1) whether a country is ready to graduate from donor support; (2) how transition will affect various aspects of the health, economic, and political system of the country; (3) where donor funds may need to be spent to bring a country closer to being transition-ready; and (4) whether the country’s progress will be sustained after transition from donor aid. To understand the benefits and limitations of TRAs, we existing tools to provide insight into the current landscape of TRAs and opportunities for guiding transition planning and supporting the sustainability of health programs and systems …”
M Jung & S Rushton; http://www.ijhpm.com/article_4044_76166119307ca44aa6577032ae6f8f06.pdf
“…In this viewpoint, we focus on what it would take to fully fund this mechanism and make it successful on its own terms. … In this viewpoint, we argue that (especially given the inability to agree any meaningful changes to the prevailing intellectual property rules), WHO member states have a moral and ethical responsibility to at least ensure the ACT-Accelerator is fully funded. We argue that, so far, the responsibility to mobilise the necessary financial resources has been shared disproportionately, with middle-income countries in particular having not shouldered their share of the burden….”
Lancet Public Health - A global public health convention for the 21st century (by J Duff et al)
In The Lancet Public Health, Johnathan Duff and colleagues outline an ambitious vision for such a treaty. “This Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimise prevention, preparedness, and response to pandemic infectious diseases. We propose ten recommendations to strengthen global public health governance and promote compliance with global health security regulations….”
+ Two comments:
· Lancet Public Health - A pandemic treaty for a fragmented global polity ( Comment by S Moon & I Kickbusch on the Duff et al article)
They list three implications for a pandemic treaty.
· Lancet Public Health - Pandemic preparedness in the 21st century: which way forward? (by s K Khor & D Heymann) (another comment on the Duff et al article)
“In summary, Duff and colleagues describe a useful set of attributes for a global health governance framework. There should, however, be an equal emphasis on strengthening national-level capacities through the IHR and WHO. A binding treaty and effective resource sharing could help to build a balanced governance framework that appropriately allocates subnational, national, and global responsibilities and that does not stifle national initiative, while providing a global safety net to support countries and geographic areas that have not yet developed those capacities…..”
Analysis ahead of a G7 Foreign & Development ministers meeting this week. “The group of wealthy nations are scrambling to agree a package to speed up the supply of vaccines to poor and middle-income countries by making commitments to export surplus vaccines and by ramping up production. At a meeting in London, the seven are also likely to agree in principle to step up the financing of the international Covax programme to distribute vaccines. The west is on course for more than 50% of adults to be vaccinated by the summer, compared with one in 100 in sub-Saharan Africa. …. The consensus inside the Biden administration has shifted towards a bold global initiative rather than simply storing up surplus vaccines to reassure domestic electorates. But UK officials stressed that the G7 foreign ministers’ meeting was not a pledging event.
… There are also some signs of a shift in position in the US on patent waivers in the face of pharmaceutical companies reporting windfall profits from the pandemic….”
“A campaign for rich countries to do their part, spearheaded by former prime minister Gordon Brown, must be heeded… An spearheaded by Gordon Brown … calls for a $60bn two-year vaccine and healthcare support package for poor countries. If the G7 committed to providing its share of the funding – roughly 60% – at the UK-hosted summit in Cornwall this June, the rest would likely follow from Russia, China, the oil states and Nordic countries….”
“… WHO’s Director General Dr Tedros Adhanom Ghebreyesus said in a press conference that COVAX and related medicines access initiatives face an immediate funding gap of US$19 billion, along with “further needs” of US $35-$US40 billion over the coming year. “We will only solve the vaccine crisis with the leadership of G7 countries,” Tedros said, speaking at a WHO press conference that featured an appeal by former British Prime Minister Gordon Brown to rich countries to immediately donate more excess vaccines. Brown, now the UN Envoy for Global Eradication, also joined WHO in an appeal to G7 nations to dedicate some US$ 30 billion a year from their combined resources to a more robust pipeline of COVID vaccines and medicines – at an upcoming G7 meeting 11 June….”
Quote: “… “The bill for mass vaccinating the world and ensuring access also to tests and treatments is affordable: a total of around US$30billions a year,” Brown asserted. “If spread across the richest countries – it’s just 25 cents a week per citizen – and it is money we cannot afford not to spend. ”
Poignant point. “The United Kingdom is hosting the first G-7 foreign ministers meeting since 2019 — and the government is under pressure to explain how it can cut funding for the same priorities it purports to lead on. On Monday, U.S. Secretary of State Antony Blinken and U.K. foreign secretary Dominic Raab took questions from reporters, and the first question for Raab pointed to the seeming contradiction between the country’s rhetoric and its massive aid cuts….”
And some (preparatory) reports, ahead of the World Health Assembly:
Insightful analysis from last week. Excerpts:
“Leith Greenslade, the coordinator of the Every Breath Counts Coalition…. : “Our members were saying this is going to be a nightmare,” she said. “People are going to be unable to get oxygen. It took us a year, until February 2021, to get the UN and others to set up the Act-Accelerator oxygen emergency taskforce.” It took so long because there is “a blind spot” in the global health architecture, she says. The institutions, from the Global Fund to the World Bank, have few people with expertise in oxygen. And yet, on top of the existing unmet need for oxygen in pneumonia, malaria, sepsis and maternal health, we now have Covid and may have entered “an era of respiratory health pandemics”, she said…. The taskforce is part of the Access to Covid-19 Tools-Accelerator (Act-A) … The coalition has set up a Covid-19 oxygen needs tracker, which estimates that 27.4m cubic metres of oxygen is needed around the world to keep patients alive every day. That is 3.9m large cylinders every day. To meet that need for a year will cost $6.2bn, they say. With the Access to Medicines Foundation, they are calling on the G7 to take immediate action to ensure that low- and middle-income countries have the medical oxygen they need to treat all Covid patients…”
“Greenslade and Watkins said there had been no engagement in the past with the world’s seven big medical gas companies that supply oxygen, mostly to high-income countries and more often to industry and the military rather than cash-strapped publicly funded health services. “In stark contrast to the pharmaceutical sector, which has a long history of engagement, the big oxygen companies don’t really have a track record of engaging in health emergency-type response work,” Watkins said. The one company that has stood out is Air Liquide, he said, which contacted the World Bank offering to provide oxygen at cost, subject to safety standards. “There was no mechanism for them to work through, which is why we started trying to scale up the oxygen framework in the Act-A system.”
(5 May) Important advocacy ahead of the G7 meeting. “An initial immediate injection of $US200 million from the G7 for an ACT-A Emergency Oxygen Fund would enable the ACT-A to respond quickly (within days) to LMIC requests to alleviate imminent medical oxygen shortages and related deaths….”
And a link:
“Expert Professor Trevor Duke provides insights into how countries with limited resources can secure supplies….”
