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Dear Colleagues,
Two years after the first case of COVID-19 was reported, “the end” of the pandemic seems nowhere near. As a Belgian journalist put it last week, it’s like a B-horror movie that just doesn’t want to end. On Wednesday, WHO said that Omicron could have a ‘major impact’ on the course of the pandemic but that it was still too early to tell. As if Delta wasn’t bad enough.
Plenty of pandemic related and other news again this week, with among others the PAVM (Partnership for African Vaccine Manufacturing) meeting in Rwanda (clearly Paul Kagame doesn’t feel like being ‘left behind’ in this drive towards regional manufacturing), an ACT-A Facilitation Council meeting, the Nutrition for Growth summit in Tokyo, the launch of a new (US) Initiative for Global Vaccine Access (Global VAX), indicating a trend of increasing support for the roll-out of vaccines, an updated (2021 ) GHS index, a new and worrying World Malaria report (even if a doomsday scenario hasn’t materialized), the first (WHO/Global Fund) State of inequality: HIV, tuberculosis and malaria report, a Lancet Commission on autism, …
I also watched interesting webinars on WHO Financing (with a key working group meeting coming up next week), and commercial determinants of health, among others. In the webinar on WHO financing, I personally found Björn Kümmel’s optimism and confidence about finally putting WHO financing on a more sustainable footing, quite encouraging. Let’s hope he’ll be proven right next week and at the EB meeting end of January. As Björn argued, “It’s show time” (i.e. member states need to show that they really want a stronger WHO, as they all seem to claim). Time to walk the talk.
I also very much liked how Cyril Ramaphosa confronted Charles Michel, “Mr Pandemic Treaty”, earlier this week. Michel is one of a number of our leaders who seem to believe their own double speak on ‘global solidarity’. More in particular, Michel claimed Ramaphosa’s references to a “vaccine apartheid” were “dramatic statements”. Ahum. (By the way: don’t say ‘pandemic treaty’, anymore, the term ‘pandemic accord’ seems to be in vogue these days.)
Let’s throw in another quote of the week. As Anna Marriott (Oxfam) argued last weekend, “With the new threat of the Omicron variant, it is clear that we cannot just booster our way out of the pandemic while leaving much of the developing world behind.” That is the view of the People’s Vaccine alliance (of which Oxfam is a member), and one I fully subscribe to.
In other news on inequity, Axios flagged a “Billionaire balloon” based on the new World Inequality Report 2022. As they called it,”the super-rich are getting stupid rich”. On a more upbeat note, I vaguely remember from my toddler time what used to happen with balloons 😊.
Finally, on Thursday and Friday, Biden is hosting his first Summit for Democracy. I’m not a big fan, for a number of reasons, although I do appreciate Orban didn’t get an invitation 😊. More in general though, I hope you find the time to read this FP analysis by Hélène Landemore in which she argues, “Democracy as it was envisioned was never about real people power. That’s what needs to change.” Key excerpt: “…the people writ large don’t hold power in these systems. Elites do. Consider that in the United States, according to a 2014 study by the political scientists Martin Gilens and Benjamin Page, only the richest 10 percent of the population seems to have any causal effect on public policy. The other 90 percent, they argue, is left with “democracy by coincidence”—getting what they want only when they happen to want the same thing as the people calling the shots.” Might be more true in some of our ‘liberal democracies’ than in others (I can think of one in particular) but most democracies will certainly recognize the problem.
Similarities with the “global health architecture” are obvious, by the way, even if nobody has coined the term ‘global health by coincidence’ yet, as far as I know.
Time for real democracy and people power. Including in global health.
PS: Mazzucato & Ghosh’s call for ‘Health Innovation for all’ would be a great start.
Enjoy your reading.
Kristof Decoster
“The 2021 GHS Index measures the capacities of 195 countries to prepare for epidemics and pandemics. All countries remain dangerously unprepared for future epidemic and pandemic threats, including threats potentially more devastating than COVID-19. Read the report’s findings and recommendations, explore the data, view the country rankings, and learn more about the GHS Index. “
Coverage:
· WP: Two years into this pandemic, the world is dangerously unprepared for the next one, report says
“Researchers compiling the Global Health Security Index — a project of the Nuclear Threat Initiative, a D.C.-based nonprofit global security group, and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health — found insufficient capacity in every country, which they said left the world vulnerable to future health emergencies, including some that might be more devastating than covid-19….”
“With its vast wealth and scientific capability, the United States held on to its top ranking among 195 countries, even as it scored lowest on public confidence in government — a factor associated with high numbers of cases and deaths…”
“The assessment of each country’s ability to prevent, detect and respond to health emergencies in 2021 was based on public information. Researchers also weighed other factors, such as public confidence in government. The average country score for 2021 was 38.9 out of a possible 100 points, essentially unchanged from 2019. No country scored above 75.9….”
· Telegraph - UK falls off second spot in global ranking of pandemic preparedness
“US retains its number one position despite a Covid response 'generally viewed as extremely poor'.”
“The index … ranks countries in six categories: their ability to prevent, detect and respond to a pandemic; their health system; commitment to international norms and practices; and their risk environment, which covers areas such as trust in government and social cohesion.”
“The report acknowledges that the US’s pandemic response has “generally been viewed as extremely poor”. “The result highlights that although the GHS Index can identify preparedness resources and capacities available in a country, it cannot predict whether or how well a country will use them in a crisis,” it says. The index cannot anticipate how a country’s political leaders will respond to recommendations from health or science experts, for example….”
Hmm. Also with Clare Wenham’s view on the GHS index update.
· NYT - The World Is Unprepared for the Next Pandemic, Report Says
“The latest Global Health Security Index finds that no country is positioned well to respond to outbreaks.”
PS: “More than 90 percent of countries have no plan for distributing vaccines or medications during a health emergency, while 70 percent lack enough capacity in hospitals, clinics and health centers….”
Coverage of last week’s GAVI Board meeting decisions. “A new malaria vaccination programme has been approved, providing Gavi-eligible countries in sub-Saharan Africa a powerful new tool with which to fight malaria. In 2022, Gavi, through COVAX, will continue to help countries meet COVID-19 vaccination targets, focusing mostly on lower-income countries and those most in need including support for delivery at scale; Gavi will invest US$ 250 million over 2022-2026 in its partnership with India; US$ 53 million over 2022-2025 will be channelled towards supporting the availability of diagnostic tests for yellow fever, cholera, typhoid, meningococcus, measles, and rubella.”
Do read especially for this section on COVAX in 2022: “… The Board also approved the Vaccine Alliance’s strategic direction and role in COVAX. In 2022, Gavi, through COVAX, will continue building the foundations of COVID-19 protection with a focus on lower-income countries and the most in need; deploying a flexible portfolio of COVID-19 vaccines to manage uncertainty and anticipate risk; and providing support for delivery at-scale. …”
This virtual meeting, chaired by Samantha Power (USAID), took place on Monday.