With updates on Covax, some of them encouraging ones.
Moderna Will Supply COVAX With 34 Million Doses In 2021 & 466 Million In 2022.
“Moderna’s latest agreement will allow COVAX to receive 34 million doses in the final quarter of 2021 and 466 million doses in 2022, with an option to access a vaccine jab that is adapted to emerging variants … … Moderna’s latest agreement represents the largest commitment of mRNA vaccines to COVAX yet, given that Pfizer/BioNTech, another mRNA vaccine frontrunner, has committed a mere 40 million doses to the global vaccine facility. …
· See also Reuters - COVAX gets boost from Moderna deal, Sweden's donation of COVID-19 vaccines -GAVI
… Sweden has donated 1 million AstraZeneca (AZN.L) shots to the global COVAX programme, a small boost as it struggles to get stocks to inoculate the world's poorest people.
… Berkley said last month that COVAX aimed to deliver one-third of a billion doses by mid-year….
· See also Cidrap News - Global officials welcome steps to shore up COVAX gaps
“… The WHO recently put out an urgent call for countries to donate 20 million doses to help fill the gap in the COVAX program, an effort to ensure equitable distribution of vaccine to middle- and lower-income countries. Bruce Aylward, MD, MPH, senior advisor to Tedros, said COVAX has so far distributed about 20 million doses, which were used as first doses for health workers and high-risk groups, and that filling the 20 million gap will allow people to receive their second doses. So far, a handful of countries have announced donations, with Sweden the latest country to donate. In a statement today, the WHO welcomed Sweden's announcement that it will share 1 million doses. Tedros said, "Sweden’s generous support is very timely as it comes at a time when the world needs it most." WHO officials said France, New Zealand, and Norway have also announced donations….”
He did so at the Vax Live event – organized by Global Citizen. … The event raised £38.3m ($53.8m ) for Covax.
And via Politico:
“WHO officials said they are negotiating with the U.S. to direct all 60 [AstraZeneca] million doses to COVAX. That could help make up for the shortfall of AstraZeneca doses produced by the Serum Institute of India, which had to redirect all the supply domestically. There’s an immediate need to match 20 million first doses of AstraZeneca’s two-shot vaccine that COVAX already shipped out, said WHO senior adviser Bruce Aylward….”
“ Gavi, the Vaccine Alliance announced today that it had signed an advance purchase agreement with Novavax for its highly efficacious NVX-CoV2373 vaccine candidate against COVID-19. The agreement is for a commitment to purchase 350 million doses of the Novavax vaccine candidate, secured on behalf of the COVAX Facility. Supply of the vaccine is anticipated to commence in Q3 2021, as soon as Novavax has secured the required regulatory approvals….”
Some more news, reads & analyses from this week in this key debate (see also ‘News of the week’ on the US gamechanger in this respect). On Wednesday and Thursday, a new WTO General Council meeting took place on the Trips waiver issue.
Coverage of the 2nd day of the meeting. “World Trade Organization’s (WTO) director general Ngozi Onkonjo-Iwela on Thursday hailed the United States government’s decision to support the suspension of intellectual prpoperty rules on COVID-19 vaccines – while also emphasizing the urgency of even more immediate actions to increase vaccine supplies to lower-income countries. …”
“…At a press briefing on Thursday, WTO Spokesperson Keith Rockwell noted that the ‘mood was different’ at the General Council meeting, meeting for a second consecutive day, following the announcement by US Trade Representative, Ambassador Katherine Tai, on Wednesday evening. “Discussions were constructive” in regards to the TRIPS waiver, he said. “Clearly, there is a change in the atmosphere,” said Rockwell…”
“WTO members seemed to be inching towards more granular, and text-based negotiations over a controversial proposal by South Africa and India to temporarily suspend intellectual property rights for needed COVID-19 treatments, tests and vaccines. But at the same time, the two countries sponsoring the blanket waiver on all such IP, South Africa and India, have also signalled that they are open to modifying the original proposal – and will table a new draft of the proposed resolution later this month in a bid to reconcile positions. Those were the key outcomes of a meeting of WTO’s General Council Wednesday, which is to continue tomorrow, according to a WTO spokesperson….”
“…It can be expected that a revised proposal, might seek to expand existing TRIPS flexibilities while stopping short of the kind of blanket waiver that was proposed in October. A new draft might also try to address some of the supply chain, tech transfer and capacity building issues that everyone agrees remain obstacles. In preparation for a debate over a revised draft, the South African and Indian delegations proposed that the TRIPS Council hold a special meeting open to all WTO members in the second half of May. That would be followed by a formal TRIPS Council meeting in early June.”
For another take, see this Reuters Explainer - COVID-19 vaccine patents dominate global trade talks
“World Trade Organization members [will] assess on Wednesday signs of progress in talks on a proposal by South Africa and India to waive patent rights on COVID-19 vaccines in order to boost supply to developing countries. After a 10th round of talks on April 30, the waiver proposal's backers said they would revise their text from October in time for the next TRIPS council meeting in the second half of May before a further discussion on June 8-9. The new text could be more limited than the current proposal.
“Norway's ambassador Dagfinn Sorli, the council chair who will brief Wednesday's WTO General Council, expressed "careful optimism". … World Health Organization chief Tedros Adhanom Ghebreyesus talked on Monday of "encouraging progress", but said the process needed to be completed as soon as possible….”
… The situation though is fluid. In Brazil, the only developing country to oppose the waiver, the Senate has passed a bill to suspend COVID-19 vaccine patents. It has become quieter at the WTO since April…. “
Analysis ahead of the WTO meetings. This article focused onon the increasing pressure in the US, which, as you know by now, has paid off: “President Biden and drugmakers are facing demands from liberal activists and global leaders to suspend intellectual property rights on the vaccines as the pandemic surges. President Biden, faced with surging Covid-19 crises in India and South America, is under intensifying pressure from the international community and his party’s left flank to commit to increasing the vaccine supply by loosening patent and intellectual property protections on coronavirus vaccines. Pharmaceutical and biotech companies, also feeling pressure, sought on Monday to head off such a move, which could cut into future profits and jeopardize their business model. Pfizer and Moderna, two major vaccine makers, each announced steps to increase the supply of vaccine around the world. … The issue is coming to a head as the World Trade Organization’s General Council, one of its highest decision-making bodies, [meets] Wednesday and Thursday.”
“The U.S. top trade negotiator will begin talks with the World Trade Organization on ways to overcome intellectual property issues that are keeping critically needed COVID-19 vaccines from being more widely distributed worldwide, two White House officials said Sunday….”
Analysis from last week on the divisions within the White House on this. “A proposal to waive drugmakers’ patents to enable developing countries to make generic vaccines wins some backers in the Biden administration.”
“A high-stakes fight over drug companies’ response to the coronavirus pandemic has split the Biden administration, with activists and progressives urging the White House to back an international petition to waive the companies’ patents — and some senior officials privately signaling they’re open to the idea. … Within the Biden administration, the patent-protection debate has split the White House along multiple political and policy factions, said three officials with knowledge of the discussions. Progressives have argued with centrists about whether the administration is wrongly siding with the pharmaceutical industry, which has lobbied to preserve its patent protections. International aid experts have wrangled with the officials focused on domestic virus response, who have worried that efforts to shake up global supply chains could undercut efforts to help Americans now….”
From late last week. “The United States is hearing “huge demand” from countries around the world for vaccines not needed by Americans, but has not yet developed a criteria for allocating them, the U.S. State Department’s coordinator for global COVID-19 response, Gayle Smith, said on Friday. … Smith said on a call with reporters that Washington hasn’t decided yet on how to allocate those vaccines that will be shared with other countries, despite the clamor from allies like India, where the virus is surging….”
Was a rather ‘remarkable’ visit, given Brazil’s pandemic “track record”, but here we mainly want to flag this stance from the Brazilian minister of health re IP:
“WHO Director-General Tedros Adhanom Ghebreyesus reported that “Brazil is scaling up the domestic production of COVID-19 vaccines and has joined the World Trade Organisation (WTO) initiative to increase vaccine production through technology transfer.” In terms of access to vaccines, still sorely lacking in most of lower-income Latin America, Queiroga appeared to offer an olive branch to critics, saying: “We are looking at the discussions that are currently underway in the WTO on protecting intellectual property. We defend that there should be access to vaccines and that they should be made available immediately because they should be considered a public good.” That statement was striking, insofar as Brazil has been one of the only developing countries to oppose the India-South Africa proposal for a WTO waiver on intellectual property for the duration of the pandemic. Brazil’s opposition to the waiver has also triggered widespread internal criticism. Brazilian parliamentarians penned an open letter recently saying that the position flails in the face of Brazil long tradition of supporting public access to essential medicines. Quieroga did not reverse the country’s stance on that matter at his briefing, but rather appeared to be seeking a middle ground on the polarizing issue. He stressed that Brazil was in favour of “reaching a consensus” on the way forward, adding that existing flexibilities in IP and trade rules need to be used more effectively… “Brazil understands that the TRIPS agreement does have a number of flexibilities regarding innovation, which are included in the Doha Declaration on TRIPS and public health, and this includes the principle of what is in the public interest to fight health crises.”
Coverage of a High-Level panel on Tuesday on the issue.“The “circular discussion” at the World Trade Organization (WTO) on the TRIPS waiver needs to move to “text-based” negotiations, Ambassador Xolelwa Mlumbi-Peter, South Africa’s Permanent Representative to the WTO said on Tuesday. Her Indian counterpart, Brajendra Navnit, added that opponents of the waiver had been using “delaying tactics” since the beginning of the year, “changing goalposts” to raise new problems once their earlier concerns had been addressed. Mlumbi-Peter and Navnit were addressing a high-level panel on Tuesday organised by a range of civil society organisations, on the eve of yet another meeting of the TRIPS Council on the issue, set for Wednesday and Thursday. …”
‘t Hoen debunks the arguments, one by one. Excellent analysis. One of the reads of the week.
Fauci got a bit more cautious on the issue of a temporary Trips waiver. “One of Joe Biden’s top coronavirus advisers has warned that forcing drug companies to abandon intellectual property rights to Covid-19 vaccines risks backfiring if it leads to long legal disputes. … …. People are dying around the world and we have to get vaccines into their arms in the fastest and most efficient way possible.”…”
New survey shows that “a supermajority of people in G7 countries believe that governments should ensure pharmaceutical companies share the formulas and technology to their vaccines, according to new polling from the People’s Vaccine Alliance. The public believes that pharmaceutical companies should be fairly compensated for developing vaccines, but should be prevented from holding a monopoly on the jabs….”
“A growing chorus of voices worldwide is demanding the lifting of intellectual property restrictions on Covid-19 vaccines and technologies and open technology transfer to enable global access. In response the pharmaceutical industry, the WTO and other actors like the Gates Foundation are promoting a ‘third way’ where industry retains total control of supply, price and distribution of Covid-19 vaccines and other health technologies. This is in fact nothing new and is a continuation of the same failed system. This paper gives a clear critique of this proposed solution, and the urgent need to take back control over vaccine production and distribution. It outlines the arguments instead for government-led, open technology transfer and equitable access.”
The murky story re C-TAP (sadly, an empty shell so far). Cfr Tweet: “Vaccine companies & US government snubbed WHO initiative to scale up global manufacturing traces how all these companies & govts say they are are committed to access but refusing to engage #CTAP tech transfer US has leverage, will it fix monopolies?”
And some links:
“According to the proposal, patent holders would be obliged to provide authorities with all the information needed to produce COVID-19 vaccines and medicines. Then, if the government were to call a state of emergency, they could be produced locally under a licensing agreement.”
Tweet Amy Kapcynszky : “Whoa. For all of you out there who worry that TRIPS waiver alone isn't enough - lawmakers in Brazil have you covered. They are trying to both suspend vaccine patents and require companies to share info about how to make them. Anyone have the text?”
With key trends, WHO messages, …
“The number of global coronavirus cases reported in the last two weeks eclipses the first six months of the pandemic, the World Health Organization (WHO) said Monday. Why it matters: It underscores the severity of the current wave of infections in India, which surpassed 400,000 cases for the first time over the weekend, as well as a record-high number of deaths, per data from Johns Hopkins University. India and Brazil make up more than half of last week's cases, according to WHO Director-General Tedros Adhanom Ghebreyesus, but many other countries all over the world "face a very fragile situation."
“Impacts of the deadly new surge in COVID-19 cases across South Asia are unlike anything the region has seen before, the United Nations Children’s Fund (UNICEF) has said, warning of a “real possibility” that health systems there will be strained to a breaking point, leading to even more loss of life. …”
“The World Health Organization is seeking to fill the gap left in the COVAX dose-sharing programme by India suspending exports of AstraZeneca (AZN.L) doses and is in talks with donors including the United States, senior WHO officials said on Monday. "In the next few months we do not expect Serum (Institute of India) to be able to supply the kind of (doses) originally predicted," WHO chief scientist Soumya Swaminathan told a news conference. Bruce Aylward, a WHO senior adviser, said there was no firm date for resumption of Indian vaccine exports amid its COVID-19 crisis…”
“A new appeal about the course of the SARS-CoV2 virus hunt, penned by an international group of scientists, urges WHO member states to seize the moment of the upcoming World Health Assembly to adopt a much tougher mandate, with more rigorous scientific measures, to get to the truth of whether the SARS-CoV2 virus first infected humans from a natural source, a wild animal market, or in a laboratory. … In their third appeal in as many months, published Friday, the scientists also called upon China to grant unfettered access to the remote Mojiang mine in Yunnan Province, including release of confiscated samples and censored data – so that researchers can unlock the mysteries it may hold. The mine was the site of where a group of six miners became infected with a mysterious pneumonia-like illness in 2012. …”
Upcoming World Health Assembly debate – a key moment : “ …In terms of the upcoming World Health Assembly debate, a 20 April copy of the draft WHA resolution that refers to the origins issue, obtained by Health Policy Watch, reflects the continuing, deep disagreements among member states over how the virus quest should be pursued. …”
Not our niche, as you know.