“USAID Administrator Samantha Power announced the foundation of a new whole-of-government effort, the Initiative for Global Vaccine Access (Global VAX), to accelerate global efforts to get COVID-19 shots into arms and enhance international coordination to identify and rapidly overcome access barriers to save lives now, with a priority on scaling up support to countries in sub-Saharan Africa. Global VAX brings together a whole-of-government effort, through which the United States has already committed more than $1.3 billion for vaccine readiness. Today Administrator Power announced an additional $400 million in American Rescue Plan Act funds, generously provided by the U.S. Congress, to further augment this work. Global VAX includes bolstering cold chain supply and logistics, service delivery, vaccine confidence and demand, human resources, data and analytics, local planning, and vaccine safety and effectiveness. Administrator Power announced the effort during a ministerial meeting of key international development partners from around the world, which she convened to discuss the next phase of actions needed to combat the pandemic. With today’s announcement, of which $315 million will support vaccine readiness programs, the United States has committed more than $1.6 billion in funding to help get shots into arms around the world….”
Related tweet Ilona Kickbusch: “USAID Announces Initiative for Global Vaccine Access (Global VAX) without mentioning @who or #COVAX - intriguing indeed!”
Coverage via HPW - US Announces ‘Global VAX’ to Push COVID-19 Vaccination Effort Worldwide
“The US Agency for International Development (USAID) has set up a new global initiative to accelerate COVID-19 vaccination efforts, called the Initiative for Global Vaccine Access (Global VAX), the agency announced on Monday. Global Vax’s aim according to USAID, is to “get COVID-19 shots into arms and enhance international coordination to identify and rapidly overcome access barriers to save lives now, with a priority on scaling up support to countries in sub-Saharan Africa”. Global VAX will coordinate the US government’s COVID-19 vaccination efforts….”
“The World Bank on Monday said its funding had helped deliver 100 million doses of COVID-19 vaccines around the world and it would reach the 150-million mark by the end of the month, if doses arrive as expected. World Bank President David Malpass said the multilateral development bank had contracted for nearly 300 million doses, with some $7.5 billion in vaccine financing operations for 69 countries to be committed by the end of December.
“Speaking at a conference hosted by the U.S. Agency for International Development, Malpass underscored the need for rich countries to fulfill their generous dose donation pledges as quickly as possible, and unveiled a new database to track which countries needed financial and operational support. … …. Malpass said the new World Bank Vaccine Deployment Tracker would help resolve specific bottlenecks to scale up vaccine deployment. It is based on joint work between the World Bank and the COVAX Country Readiness and Delivery Team, which includes the World Health Organization, UNICEF and GAVI…..””
Excerpts from Tedros’ speech, which has updates on Covax & ACT-A, among others.
“…. we have shown that COVAX and AVAT work, when they have access to vaccines. COVAX has now shipped more than 600 million doses to 144 countries and territories. More than 80% of those doses have gone to low- and lower-middle income countries. As supply increases, COVAX is picking up speed. In the last two months alone, COVAX shipped more doses than in the first 8 months of this year combined. All but two low and lower-middle income countries have now started to roll out vaccines. In the coming months, we expect supply to continue increasing. And as it does, countries will need increased support to scale up capacity for widespread vaccination. To do that, WHO and UNICEF, in partnership with Gavi, are appointing Mr Ted Chaiban, an experienced humanitarian leader, as global coordinator for country readiness and delivery, to lead an enhanced joint effort to turn vaccines into vaccinations faster. This effort will be focused on the 40 to 50 countries at highest risk of missing the target to vaccinate 40% of their populations by the end of this year.
“… And we must all remember that vaccines alone will not end the pandemic. The emergence of Omicron highlights the need to scale up equitable access to testing and sequencing, as well as to oxygen and new antivirals. And yet the ACT Accelerator is currently out of cash, especially to buy tests, oxygen, PPE, and to fund vaccine delivery. It’s therefore essential that countries fully fund the ACT Accelerator, which needs US$ 23.4 billion over the next 12 months to get tests, treatments and vaccines to where they are needed most….”
Link:
https://www.nature.com/articles/d41586-021-03616-x
“The pandemic will not end while vaccine equity keeps getting pushed to the margins.”
A few excerpts:
“… IP scholars such as Luke McDonagh at the London School of Economics and Political Science say IP relief for the duration of the pandemic will kick-start vaccine manufacturing around the world. But the EU is resisting, partly because of the strength of opposition from European pharmaceutical companies that fear they will lose their market share if their competitors are allowed to use their designs. But another way is possible….”
“The COVID-19 Vaccines Global Access (COVAX) scheme for providing vaccines to low-income countries needs a shot in the arm. …. With populations in high-income nations largely vaccinated, COVAX looks to be turning a corner and will have delivered around 600 million vaccines by the end of the month. But these green shoots could be short-lived now that Omicron is prompting high-income nations to once more place large vaccine orders, especially for Omicron-specific vaccines based on messenger RNA. So long as this cycle continues, low- and lower-middle-income countries will always be at the back of the vaccines queue.”
“David Heymann, a long-standing science adviser to the WHO, says COVAX needs a high-profile global figure — someone of the stature of a leader of one of the G7 group of wealthy nations — to head it. Someone with the contacts, heft, star power and skills to knock heads together to hammer out a global solution to vaccinating the world, including compelling pharmaceutical company executives to agree that IP has to be shared, as happened with HIV drugs. This is not a criticism of COVAX’s present leadership, Heymann emphasized — but adjustments are needed….”
“ Global vaccine-sharing network COVAX is still seeing strong demand for India-made doses of the AstraZeneca (AZN.L) COVID-19 shot, its co-lead GAVI said, following comments from producer the Serum Institute of India (SII) that uptake had slowed sharply….”
PS: “… The SII has a deal to supply up to 550 million Covishield doses to COVAX but has sent only about 37 million so far….”
“This document sets out WHO’s unique role and funding requirements to deliver on its role and work under the Access to COVID-19 Tools (ACT)-Accelerator, October 2021 to September 2022. The ACT-Accelerator – and WHO’s funding requirement within it – is a subset to WHO’s global Strategic Preparedness and Response Plan (SPRP) which outlines WHO’s overall objectives and funding needs for the COVID-19 response. The ACT-Accelerator needs US$23.4 billion until September 2022. Of this, WHO’s funding needs are $1.57 billion, less than 7% of the total ask. This is an urgent call for the international community to fund the low cost, high impact work of the WHO to deliver on its new role within the new ACT-Accelerator….”
A Shen et al; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640687/
“UNICEF, WHO and Gavi have established a COVID-19 vaccination Country Readiness and Delivery workstream to support country readiness for COVID-19 vaccination programmes as part of COVAX….” In this Bulletin editorial, some more info on this workstream.