Somewhat remarkable indeed that the B.1.617 variant in India is just a ‘variant of interest’ so far, but this is WHO’s rationale for it, which has to do a lot with the lack of good info on it:
Quote: “This week, we asked Dr Maria Van Kerkhove, WHO Technical Lead on COVID-19 to tell us more about these distinction between these variants and on the lack of enough information on the B.1.617 variant in India. This is what she had to say: Yes, indeed, the B.1.617 has been classified as a variant of interest. What WHO does is we have characterizations of variants of concern and variants of interest at a global level. So currently we have three variants of concern at the global level. The B.1.1.7 first identified in the UK, the B.1.351 identified in South Africa and the P.1 first identified in Japan from travelers from Brazil. We have an additional seven variants of interest that we are tracking worldwide. B.1.617 is one of those. Indeed, there actually are a number of virus variants that are being detected around the world, all of which we need to properly assess. This is based on information that we know about its circulation….”
And a link (related to two new NEJM studies):
NEJM (Editorial) - Interplay between Emerging SARS-CoV-2 Variants and Pandemic Control.
Recommended read. “Worries about AstraZeneca and Johnson & Johnson vaccines may slow plan to immunize the world.”
Quotes : “Once there are clear policies from the West regarding in what age groups to use these vaccines, it’s going be very hard to recommend anything different here,” says John Amuasi, an epidemiologist at the Kwame Nkrumah University of Science and Technology in Ghana, one of the first countries in the world to receive the AstraZeneca vaccine through COVAX. But if no other vaccines are available, limiting use of these could ultimately cause many more COVID-19 cases—and deaths….”
“… For an older person in an area with lots of infections, the benefits vastly outweigh the risks. For a young person in a place where the pandemic is ebbing, they may not.”
With some very nice maps, based on Airfinity data.
“Less than one dose for every 100 of the world’s people has been given away.”
“…Donations are failing to fill the void. COVAX, a global vaccine-sharing scheme funded by rich countries mainly in Europe and America, has donated 49m doses to 120 countries, according to Airfinity, a London-based analytics firm. China has doled out 13.4m doses to 45 different countries, with the largest quantities going to Pakistan, Laos, Cambodia and the Philippines. India, home to the Serum Institute, the world's biggest vaccine-maker, has donated 10.5m, mainly to Bangladesh, Myanmar, Nepal and Bhutan, which roughly equals the 10m doses India has itself received from COVAX. Altogether, the world has given away 73.4m doses, enough to administer one shot to only 1% of the world’s population. On April 26th the White House said the United States would share up to 60m doses of the AstraZeneca vaccine with the rest of the world, but so far only 10m doses have been produced. … … More are on their way, but not nearly fast enough. By mid-2021 COVAX expects to ship 238m doses, enough to offer one jab to 3% of the global population. A shortage of vaccines is the biggest problem….”
From late last week. “The World Health Organization has listed Moderna’s (MRNA.O) COVID-19 vaccine for emergency use, the agency said on Friday, the fifth to be given the status meant to expedite countries’ own approval of shots.” And does also make it available for Covax.
“Moderna has announced new investments from Europe and the US to increase global vaccine supply, expecting to increase 2022 capacity to up to 3 billion doses of its COVID-19 vaccine. The announcement was followed by the World Health Organization’s (WHO) decision to list the Moderna vaccine for emergency use, making it the fifth vaccine to receive emergency validation from WHO. … Bancel, at the press briefing, had said that the company is “in the final stretch to get an agreement with COVAX” for its vaccine.
… Pfizer’s experimental oral drug for treating COVID-19 could be available at the end of 2021, CEO Albert Bourla told CNBC on Tuesday. “If clinical trials go well and the Food and Drug Administration approves it, the drug could be distributed across the U.S. by the end of the year,” Bourla told CNBC. … Bourla also told CNBC that the company is ‘comfortable’ in producing at least 2.5 billion vaccine doses for 2021, noting how Pfizer had overcome the original ‘forecasted losses’.
“The World Health Organization (WHO) appears to be inching towards the approval of the Chinese Sinopharm and Sinovac vaccines as it struggles to fill a looming vaccine vacuum left by India’s Serum Institute – which has halted exports as the country continues to reel from a tragic coronavirus outbreak. … Approval of Chinese Vaccines Could Catapult Chinese Vaccine Diplomacy … If both vaccines are approved, China could become the world’s largest vaccine supplier – given the combined capacity of Sinopharm and Sinovac to produce two billion vaccine doses this year, according to statements by both firms. …”
“The WHO is reviewing two of China’s COVID-19 vaccines for use worldwide, with a decision expected soon. But published trial data remain scarce.”
“The World Health Organization (WHO) is considering authorizing two COVID-19 vaccines developed in China for emergency use. One of the two vaccines under review is made by Chinese state-owned firm Sinopharm, and the other is produced by a private company, Sinovac. More than 45 countries have already approved their use, but the WHO is among the first stringent regulatory authorities to review the data. Many questions remain about the vaccines, and published trial data remain scarce. If the WHO backs the vaccines, it could boost desperately needed distribution in lower-income nations through the COVID-19 Vaccines Global Access (COVAX) initiative.”
And a link :
“WHO experts have voiced "very low confidence" in data provided by Chinese state-owned drugmaker Sinopharm on its COVID-19 vaccine regarding the risk of serious side-effects in some patients, but overall confidence in its ability to prevent the disease, a document seen by Reuters shows….”
“China’s once frenetic global vaccine distribution drive appears to have come to a grinding halt, at least temporarily, amid a push to gets jabs into the arms of its own people (photo). As of Sunday, China had inoculated 275 million people domestically. …. It’s unlikely there’s been any change in the strategic direction of China’s vaccine distribution outreach. Instead, Chinese leaders could be motivated by the rapid vaccination rates in the United States, where herd immunity is now forecast to be in reach sometime this summer. Officials may want to ensure that China isn’t perceived as lagging behind the U.S. in terms of vaccination rates. …”
“The Serum Institute of India, which manufactures the AstraZeneca (AZN.L) COVID-19 vaccine, is planning to start vaccine production in other countries as it struggles to meet supply commitments, its chief executive officer told The Times. … “He hoped to increase the Serum Institute's production capacity from 2.5 billion to 3 billion doses a year within six months…”
“Chief of Serum Institute says problem will persist after government failed to prepare for second Covid wave.”