“Africa needs to make its own vaccines to avoid a repeat of its supply problems in the COVID-19 pandemic but faces big obstacles in turning itself from a pharmaceutical testing ground into a place where vaccines are created, experts said on Tuesday. The Partnership for African Vaccine Manufacturing (PAVM) has set as a target that 60% of the continent's routine vaccine needs, or between 1.4 and 1.7 billion doses yearly, should be met by local manufacturing by 2040, up from about 1% now. Experts meeting at a PAVM conference in Rwanda said the pandemic had shown Africa urgently needed to tackle its dependence on imported vaccines. But they outlined daunting obstacles, from brain drain to power shortages….”
“Martin Friede, coordinator of the World Health Organisation Initiative for Vaccine Research, said Africa had produced many scientific researchers but not a workforce capable of designing and making vaccines. He urged the continent's political and scientific leaders to focus on changing that skillset, drawing a contrast with Africa's customary role in pharmaceuticals….”
“… Charles Gore, head of the United Nations-backed Medicines Patent Pool which seeks to boost drugmaking in developing countries, said seeking licences from pharmaceutical firms elsewhere was not a sustainable solution for Africa as it had few incentives to offer those firms….”
More coverage via Devex – Pfizer outlines challenges in localizing vaccine manufacturing
“ Patrick van der Loo, regional president for Africa and the Middle East at Pfizer, during an Africa Centres for Disease Control and Prevention stakeholder meeting on vaccine manufacturing on Monday, outlined what he said are the challenges the company faces in finding local manufacturing partners to transfer its vaccine technical know-how….”
“They are: 1) Consistent electricity and water. 2) Employee retention. 3) Limited volume. 4) Regulatory standards. 5) Cold chain capacity. 6) The time-consuming nature of technology transfers.”
And via HPW – African Medicines Agency Has Key Role as Continent Pushes Local Vaccine Production
“The newly constituted African Medicines Agency (AMA) will be key in assisting the African Union (AU) to achieve its aim of producing 60% of vaccines on its own soil by 2040. This emerged at a two-day meeting of the Partnership for Africa Vaccine Manufacturing (PAVM) hosted by Rwanda this week. The PAVM was set up six months ago by the AU and Africa Centre for Disease Control and Prevention (CDC) to drive vaccine development. Major global pharmaceutical companies Pfizer, BioNTech, Moderna and Johnson and Johnson told delegates that vaccine manufacturing required long-term, capital intensive investment. But they also stressed the need for a harmonised regulatory environment to ensure the smooth and speedy assessment and registration of vaccines and medicines….”
Hardhitting op-ed by Winnie Byanyima.
“On 6 and 7 December, Rwanda’s President Kagame hosted the Partnership for Africa Vaccine Manufacturing meeting in Kigali and online. African leaders, and Africa CDC, are taking an approach that will be key to ending Covid-19 in Africa and to beating all other pandemics. That approach has two key elements: First, that Africa must strengthen self-reliance in the development and manufacturing of life-saving technologies, so that it will never again find itself dependent on what other countries and pharmaceutical companies may choose to provide. Second, that self-reliance for Africa in research, development and in manufacturing will only be achieved through pan-African collaboration. …”
Coverage of last week’s webinar by the Graduate Institute’s Global Health centre.
“…Now that the World Health Assembly Special Session has overwhelmingly resolved to negotiate a “pandemic accord”, the urgent work of producing a workable plan to tackle future pandemics begins. This was the view of speakers – most of whom have been integrally involved in “pandemic accord” discussions – addressing an event convened by the Global Health Centre at the Graduate School of International and Development Studies (IHEID) and the United Nations Foundation on Friday….”
https://www.twn.my/title2/health.info/2021/hi211205.htm
“The World Trade Organization’s General Council (GC) chair and the WTO director-general on 8 December appealed to trade ministers to empower their trade envoys in Geneva to conclude multilateral decisions on the “WTO’s response to the pandemic, including the TRIPS dimension” and on “fisheries subsidies” by the end of February….”
P Patnaik; Geneva Health Files;
Last Friday’s Deep Dive.
“Days after the postponement of WTO’s ministerial conference at the cusp of its convening, the proponents of the TRIPS Waiver are fighting to keep it front and center even as the emergence of a new variant has cast a spotlight on the WTO to resolve the waiver discussions to meet new challenges in the on-going pandemic. Depending on who one speaks to, it seems that the new variant gives urgency to both the opponents and the supporters of the waiver….”
Read why both sides find arguments for their respective stance in Omicron.
R Kanth; https://www.twn.my/title2/health.info/2021/hi211203.htm
“Many developing and least-developed countries have raised the stakes on the temporary TRIPS waiver and on public stockholding programs for food security, suggesting that other issues, including fisheries subsidies, could be calibrated due to the postponement of the WTO's 12th ministerial conference (MC12), said people familiar with the discussions. At an informal Heads of Delegation (HoD) meeting on 2 December, the developing countries, led by South Africa and India, flagged their specific demands centering on the unresolved issue of the TRIPS waiver in the WTO's response to the pandemic as well as on the permanent solution for public stockholding programs for food security (PSH). With the emergence of the new Omicron variant of the SARS-CoV-2 virus that is capable of slowing down global economic activity, South Africa, India, and several other developing countries spoke about the heightened urgency on agreeing on the TRIPS waiver, said people familiar with the discussions….”
“WHO is looking to China and India to share patents to help boost Covid-19 jabs in developing countries.”
“…the WHO had contacted the Chinese mission in Geneva, as well as Sinopharm and Sinovac directly, to see if the two companies were willing to share their technologies and patents via the Covid-19 Technology Access Pool (C-TAP)…. She said Sinopharm and Sinovac had shown interest in sharing technologies in the early stages, but were more eager to strike bilateral agreements with individual countries after their jabs obtained WHO approval for emergency use. “We are still in touch with them in discussions to see how we can move forward the licensing through C-TAP, because even if they already had a few licences, we know that we need more.” Indian drug maker Bharat Biotech had offered its technology to C-TAP and the WHO was negotiating a licensing agreement with it, Loayza said. “And we hope the Chinese will come on board as well soon,” she said….”