“The chief executive of India’s Serum Institute, the world’s biggest vaccine manufacturer, has warned that shortages of jabs will persist for months after Narendra Modi’s government failed to prepare for a devastating second coronavirus wave. Adar Poonawalla told the Financial Times that India’s severe vaccine shortage would continue through July, when production is expected to increase from about 60m-70m doses a month to 100m….”
“This brief reviews the main policy options that have been proposed, and related questions, and identifies the actions taken by the administration thus far (see Table 1). These policy options fall into four main areas: Scaling up in-kind donations of surplus COVID-19 vaccines; Providing additional funding for global vaccine efforts such as COVAX; Helping to expand vaccine manufacturing; Relaxing or waiving intellectual property (patent) restrictions on COVID-19 vaccine technologies.”
J Sandefur & A Subramanian; https://www.cgdev.org/blog/how-biden-can-end-vaccine-apartheid
“…We’re headed toward global “vaccine apartheid.” Visibly leading the charge to vaccinate the world, with significant political and financial commitments, offers the US the chance to regain considerable soft power.” Do check out what these CGD authors suggest.
On the fear for ‘Indian scenarios’ in SSA (including the view of Nkengasong, M Moeti, ..)
“…Kate O’Brien, director of immunisation, vaccines and biologicals at the World Health Organization, said western countries’ drive to get as close to complete vaccine coverage as possible — and potentially penalise less-covered countries through vaccine-passport schemes — may be putting undue pressure on poorer countries to follow suit. “We don’t necessarily need to have the same goal across all countries,” she said, adding that countries have to juggle a range of budgetary and health priorities, including combating other diseases such as malaria, HIV and tuberculosis. But officials leading the African response remain committed to vaccinating at least 60 per cent of the population. “If we are to defeat this pandemic — which we have to do for our own survival and the survival of our economies — we have to do this at speed and at scale,” said Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention….”
“… Given the young median age in many African countries, the 60 per cent immunisation target would probably involve vaccinating some children, according to Matshidiso Moeti, the WHO’s regional director for Africa. … “The logical way is to target the areas that have been hit most severely, like the cities,” said Moeti. “Even if younger people don’t get seriously ill, they can transmit the virus.”…”
“…But for some scientists it remains a contentious proposal, given that the disease poses little risk to children and that the vaccines are yet to be approved for those under 18….”
“In Africa, health experts say a combination of warnings about possible rare blood clots, the rubbishing of vaccines by some leaders and mixed messages over expiry dates have all contributed to the slow rollout across the continent. … … COVID-19 has also not hit Africa's 1.3 billion people to the extent it has ravaged some countries in Europe, Brazil, the United States and India, leaving some on the continent doubting the seriousness of the disease….”
“BioNTech SE is discussing the possibility of Covid-19 vaccine production sites in Africa to expand the company’s supply network in regions around the world, Chief Executive Officer Ugur Sahin said.
“I can imagine a production network in South America and for Africa,” Sahin said at a briefing with members of Germany’s foreign press association. “We are also talking about African production sites.” … Sahin said he had met with representatives from Gavi, the Vaccine Alliance, earlier on Wednesday about how to make more shots available in low-income countries. Giving up patent rights on the vaccine isn’t the solution, the CEO said, adding that BioNTech wants to avoid a proliferation of versions of its shot. One possibility instead would be a special license for competent manufacturers, though he said such production wouldn’t be able to help with supply until the end of next year….”
“ Rwandan President Paul Kagame said his country is in talks to establish the first mRNA vaccine plant in Africa as the continent battles the coronavirus pandemic. “Rwanda is working with partners to bring the first mRNA manufacturing facility to Africa,” Kagame said at a virtual event this week organized by the Independent Panel for Pandemic Preparedness and Response. He didn’t give further details….”
From late last week. “Several African countries struggling with vaccine rollout programs are forced to donate COVID-19 vaccine doses to other countries before the lifesaving drugs expire, the Africa CDC revealed on Thursday. Details of the “donations” are sketchy, but Africa CDC director John Nkengasong, during a media briefing, disclosed how one African country, the Democratic Republic of Congo (DRC), was forced to return 1.3 million doses of vaccines received via the COVAX Facility for redistribution to other countries, including to Caribbean countries, that can expedite its rollout before expiry dates….”
Analysis. “As the pandemic wears on, countries are discovering that vaccine agreements and contracts are fickle. Entering into agreements doesn’t necessarily lead to promised doses, leaving populations in the lurch as vaccination campaigns stall. Delivery dates have been complicated by shortages in materials needed for the manufacturing process, export restrictions, and quality control….”
“… According to a recent paper from the Institute for New Economic Thinking, governments and pharmaceutical companies last year concluded 44 bilateral COVID-19 vaccine deals, many of which have undisclosed details and poorly understood escape clauses. Poor countries were, by and large, left out….”
… We sorely need a theoretical framework to understand this market. Currently, it resembles what oligopoly must have looked like before Augustin Cournot captured its essentials in 1838.
… Today, we are making vaccine-market rules while trapped in a fog of uncertainty. From the little we know, it is clear that intellectual-property rights must continue to play a role, at least for now. On the other hand, pharmaceutical firms are arguably making vastly larger profits than needed to sustain their incentive to innovate (especially given how much of their IP has resulted from publicly funded research). In large pandemics such as the current one, we should compensate drug companies with lump-sum payments to cover costs, revoke some of their patents, and allow generic firms to mass-produce essential vaccines….”
“Drugmakers and government labs are developing doses easier to take and transport to tackle coronavirus variants and avert future pandemics … The next generation of Covid-19 vaccines in development could come as a pill or a nasal spray and be easier to store and transport than the current handful of shots that form the backbone of the world-wide vaccination effort. … These newer vaccines, from U.S. government labs and companies including Sanofi SA, Altimmune Inc. and Gritstone Oncology Inc., also have the potential to provide longer-lasting immune responses and be more potent against newer and multiple viral variants, possibly helping to head off future pandemics, the companies say… “
“… Many of the next-generation vaccines are in the early-to-middle phase of human testing, which means they may not become available until later in 2021 or in 2022. There is no guarantee the vaccines will succeed in testing, and some of the companies developing them, such as Altimmune and Gritstone, have never brought a vaccine to market….”
“Pfizer made $3.5bn from Covid-19 vaccine sales in the first quarter and boosted its full-year expectations for revenue from the jabs to $26bn from $15bn as it reported its quarterly earnings on Tuesday….”
See also Reuters - Pfizer lifts sales forecast for COVID-19 vaccine to $26 billion
V Jain et al ; https://www.who.int/bulletin/volumes/99/5/20-283846/en/
Important editorial. Concluding: “Despite welcome initiatives such as the COVAX Facility, estimating needs for COVID-19 vaccines across countries is difficult. Using vaccines to pursue locally determined disease control targets will lead to a fragmented and inequitable global pandemic response. Specifying the epidemiological parameters at which COVID-19 outbreaks can be considered well controlled under various vaccination scenarios is essential. As population immunity changes heterogeneously around the world, a single international classification will inform our understanding of national needs for vaccines, diagnostics, therapeutics and other public health interventions.
“There is currently no plan to get to global herd immunity, needlessly leaving the world vulnerable to case resurgence and the proliferation of variants. We are calling on leaders to agree to a Global Vaccine Roadmap to achieve global herd immunity as soon as possible (at least 70%, more if the evolving science points to the need for further coverage). This Roadmap should: Set out a comprehensive, coordinated strategy to get to global herd immunity as soon as possible; Increase and improve the global supply of all COVID tools through investment, policies and the redistribution of excess doses; Fully cost the response, agree to a burden sharing model and begin to plug the gap by fully funding the ACT-A.”
“As COVID-19 vaccines are rolled out in LMICs, they offer new hope to stem the pandemic and protect populations. To ensure strong, efficient and equitable COVID-19 vaccine rollout, governments must rapidly mobilize the private health sector and effectively steward all available resources in their health systems toward achieving this life-saving objective. “
“A new (IHME) analysis of the toll of the Covid-19 pandemic suggests 6.9 million people worldwide have died from the disease, more than twice as many people as has been officially reported … Most countries have under-reported deaths, the institute’s director, Christopher Murray, told reporters in a briefing. In many cases, the under-estimates seem to be a result of health systems being overwhelmed, and of insufficient testing. But in several cases it appears something else would have to account for the scale of the differences between the deaths countries are reporting and the excess mortality they have experienced during the pandemic, he said, pointing to countries like the Russian Federation and Egypt, where the estimated deaths, 170,000, are 13 times higher than the country’s official death toll, 13,529….”
“Laos, Nepal and Thailand risk facing India-like Covid crisis; Situation in India can happen anywhere, WHO’s Hans Kluge says.”
“Journals risk being used in place of regulators when they publish studies of novel vaccines that have not yet been authorised by a major regulator. Chris van Tulleken argues that peer review is inadequate to decide the risk-benefit ratio of new drugs.”
By a number of scientists. With focus on three specific countries, selected because they have had the highest number of reported COVID-19 deaths in their respective regions: Brazil (Latin America), India (Asia) and South Africa (Africa).
C Ahanhanzo et al ; https://gh.bmj.com/content/6/5/e004762
“…this practice paper from the West African Health Organization presents experience and data from the field on how countries in the region mobilised support to address the pandemic in the first year, leveraging on systems, infrastructure, capacities developed and experiences from the 2014 Ebola virus disease outbreak.”
“Despite heterogeneity in income levels, countries implemented similarly strict containment and closure policies to mitigate the COVID-19 pandemic. This research assesses the effectiveness of these containment and closure policies, which we defined as larger decreases in mobility and smaller COVID-19 case and death growth rates. Using daily data for 113 countries on mobility and cumulative COVID-19 case and death counts over the 130 days between February 15, 2020 and June 23, 2020, we examined changes in mobility, morbidity, and mortality growth rates across the World Bank’s income group classifications. Containment policies correlated with the largest declines in mobility in higher income countries. High-income countries also achieved lower COVID-19 case and death growth rates than low-income countries. This study finds better epidemiological outcomes of containment and closure policies for higher income countries than lower income countries. These findings urge policymakers to consider contextual differences, including levels of economic activity and the structure of the economy, when crafting policies in response to public health emergencies.”
S Keestra; https://gh.bmj.com/content/6/5/e004916
“… Universities are contributing to the violation of the social and economic rights of those unable to access novel health technologies by unquestioningly engaging in a biomedical innovation system that relies on profit-driven commercialisation of knowledge generated with public funding, and this should be considered structural violence. Applying the lens of structural violence can help reframe the responsibilities of universities in the access to medicines debate by: (1) highlighting universities’ position in the structures of the biomedical innovation system, (2) bringing attention to the systematic inequities in knowledge dissemination and how this can result in differential health outcomes when particular groups are denied timely access to health innovations and (3) reconsidering the role of universities’ technology transfer practices in sustaining the unequal structures and power relations inherent to the biomedical innovation system….”
“This article describes PFM “stress points” in each phase of the budget cycle that may arise throughout the vaccine roll-out. The article also uses country examples to illustrate possible ways to overcome these barriers….”
“Even after mass vaccinations, some hospitalizations and deaths from the coronavirus are inevitable — but opinions differ on how many is too many for a return to relative normality.”
The Lancet’s view on the unfolding tragedy in India and what needs to be done- a twofold approach.
For the health economists among you.
Good news. “The Democratic Republic of Congo declared an end to its most recent Ebola outbreak in North Kivu after three months and 11 confirmed cases. But there's a possibility of new cases emerging, responders warned….”
See also last week’s IHP News. “Inequalities in addressing AIDS threaten global efforts to stamp out the disease as a public health threat by 2030, UN Secretary-General António Guterres warned in a report published on Friday, which provides 10 key recommendations to get the world back on track.”
“On 5 May 2021, WHO launched the WHO global sodium benchmarks for different food categories at a virtual high-level event. It is a first-ever globally harmonized set of benchmarks for more than 60 food categories that define the maximum levels of sodium that processed foods can contain….”
Discussion & conclusions : « Sex-based harassment was pervasive in Ugandan public health workplaces, corrupted management practices, silenced reporting and undermined the achievement of human resources goals, possibilities overlooked in technical discussions of support supervision and performance management. Harassment of both health system patients and employees appeared normative and similar to “sextortion.” The mutually reinforcing intersections of sex-based harassment and vertical occupational segregation are related obstacles experienced by women seeking leadership positions. Health systems leaders should seek organizational and sectoral solutions to end sex-based harassment and make gender equality a human resource for health policy priority.”
A N C Derkyi-Kwarteng, L Gilson et al ; http://www.ijhpm.com/article_4043.html
“…One of the observed challenges in SSA is that even where services are supposed to be “free” at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA….”
“…This guidance note was prepared for countries that have already made the decision that they require a health technology assessment (HTA) mechanism. It is not intended to convince readers that an HTA is necessary, as it is expected that they have already reached that conclusion. It is designed to be extremely practical, with checklists to support implementation in each chapter….”