Coverage of a (Graduate Institute Global Health Centre) webinar on WHO financing earlier this week. “The way in which WHO is financed is “fundamentally rotten” with excessive financial dependence on just a handful of rich countries and a few private donors. But Germany’s deputy head of global health in the Ministry of Health, Björn Kümmel, is hopeful that WHO member states may turn course in coming months – and reclaim responsibility for the financial support of the global health agency. A member state Working Group on Sustainable Finance is due to meet Monday, for the fifth time this year, to consider a set of recommendations that would see regular assessed contributions paid by member states to fund WHO rise to 50% of its budget by the 2028-2029 fiscal year. Currently, the regular annual fees assessed to WHO’s 194 member states represent only about 16% of the agency’s US $3 billion a year annual budget for 2020-2021. The draft recommendations, which still need approval by the Working Group, also call for exploring a “replenishment mechanism” to broaden further WHO’s financing base – a model that has been successfully used by public-private partnerships like the Global Fund and Gavi to drive higher budget pledges from countries and foundations in high-profile events – but without strings attached to the money. If the Working Group of member states gives the greenlight, then the reform proposals would go to the Executive Board in January 2022 and then to the full World Health Assembly for its 75th meeting in May….”
D Fidler; https://www.thinkglobalhealth.org/article/summit-democracy-and-us-foreign-policy-global-health
« As the COVID-19 pandemic continues, this week's summit underscores the need to rethink global health in foreign policy.” US foreign policy, Fidler means.
Some excerpts:
“In his first year in office, President Joe Biden has made restoring democracy a defining feature of U.S. foreign policy. This week, Biden hosts a Summit for Democracy. The summit will address countering authoritarianism, corruption, and human rights violations and the threats they pose to the United States and other democracies. Addressing these threats is important for global health because better health outcomes are associated with democratic governance, corruption mitigation, and respect for human rights. However, whether foreign policy engagement on global health helps counter authoritarianism, corruption, and human rights violations proves a more uncomfortable question. “
“… Heightened foreign policy interest in global health before COVID-19 contributed little, if anything, to mitigating threats now considered grave risks to the community of democracies. This context will intensify scrutiny of claims that engagement on global health produces a range of foreign policy benefits for the United States.”
Case in point: PEPFAR. “ … Global health’s pre-pandemic story diverges from the contemporaneous deterioration in democratic governance, respect for human rights, and anticorruption efforts. This divergence is apparent in PEPFAR. Freedom House analyses and Transparency International rankings over time reveal no patterns of improvements in democratic governance and corruption across countries receiving PEPFAR funds. In sub-Saharan Africa, an area of focus for PEPFAR, COVID-19 accelerated a decline in democracy that was already underway, resulting in more Africans living “under fully or partially authoritarian states today than at most points in the last two decades.” In addition, many PEPFAR recipients have joined China’s Belt and Road Initiative (BRI)… “
“… The United States faces the challenge of reorienting its foreign policy on global health and democracy without much evidence from the recent past that global health engagement produces benefits that strengthen and promote democracy at home or abroad. This highlights the need for the United States to rethink how global health activities fit into its strategic foreign policy objectives, including those the Summit for Democracy will address. Such a rethink should confront whether the United States should condition global health assistance based on U.S. geopolitical and ideological interests or should come with “no strings attached.”…”
Link:
The Conversation - Biden’s summit for democracy: what Africa needs to bring to the table (by J J Stremlau)
“In a new end-of-year blog post, billionaire philanthropist Bill Gates said he plans to step up his advocacy around “broad support for pandemic preparedness efforts” and ramp up work on climate and energy issues in 2022. Gates, who finalized his divorce from Melinda French Gates earlier this year, was candid in Tuesday’s post about how he has fared over the past few months, calling 2021 “the most unusual and difficult year of my life.” However, he said that he continues to devote the bulk of his time to the Bill & Melinda Gates Foundation and that he and French Gates, his co-chair at the organization, have developed a “good new working rhythm.”…”
With 3 big takeaways.
And a quote: “….Gates further cited inequities in vaccine allocation as slowing down efforts to increase vaccination rates globally. “The world has done an outstanding job manufacturing and distributing billions of doses of vaccine, but the fact that so few people at high risk in low-income countries have received them is unacceptable,” the post said. He called for a change in how doses are allocated, as well as expanding vaccine-making capacity globally and further assistance for countries seeking to develop, manufacture, and approve their own vaccines….” #ahum
https://www.twn.my/title2/health.info/2021/hi211204.htm
“The United States has submitted a proposal to amend the International Health Regulations (IHR) 2005 that pursues a health security agenda without paying any attention to the issue of equity….”
L Downey, K Buse et al; https://www.bmj.com/content/375/bmj.n3043
Cfr tweet Kent Buse: “As @FCDOGovUK publishes its first position paper on health systems strengthening, Downey et al offer five recommendations to support stronger, fairer & more resilient systems starting with reversing #odacuts #UKRIcuts. “
https://www.devex.com/news/covid-19-vaccine-gap-looms-over-eu-au-summit-102291
“It’s too late to address the stark gap in COVID-19 vaccination rates between Europe and Africa before a clutch summit in February, a European Union official said Wednesday. The meeting between heads of state from the EU and African Union — pushed from October 2020 to Feb. 17-18 of next year due to COVID-19 — has been cast by EU institutions as a chance to reset the bloc’s “partnership” with Africa. But officials in Brussels have been fretting for months about how to convey that message when EU citizens are receiving booster shots while many in Africa still await their first dose….”
“…The European Commission reported this week that 308.2 million doses have been transferred by EU member states to COVAX, and 72.7 million of these have been delivered to recipient countries. A further 45.2 million doses have been delivered to recipient countries by EU states bilaterally, with the commission reporting that 353.4 million doses have been donated by member states overall and about 118 million delivered. That allowed the commission to assert Wednesday that the EU has met its target of sharing 250 million doses with low- and middle-income countries, particularly through COVAX, by the end of 2021….”
“From a legal point of view, those doses are no longer with the EU member states,” a second EU official said. “Those doses are with COVAX or donated on a bilateral basis.” The second official attributed the difference between the number of doses shared with COVAX and the total actually delivered to low-income countries to a range of factors: recipient states’ readiness to handle large shipments from COVAX, local regulators approving each type of vaccine, and the necessary low-temperature supply chain for adequate storage and distribution….”
See also FT – ‘Erratic’ European Covid vaccine donations hamper African jabs rollout
“….The European Commission says its member states have shared 353m doses to date — mostly via Covax, the World Health Organization-backed initiative to provide equitable access to vaccines — ahead of its year-end target of 250m. Doses actually delivered stand at 124m, however, according to new figures from the IMF. That is well behind the US, which has shipped or delivered 205m donated vaccines on a comparable basis, the IMF numbers show. The EU says it aims to share 700m doses by mid-2022, while the Biden administration has pledged to share over 1.1bn doses….”
“G20 Common Framework for Debt Treatments set to be the only multilateral mechanism for debt relief left in 2022. Private creditors' participation in debt relief has thus far been negligible.”
“….The coming months will see the end of two of the main multilateral mechanisms for debt relief: The G20’s Debt Service Suspension Initiative (DSSI), which expires in December 2021, and the IMF’s Catastrophe Containment and Relief Trust (CCRT), set to expire on 10 January 2022 – although the IMF will consider its possible extension for “a final tranche of debt relief” until 13 April 2022, “subject to the availability of sufficient resources in the CCRT.”…”
“The forthcoming termination of the DSSI and the CCRT means that there will only be one active multilateral mechanism for debt support, the G20 Common Framework for Debt Treatments …” A deeply flawed one.