“In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies….”
“… Degrowth, then, is not just a critique of excess throughput in the global North; it is a critique of the mechanisms of colonial appropriation, enclosure and cheapening that underpin capitalist growth itself. … … These demands align strongly with those of social movements in the global South. This is clear, for instance, in the People's Agreement of Cochabamba, drafted in 2010 by thousands of grassroots organizations from more than 130 countries. The Cochabamba statement explicitly attacks the economics and ideology of growthism and explicitly critiques excess resource use in the global North (“hyper-consumption”) as the driver of “overexploitation and unequal appropriation of the planet's commons. … in the face of ecological breakdown, solidarity with the South requires degrowth in the North.”
J Galjour et al; https://link.springer.com/article/10.1057/s41271-021-00280-3
“The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: learning from the field. While ‘the field’ often denotes people, patients, communities, and healthcare workers, we challenge the notion and its usage. A group of like-minded conference participants set up a working group to examine the term ‘the field’ and look at questions related to language, power, participation, and rights. By highlighting deficiencies of existing terms and jargon, we explain why language is a form of power that matters in public health. We describe global, regional, and national case studies that facilitate full participation to achieve more equitable health outcomes.”
“ICRC finds that between 2016 and 2020, there were 3,780 attacks on health care providers and patients.”
“…In 2016, the U.N. Security Council adopted its first resolution to protect health care systems in conflict. This resolution included steps countries could take to stop these attacks. But ICRC’s data shows this resolution has not been effective in preventing these attacks and according to the organization implementation of these measures is weak….”
“WHO’s latest global survey on implementation of national infection prevention and control programmes highlights the urgent need to reduce inequalities in the availability of good hand hygiene and other infection prevention and control measures between high and lower income countries. A new WHO online monitoring portal will help countries identify and address gaps….”
“…This systematic review aims to understand the effects of changes in hospital payment mechanisms introduced in low- and middle-income countries (LMICs) on hospital- and patient-level outcomes…”
“While implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity….”
The authors sought to map existing evidence on health system responsiveness.
Conclusions: “…This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work….”
L Pierson et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1922731
“Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs.”
Guest Editors: Fabiana da Cunha Saddi, Lindsay J L Forbes, Stephen Peckham.
Link: Disasters - Re‐examining critiques of resilience policy: Evidence from Barpak after the 2015 earthquakes in Nepal (by Simon Rushton et al)
“ The concept of ‘resilience’ has been subject to a number of critiques. In this paper, we examine three of the most common: i) that resilience is a ‘top‐down’ policy discourse that pays too little regard to local specificities; ii) that resilience policy represents a neoliberal shift towards the responsibilization of communities and a retreat of the state from its role in providing protection; and iii) that the focus on resilience tends to divert attention away from the underlying social, political, and economic causes of vulnerability. Using data collected in post‐earthquake Nepal from Barpak, the village at the epicenter of the 2015 Gorkha earthquake, the District Headquarters, and at the national level in Kathmandu, we argue that these critiques have mixed salience in this particular context, but that the first and third in particular point to important problems in the ways in which the Government of Nepal and its international partners have approached the task of enhancing the resilience of Nepalese communities….”
C Lodesani, R Ravinetto et al ; https://blogs.bmj.com/bmj/2021/05/02/european-migration-policies-should-prioritize-health-needs-and-life-saving-strategies/
Concluding: “…As European medical staff and public health specialists serving patients and communities within our own borders and beyond, we should take an ethical stand by speaking out against policies that threaten health, lives and public health, and by combating misinformation. Today more than ever, in the middle of an unprecedented pandemic, solidarity needs to reach beyond national borders. The systematic collection, analysis, sharing, and dissemination of robust and ethical data will be essential for shaping public health and human rights oriented policies, and for contributing to building an inclusive society, able to adequately respond to medical needs including in global emergencies.”
“ Our reluctance to look at capitalism when we investigate global patterns of health and disease has a cost, writes Nicholas Freudenberg. A cascade of health crises—from the covid-19 pandemic, to our climate emergency, and a rise in “deaths of despair”—are contributing to growing global health burdens, making this the time for health professionals to seek the common causes of these catastrophes. Mounting evidence suggests that key features of 21st century capitalism add to the global burden of disease and to health inequities within and among nations…”
“Important but more than this, the leadership of all global health academic / public health institutions in France, US, UK, Canada etc.... should collectively (in an organized manner) demand that their respective countries stop blocking the TRIPs and share all technologies ASAP.”
“WHO is developing international vaccine certificates to get safe movement going again”
Re tweet L Gostin: “Insightful talk by @doctorsoumya @P4HR webinar on #VaccinePassports @WHO is developing smart Int'l Vaccine Certificates * Proof of vac * Confidential & Secure * Open Access * Interoperable But @WHO doesn't support requiring vacs for int'l travel until the world is more equal”
“Pfizer: "It would be IMPOSSIBLE to scale up mRNA vaccine manufacturing in other parts of the world." Biontech's Website: Two advantages of mRNA vaccines are that they can be produced extremely quickly and can be easily shared and don't require bespoke production processes.”
“Rich countries say that there is no need for a #TRIPSWaiver because countries can use compulsory licensing enshrined in TRIPS. Russia did so on remdesivir. The result? : Gilead sues Russia over a compulsory license issued to a company making remdesivir.”
“@JNkengasong praises the U.S. announcement on waiving intellectual property rights as a "remarkable expression of leadership.” He adds, on countries that don't support the waiver, that when the history of the pandemic is written, we will "remember the silence of our friends."
“Time for the unfolding global crisis to be discussed & immediate collective action at the @UN Security Council. The public health & humanitarian crisis in India will not stop at the borders & risks a regional & global wider catastrophe.”
Roberto Bissio; Development (paper);
“The International Finance Corporation, the branch of the World Bank that lends to the private sector, is closely associated with the biggest corruption cases in history, including the infamous Odebrecht scandal that resulted in the removal, imprisonment and even suicide of several Latin American presidents. Yet diplomatic immunity has kept the Bank and its Private–Public Partnerships model away from scrutiny.”
With some of the usual arguments.
CGD - Expanding Vaccine Access and Humanitarian Financing Should Be Urgent Objectives for the World Bank and IMF (by M Ahmed & M Lowcock)
New Lancet Commission.
( By Edwine Barasa et al)
· BMJ Global Health - Health spending and vaccination coverage in low-income countries
“ Vaccination coverage success of some LIC was not explained by economic development, total health spending nor aggregated DAH. Vaccination coverage success of LIC+ (i.e. LICs with high coverage) was associated with increasing government health spending particularly in routine immunisation vaccines….