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02786-0/fulltext
Richard Horton’s take on this. Given that the Lancet published a letter on Feb 18 2020 already, related to this (soon becoming also a geopolitical) story, well worth a read.
He ends like this: “…they condemned “conspiracy theories” suggesting the pandemic did not have a natural origin. They argued that the overwhelming majority of scientific opinion supported the view that SARS-CoV-2 “originated in wildlife”. And they signed off their letter, “We declare no competing interests”. But what fast became clear is that one author of that Lancet letter did indeed have an interest to declare, and an incendiary one at that—a direct link to the Wuhan Institute of Virology, including experiments on viral spillover events and recombinant bat coronaviruses. Was this Lancet letter a smoking gun? Did it point to something sinister taking place in Wuhan? Or was it an astonishing coincidence? After almost 2 years of divisive argument, there is still no clear answer.”
I doubt there’ll ever be.
With some key WHO messages from this week, and Covid trends, among others.
“ …. the World Health Organization (WHO) in its weekly update today said global cases were at a plateau last week for the second week in a row, though cases rose sharply in Africa—especially in South Africa and neighboring countries. … …. In its weekly update on the pandemic, the WHO said cases last week remained at a plateau, though numbers were up significantly in two regions: Africa and the Americas. Africa's cases were up 79% from the previous week, led by South Africa's surge in Omicron variant activity. Cases also soared in neighboring countries such as Eswatini, Zimbabwe, and Mozambique, though it's not clear if Omicron, thought to be more transmissible, is playing a role. The WHO noted that the countries have very low vaccination rates, with about 12% of populations fully vaccinated….
On WHO’s media briefing on Wednesday. “Governments should urgently reassess their national responses to COVID-19 and accelerate their vaccination programmes to slow the spread of the Omicron variant, WHO director-general Tedros Adhanom Ghebreyesus said on Wednesday. The global spread of the variant suggests it could have a major impact on the pandemic, and the time to contain it is now, before more Omicron patients are hospitalised, he told a news briefing. "We call on all countries to increase surveillance, testing and sequencing," he said. "... Any complacency now will cost lives."…”
· See also HPW - As 57 Countries Report Omicron Cases, Pfizer Says its Boosters Offer Protection – But WHO Cautions More Research is Needed
“…WHO expert bodies are examining Omicron: “The technical advisory group for virus evolution is assessing Omicron’s effect on transmission, disease severity, vaccines, therapeutics and diagnostics and the effectiveness of public health and social measures,” said Dr Tedros. The joint advisory group on COVID-19 therapeutics is analysing the possible effects of Omicron on treatment of hospitalised patients. The Research and Development Blueprint for Epidemics is convening researchers to identify knowledge gaps, and the studies needed urgently to answer the most pressing questions. And the technical advisory group for COVID-19 vaccine composition is assessing impacts of Omicron on current vaccines, said Dr Tedros….”
“….Describing the idea that viruses became less virulent as they evolved as “something of an urban myth”, the WHO’s Assistant Director-General for Health Emergencies, Dr Mike Ryan, said that even if this was the case with Omicron, if it generated more cases this would put pressure on health systems and more people die. “That’s what we can avoid. We cannot do anything about maybe the inherent qualities of a virus but we can prevent our systems coming under pressure,” stressed Ryan – through vaccination, masks and reducing social contact. “
PS: “Dr Tedros thanked Switzerland and France for lifting their travel bans on southern Africa and called on other countries to do the same.”
· And via the Guardian - Omicron spreads to 57 countries but too early to tell if variant more infectious, WHO says
“The Omicron variant of Covid-19 has now been reported in 57 countries and continues to spread rapidly in South Africa, the World Health Organization (WHO) says. …. But the latest epidemiological report from WHO says given the Delta variant remains dominant, particularly in Europe and the US, it is still too early to draw any conclusions about the global impact of Omicron….”
· And Cidrap News :
“Also at today's briefing, Soumya Swaminathan, MD, the WHO's chief scientist, said booster doses are probably not the solution, though officials are still looking at the evidence. She emphasized that many countries, even those with ample vaccine supplies, have substantial portions of people who aren't vaccinated. She said the benefits of reaching people who haven't received their primary doses are likely to be higher than administering booster doses….”
And via UN News :
“Also on Wednesday, the UN High Commissioner for Human Rights, Michelle Bachelet, said that “in no circumstances should people be forcibly administered a vaccine”. …”
https://www.reuters.com/world/whos-advisory-panel-outlines-recommendations-boosters-2021-12-09/
As of yesterday. “The World Health Organization (WHO) recommended on Thursday that people who are immunocompromised or received an inactivated COVID-19 vaccine should receive a booster dose to protect against waning immunity.”
“…The recommendation comes after the Strategic Advisory Group of Experts (SAGE) on immunisation held a meeting on Tuesday to evaluate the need for COVID-19 boosters and was largely in line with guidance given in October….”
“… Inactivated vaccines which take the SARS-CoV-2 virus and inactivate or kill it using chemicals, heat or radiation, are made by Chinese manufacturers Sinovac Biotech (SVA.O), state-owned Sinopharm and India's Bharat Biotech….”
https://news.un.org/en/story/2021/12/1107092
On last week Friday’s WHO Media briefing.
“As scientists continue to investigate the Omicron COVID-19 variant, the UN World Health Organization (WHO) on Friday urged countries not to panic but to prepare for its likely spread. Heralding South Africa’s and Botswana’s decision to report the appearance of the Omicron coronavirus mutation last month, the UN health agency repeated that it will take another two weeks before more is known about how transmissible and how dangerous it actually is….”
Also from last week Friday. “The World Health Organization's chief scientist Soumya Swaminathan told Reuters [last week] on Friday that while the new coronavirus variant Omicron appeared to be very transmissible, the right response was to be prepared, cautious and not panic. The WHO has urged countries to boost healthcare capacity and vaccinate their people to fight a surge in COVID-19 cases driven by the Omicron variant, saying travel curbs could buy time but alone were not the answer. …Asked about the need for annual vaccine boosters, she said "the WHO is preparing for all scenarios", which could include an additional dose, particularly among some age groups or vulnerable sections of the population, or a modified vaccine.;…”
WHO: wealthy countries may hoard COVID-19 shots again to fight new variant | Reuters
“Wealthy countries may start to hoard COVID-19 vaccines again, threatening global supplies as they seek to shore up stocks to fight the new Omicron variant of the virus, a senior World Health Organization official said on Thursday. The warning by the WHO's vaccine director, Kate O'Brien, comes as supplies to the COVAX dose-sharing programme run by the WHO and vaccine charity GAVI have increased in the past few months due to donations from wealthy countries and after India eased limits on exports of vaccines….”
PS: “Wealthy countries donating COVID-19 vaccines with a relatively short shelf life has been a "major problem" for the COVAX dose sharing programme. Kate O'Brien, the WHO's vaccine director, said in a briefing the proportion of wasted doses is smaller in countries receiving doses through COVAX than in many high-income countries….”
“Makers of COVID-19 vaccines should gear up for the "likelihood" of needing to adjust their products to protect against the Omicron variant, the World Health Organization's (WHO) spokesperson said [last week] on Friday…..”
See also Reuters - WHO says no evidence yet to support tailoring COVID-19 vaccines to Omicron
“ The World Health Organization's emergencies director, Mike Ryan, said on Friday there was no evidence to support a change in COVID-19 vaccines to tailor them to the Omicron variant. Ryan, speaking at a social media event, said that if needed, however, the work was already underway in case Omicron-specific vaccines were needed. "Right now, we have highly effective vaccines that are working. We need to focus on getting them more equitably distributed. We need to focus on getting people most at risk vaccinated," Ryan said….”
“A group of eminent South African scientists has warned that the damaging effects of travel bans issued after the identification of the Omicron variant in South Africa, with little scientific data to back it up, was not only unwarranted and deeply damaging to the country but also could potentially threaten their willingness to share information on the pandemic in future. In a hard-hitting editorial published in the authoritative medical journal, Lancet, on Saturday 4 December a group of eminent South African scientists have warned that the travel bans slapped on South Africa after reporting the Omicron variant was not only unwarranted but a threat to global solidarity and could have dire consequences for the sharing of information in future…..”
https://www.theguardian.com/world/2021/dec/07/omicron-covid-variant-is-already-everywhere-who-says
“The Omicron coronavirus variant is “already everywhere” and travel bans will not stop its spread, the World Health Organization’s top Europe official has said…”
African Union calls for end to Omicron travel curbs on some African nations | Reuters
“The African Union on Tuesday called for an urgent end to travel restrictions imposed on some of its member states, saying the measures effectively penalize governments for timely data sharing in line with international health regulations. The measures act "as a disincentive for information sharing in the future, potentially posing a threat to health security on the continent and globally," the AU said in a statement….”
“African governments will have no choice but to start imposing vaccine mandates if citizens refuse to get vaccinated against COVID-19, the head of the African Centres for Disease Control said on Thursday.”
See also AP - Africa CDC: Nations might turn to COVID-19 vaccine mandates
“The warning by John Nkengasong to reporters that governments “will not have a choice” came as the flow of doses to Africa’s 54 countries grows but vaccine hesitancy — and the short shelf life of some donations — create new pressures to get them into the arms of the continent’s 1.3 billion people. “We don’t need to get there if we just do the right thing,” Nkengasong said of vaccine mandates. He called any lack of interest in vaccine uptake “extremely unfortunate” after African officials have fought for months against dramatic vaccine inequality between their nations and richer ones around the world….”
“…The African continent is now receiving around 20 million vaccine doses a week, an encouraging trend, the WHO’s Mihigo said, “but it is very important that these donations come with shelf life” instead of a rapidly looming expiration date….”
And via Reuters: Africa accounts for 46% of reported cases of Omicron, WHO official says | Reuters Richard Mihigo, coordinator of the World Health Organisation's Immunisation and Vaccine Development Programme for Africa, did so on Thursday.
See also WHO Afro - Omicron spreads but severe cases remain low in South Africa (9 Dec)
“ Africa has so far received more than 372 million COVID-19 vaccine doses and administered 248 million. That represents only 3% of the 8.2 billion doses given globally. Although the pace of vaccination has increased in recent months, only 7.8% of Africa’s population is fully vaccinated. … …. “Only six of Africa’s 54 countries have reached the global target of vaccinating 40% of their population by the end of this year, leaving millions of people in our region without protection against COVID-19. This is simply dangerous and untenable,” said Dr Richard Mihigo….”
“New variant appears to evade immunity and shows signs of being more transmissible.”
“…Researchers are focusing on three key questions: Can Omicron evade immunity from vaccines or previous infections? How transmissible is it? And how much severe disease will it cause? The most solid clues so far pertain to the first question—and they are not reassuring…”
https://www.nature.com/articles/d41586-021-03619-8
Neat analysis (and some speculation). “The rapid spread of new variants offers clues to how SARS-CoV-2 is adapting and how the pandemic will play out over the next several months.”
“The World Health Organization's group of advisory experts is considering evidence this week on COVID-19 heterologous vaccines, or mix and match vaccines, and will report their findings on Thursday, a spokesperson said on Tuesday. The independent experts will also look at "the Johnson & Johnson series - whether you should have one dose or two doses", WHO spokesperson Margaret Harris told a U.N. briefing in Geneva.;..”
https://www.statnews.com/2021/12/08/changing-definition-fully-vaccinated-more-than-semantics/
“Who’s “fully vaccinated” against Covid-19 — and who’s not — is starting to get a lot more complicated. The Centers for Disease Control and Prevention says you are only granted the status two weeks after you get a single-dose vaccine or the second dose in a two-dose series. But with the advent of boosters, certain colleges, the NBA, and the state of New Mexico are saying you’re only there with three shots. “For the time being, the official definition of ‘fully vaccinated’ is two,” although that determination could change as we learn more about the Omicron variant, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said at a White House briefing last week. This isn’t just a discussion of semantics: The CDC’s definition matters for how states refine vaccine mandates and requirements for travel, dining, and other indoor activities. Even the phrase “fully vaccinated” can shape the public’s imagination in ways that can affect their response to public health interventions, and signal an end in sight to the pandemic….”
“….Experts who spoke with STAT raised questions about a potential switch, noting that it could have negative implications for additional boosters and international vaccine equity. Here are the biggest questions they have about changing the term “fully vaccinated” to mean three vaccine doses…”
“Arrival of the highly-mutated Omicron variant is a wake-up call to develop vaccines less susceptible to the rapid changes of the coronavirus, leading virologists and immunologists told Reuters.”
“Most first-generation COVID-19 vaccines target the spike protein on the outer surface of the SARS-CoV-2 virus used to infect human cells. Omicron has prompted alarm among scientists because it has far more mutations than earlier variants, including more than 30 on its spike. … Even if current shots remain effective for now, the dramatic evolution of the virus highlights the need for vaccines targeting parts of the virus less prone to mutate….”