· HP&P - Why did Ghana’s national health insurance capitation payment model fall off the policy agenda? A regional level policy analysis (by Gilbert Abiiro et al)
Based on figures from the Climate Action Tracker.
“New climate targets announced by the US and other rich nations in recent weeks have put the world on track for global heating of about 2.4C by – the end of the century, research has found. That is a 0.2C improvement on the previous forecast of 2.6C, but still substantially above the Paris goal of holding temperature rises to no more than 2C above pre-industrial levels, with an aspiration to limit heating to 1.5C….”
“Slashing methane emissions is vital to tackling the climate crisis and rapidly curbing the extreme weather already hitting people across the world today, according to a new UN report. … Achieving the cuts would avoid nearly 0.3C of global heating by 2045 and keep the world on track for the . Methane cuts also immediately reduce air pollution and would prevent many premature deaths and lost crops….”
“Head of the Kunming biodiversity summit asks nations to review destructive support for fishing, agriculture and other industries.” “Billions of pounds of environmentally harmful government subsidies must be redirected to benefit nature, the United Nation’s biodiversity chief has said, before the restart of negotiations on an international agreement to set new targets for protecting nature….”
“The Brazilian Amazon released nearly 20% more carbon dioxide into the atmosphere over the past decade than it absorbed, according to a startling report that shows humanity can no longer depend on the world’s largest tropical forest to help absorb manmade carbon pollution. From 2010 through 2019, Brazil’s Amazon basin gave off 16.6bn tonnes of CO2, while drawing down only 13.9bn tonnes, researchers reported Thursday in the journal Nature Climate Change. The study looked at the volume of CO2 absorbed and stored as the forest grows, against the amounts released back into the atmosphere as it has been burned down or destroyed. “We half-expected it, but it is the first time that we have figures showing that the Brazilian Amazon has flipped, and is now a net emitter,” said co-author Jean-Pierre Wigneron, a scientist at France’s National Institute for Agronomic Research (INRA)….”
K S Gallagher; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12952
“The bottom line is that while multilateral initiatives and speeches about the need to green the BRI are important, concrete and enforceable policies do not yet match the rhetoric.”
David Musoke Serwadda; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00177-7/fulltext
Comment linked to a new study in the Lancet Global Health - Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis “…There are concerns MMC might prompt higher-risk sexual behaviours because of lower self-perceived risk of HIV infection. We reviewed the published literature to examine associations between MMC and both condom use and number of sex partners among heterosexual men….”
“… In The Lancet, Mehreen Datoo and colleagues report on another vaccine that might have an important role in preventing malaria, barring unforeseen safety issues that arise once it is evaluated at larger scale….”
“Biotech firm Oxitec launches controversial field test of its insects in Florida after years of push-back from residents and regulatory complications.”
« …Here we focus on the main tobacco companies operating in Africa: Philip Morris International, British American Tobacco, Imperial Brands and Japan Tobacco International, and on their attempts to increase the supply and demand of tobacco to the African market…”
“…We urge the Indian government to issue compulsory licence for both the drugs as requested in the petition….”
“Civil society activism and competition from manufacturers of generic drugs drove down the prices of antiretroviral medicines from about US$ 14 000 per person per year for first-line regimens in high-income countries in 1990 to about US$ 1200 per year in low- and middle-income countries in 2003. By 2018, the price per person per year in sub-Saharan Africa was under US$ 100 for most fixed-dose combinations that include tenofovir. The prices of other fixed-dose combinations also have continued to decline over the past few years. UNAIDS estimates that the market value for generic antiretroviral medicines within low- and middle-income countries was about US$ 1.8 billion in 2018. Approximately 80% of generic antiretroviral medicines procured by low- and middle-income countries are currently manufactured in one country: India. While there remains significant scope for further price reductions in countries where generic antiretroviral medicines are not yet easily accessible, disruptions caused by the COVID-19 pandemic could have the opposite effect. Lockdowns, disruptions to production, border restrictions and transport disruption threaten to affect the supply of materials and the manufacture and distribution of HIV medicines, with tighter supply factors possibly leading to pressure on market prices.”
The authors used Kingdon’s model to analyse agenda setting for essential medicines policy in sub-Saharan Africa during the formative phase of the primary healthcare (PHC) concept.
Human Resources for Health - Conceptual framework for task shifting and task sharing: an international Delphi study
“New figures show deteriorating press freedom in 2020, which health experts say will have hampered the COVID-19 response. Ed Holt reports.”
New report. “This report presents the documented threats and violence against health care between January 2016 and December 2020. …” As you know, the trend has been, sadly, increasing.
“…There have been roughly two incidents of violence daily against health care workers around the world in the past five years.. Between 2016 and 2020, there were more than 4,000 incidents of violence — these involved nearly 1,000 incidents where health centers or clinics were destroyed, nearly 700 workers' deaths and 400 kidnappings. Although many of these incidents occurred in war-torn countries, the report noted that in 2020, violence against health workers also increased in countries not at war, including India and Mexico. …”
Review on the literature of ‘transitions finance’.
“Against the backdrop of the world's second most populous country in the grips of a catastrophic COVID-19 surge, the Global Fund today said it approved $75 million to help India buy oxygen concentrators and oxygen plants….”
“Agency declines import permit, claiming crippled adenovirus that serves as vaccine is active in second doses.”
“Brazil’s covid-19 response is failing women by actively condemning them to greater vulnerability and risk from covid-19, say these authors.”
By A Binagwaho et al.
“…This Review describes the changing role of testing during the COVID-19 pandemic, including the use of genomic surveillance to track SARS-CoV-2 transmission around the world, the use of contact tracing to contain disease outbreaks and testing for the presence of the virus circulating in the environment. Despite these efforts, widespread community transmission has become entrenched in many countries and has required the testing of populations to identify and isolate infected individuals, many of whom are asymptomatic. The diagnostic and epidemiological principles that underpin such population-scale testing are also considered, as are the high-throughput and point-of-care technologies that make testing feasible on a massive scale….”
“Novavax Inc's (NVAX.O) COVID-19 vaccine had efficacy of 51% against infections caused by the South African variant among people who were HIV negative, and 43% in a group that included people who were HIV positive, according to a new analysis published on Wednesday….”
“The German company CureVac hopes its RNA vaccine will rival those made by Moderna and Pfizer-BioNTech. It could be ready next month.”
“World Bank President David Malpass on Wednesday urged wealthy countries to quickly free up excess vaccines for developing economies that are now facing greater needs, by exporting stockpiled doses and giving up options for future deliveries….”
“Pfizer and its partner BioNTech announced Thursday that they would provide Covid-19 vaccine to all Olympic and Paralympic delegations headed to the Summer Games in Tokyo, vaulting them ahead of health workers, the elderly, and others in countries struggling to acquire their own supplies….”