“… World Health Organization chief scientist Soumya Swaminathan said on Friday at the Reuters Next conference that next-generation vaccines are needed … … … For the immediate Omicron threat, most companies are working on new versions of their existing vaccines targeting the variant…. Several research groups and companies have started work on more broadly protective vaccines, such as those that target parts of the virus too essential for its survival to change. Experts caution it will likely take more than a year and generous funding to succeed….”
https://www.nytimes.com/2021/12/08/health/covid-fat-obesity.html
“The research may help explain why people who are overweight and obese have been at higher risk of severe illness and death from Covid.”
Links:
· Stat - A first, small study suggests Omicron is a larger threat to Covid-19 immunity than other variants
· Telegraph - Omicron could partially evade booster jabs, early data suggests
“Blood from those who had three jabs performed better against omicron than those not boosted, but was still much reduced compared to delta.”
“UNICEF has received a new grant from the European Union’s Humanitarian Aid to help roll out COVID-19 vaccination in 12 countries in Eastern, Southern, West and Central Africa. The 18-month joint programme will help ensure that as vaccines arrive, countries are supported and vaccines reach the whole population, including the most vulnerable. Support will be provided through, inter alia, training for health workers, shoring up logistics and building confidence in vaccine take up….”
“…“Ever since the COVID-19 pandemic broke out, the EU, its Member States and European financial institutions have come together as Team Europe, to provide support against the pandemic around the world. In addition to being a leading donor to the COVAX facility, the EU is providing a total of €100 million in humanitarian assistance to support the rollout of vaccination campaigns in Africa, in cooperation with the Africa Centres for Disease Control and Prevention (Africa CDC),” said Paraskevi Michou, Director General for Humanitarian Aid and Civil Protection in the European Commission. “…”
“….Global demand for Covid-19 vaccination surged over the weekend as a rapidly growing number of people worldwide were reported to have been infected with the Omicron variant of the coronavirus. … "Omicron will essentially make rich nations hoard vaccines even more, be even less generous about donations, give boosters to entire populations (and) close borders. How will we vaccinate the world at this rate?" said Dr Madhukar Pai, an epidemiologist at McGill University's School of Population and Global Health in Canada….”
https://www.cfr.org/article/visualizing-2022-trends-watch
Check out the first take, by Tom Bollyky. “COVID-19 Vaccine Pledges and Politics: Countries’ Vaccine Donations Prioritize Politics Over Need.”
“….Donor countries are expected to give roughly three-quarters of the nearly 2.7 billion COVID-19 vaccine doses they have pledged so far to recipient countries in 2022. Although these doses alone will not close the enormous vaccination gap between developed and developing countries, they can make a significant difference provided they go where vaccines are needed most. Yet, while most major donor nations, such as the United States and China, have indicated their pledges are intended solely to address vaccine inequity, distribution trends suggest that strategic and diplomatic considerations could be playing a more influential role. …. Countries in the Asia-Pacific have received a disproportionate amount of vaccines: about half of all donated doses. Just four nations have received more than one-quarter of those doses: Bangladesh, Indonesia, Pakistan, and Vietnam. Bhutan, Malaysia, Morocco, and Sri Lanka continue to receive donations despite having fully vaccinated more than 60 percent of their people. Cambodia, the tenth-largest recipient of doses, has fully vaccinated 78 percent of its population and begun re-donating shots elsewhere in Asia….”
Meanwhile, 42 LMICs, representing 1.1 billion people, have fully vaccinated 10% or less of their populations….
A M Ekström et al ; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640685/
Good helicopter view of what’s in the pipeline (with initiatives from various actors and stakeholders), if all goes well.
By way of example, an excerpt:
“…Although future technologies may avoid this requirement, investments in ultra-cold chains for COVID-19 vaccines across Africa could serve multiple purposes if upcycled into future research laboratories and facilities for storage of new mRNA vaccines. mRNA technology also offers the potential to develop new or better vaccines, for example for malaria and tuberculosis. We believe that mRNA technology offers opportunities to African countries, and even worldwide, that African researchers should be driving forward. This approach could become a rewarding investment for companies, governments and funders. Assuming the approval of and steady demand for emerging vaccines, Africa’s publicly funded vaccine market could be worth between US$ 2.4–5.4 billion by 2030. Africa’s demand for vaccines already makes up about a quarter of global vaccine volume and will increase with the estimated 2.5% annual population growth in the region. Average gross domestic product in Africa is also expected to grow, creating co-financing opportunities in countries eligible for support from GAVI, the Vaccine Alliance. The World Bank has pledged a 600 million euro investment in Aspen Pharmacare, Africa’s largest pharmaceutical company, with support from the governments of France, Germany and the United States of America. The initiative aims to fund the entire vaccine supply chain for Africa and is part of the World Bank’s enhanced support for global vaccine rollout. The investment appears to be highly cost-effective, as the global economy is estimated to lose up to US$ 9.2 trillion due to the uncoordinated approach to COVID-19 vaccine access that risks prolonging the pandemic…”
“The likelihood that people will need to have an annual COVID-19 vaccine, similar to the influenza shot, is increasing, German company BioNTech, chief executive and co-founder Ugur Sahin told the Reuters Next conference on Friday…..”
“Vaccine deliveries to Africa finally accelerating; Deliveries welcome, but not all countries are prepared; Lack of funds, staff and community outreach hamper campaigns; Continent already well behind in vaccination rates; Omicron variant a warning of risks this poses…”
“… Shortages of funds, medical staff and equipment, as well as vaccine hesitancy, were already hobbling inoculation campaigns in some parts of Africa. The anticipated surge, comprising millions of jabs in the coming weeks, could expose those weaknesses further, experts warn. …. About 40% of vaccines that have arrived so far on the continent have not been used, according to data from the Tony Blair Institute for Global Change, a policy think-tank. The rate of vaccine use will have to rise four-fold to keep up with expected supply in coming months, the institute says….
Analysis of last week’s FOCAC meeting. “After two decades of major financial aid, Beijing is rethinking its strategy on continent amid Covid crisis and fierce competition for power, analysts say…”
As already flagged last week: “… The pledged billion doses includes 600m donations and 400m locally produced, and is in addition to 200m doses already delivered to African nations under previous pledges. Xi says China will also send 1,500 health experts to Africa to assist.”
PS: “… Critics, however, argue that Xi’s emphasis on vaccines in Africa is not new. In late February, China pledged to provide vaccines to 19 African countries. To date, 46 African countries have been receiving vaccines from China. Out of the 155m pledged doses to Africa so far, China has delivered 107m, of which only 16m have been donations, according to Bridge Beijing, a vaccine tracker….”
“South Africa's Biovac Institute will start making Pfizer-BioNTech's (PFE.N), COVID-19 vaccine early next year after receiving the drug substance from facilities in Europe, a Pfizer executive said on Monday. That earlier than the forecast start at around the second half of 2022 given by Cape Town-based Biovac's chief executive in July when the partnership between the companies was announced. The deal to "fill and finish" the vaccine, the final stages of manufacturing where the product is processed and put into vials, will make Biovac one of the few companies processing COVID-19 shots in Africa, where many countries have struggled to access sufficient doses during the pandemic…..”
https://www.bbc.com/news/world-asia-india-59574878
“The world's largest vaccine maker will halve the production of its Covid-19 vaccine because it has no fresh orders, its top-ranking executive has said.”
“ The Serum Institute of India, the world's biggest vaccine maker, let Africa down by pulling out of talks to supply COVID-19 vaccines, creating distrust that has affected demand, the head of the Africa Centres for Disease Control said on Thursday. John Nkengasong denounced recent comments from Serum that uptake of its COVID-19 shots had slowed because of low demand from Africa and vaccine hesitancy, saying the real problem was that Serum had acted unprofessionally. Serum did not immediately respond to a Reuters request for comment. Nkengasong said Serum had engaged in discussions last year with the Africa Vaccine Acquisition Task Team (AVATT), and that at one point he had believed a deal was very close, but then Serum abruptly ended the talks….”
“…Nkengasong described as "condescending" comments by Adar Poonawalla, the chief executive of Serum, in a recent interview with British newspaper The Times about low demand from Africa. "It’s a combination of vaccine hesitancy and nations not coming forward and placing orders in the way in which they claim they would, particularly the African nations," Poonawalla was quoted as saying. "I’m happy to say that on record and I hope they read it because maybe they’ll get activated and do something about it." Although vaccine supplies have started increasing to Africa, where just 7.5% of its more than 1 billion people are fully vaccinated, many African nations are finding they do not have the capacity to manage the shots….”
See also HPW - As COVID-19 Vaccine Supplies Increase Substantially to Africa, the Continent Has ‘Moved on’ From Serum Institute of India
On the troubles the COVAX Humanitarian buffer experiences.
Excerpt: “…. Ending a global pandemic requires authentically global — and not just international — mechanisms for getting vaccines to unprotected people. One such measure is the COVAX Humanitarian Buffer, administered by Gavi, the Vaccine Alliance, which I lead, and its partners. The buffer recently began its rollout to provide vaccines to displaced people in Iran. A measure of last resort, the buffer is a flexible, responsive safety net — a reserve of Covid-19 vaccine doses that is untethered from country allocations but is, instead, borderless: ready to be made available to populations of concern, regardless of their location or legal status. … Applications to the buffer from humanitarian agencies and country governments on behalf of missed populations are being assessed by an expert group constituted by the Inter-Agency Standing Committee, a forum of United Nations and non-U.N. partners. As I write this, two applications, the first from Iran and a second on behalf of a vulnerable population in Thailand, have been approved so far; a third decision is anticipated imminently. In the coming months, millions of vaccines will make it into some of the world’s Covid-19 blind spots for some of the world’s most excluded people. But the buffer should already have protected many more vulnerable communities than it has been able to. The reason it hasn’t is that private-sector vaccine manufacturers have not stepped up uniformly to play their part. … Unless manufacturers waive these indemnification requirements, vaccine doses cannot be delivered to people in desperate need of them. After six months of intense effort, just four vaccine manufacturers — Clover, J&J, Sinopharm, and Sinovac — have agreed to waive these requirements for the COVAX Humanitarian Buffer. Since Clover has yet to receive WHO approval for its vaccine, the practical upshot of this legal stalemate is that only three of the eleven vaccines being supplied to countries through COVAX can be deployed to the high-risk, often hard-to-reach communities the buffer serves….”
“Drugmakers licensed pill formulas for low- and middle-income countries to generic drugmakers, who are now ramping up.”
“Promising Covid-19 treatment pills are likely to take longer to reach patients in low- and middle-income countries than in rich ones because of manufacturing and pricing obstacles, despite efforts by drugmakers to make them more available, drug-access advocates and public-health experts say….”
https://www.ft.com/content/4597ede8-f698-483a-81a2-1a9610be9784
“Large parts of the world lack tools needed to identify new coronavirus strains.”
See also Devex - - Why South Africa keeps detecting COVID-19 variants like omicron
Excerpts:
“Over the last few weeks, the B.1.1.529 variant of COVID-19, known as the omicron variant, has been the subject of many concerns by the global health community. Though experts are still trying to determine the impact of this new variant, the discovery has highlighted the genomic surveillance capabilities of South Africa — where scientists first discovered the beta variant in 2020 and were involved in the detection of the omicron variant.”
“… The country’s genomic sequencing capabilities heavily rely on the Network for Genomic Surveillance in South Africa, known as NGS-SA, which is a network of laboratories, scientists, and academic institutions that have joined forces to ensure the public health responses to COVID-19 in South Africa have access to the best possible scientific data. The initiative was launched in June 2020 when five of the South African National Health Laboratory Services’ largest laboratories and their associated academic institutions in Bloemfontein, Cape Town, Durban, Johannesburg, and Tygerberg were awarded a grant by the South African government. The network has since expanded to include private diagnostic laboratories and other academic institutions within South Africa and beyond. Beyond South Africa, NGS-SA is also an integral part of the Africa Pathogen Genomics Initiative, which is led by the World Health Organization and the Africa Centres for Disease Control and Prevention and connects the continent’s genomic sequencing laboratories. Launched in September 2020, the network of 12 laboratories has reinforced genome sequencing of the virus. This has resulted in a significant advancement of genomic surveillance on the continent, which has since recorded a fivefold increase in the number of genomes sequenced. So far South Africa has published 24,000 COVID-19 genomic sequences — accounting for over 41% of total genomic sequences from Africa. Kenya — which has the second-highest number of sequences in the continent — has published just over 5,000. While South Africa leads with the highest number of COVID-19 sequences in Africa, it has only sequenced about 0.8% of its confirmed cases….”
H A Shah et al; https://www.cgdev.org/blog/we-should-prepare-omicron-covid-19-wave-prioritising-cost-effective-essential-emergency
“The new Omicron variant of COVID-19 may be more transmissible and more capable of evading vaccines than older variants due to its high number of mutations. There is a real concern that it could spread rapidly throughout the world and lead to another wave of critically ill patients in low-and middle income countries (LMICs), where vaccine coverage remains low. Given this potential bleak outlook, policy makers must decide whether to invest in advanced critical care such as mechanical ventilators, which are expensive and difficult to provide at scale, or a new and easy to scale-up package of care called Essential Emergency & Critical Care (EECC). This includes for example: monitoring basic vital signs to identify critical illness; provision of oxygen therapy and intravenous fluids; and positioning of unconscious patients to maintain a free airway….”
M Mazzucato & J Ghosh; https://www.project-syndicate.org/commentary/health-innovation-for-all-by-mariana-mazzucato-and-jayati-ghosh-2021-12
“The shameful inequity in global vaccine distribution shows that we cannot rely on monopolies, commercial imperatives, and charitable efforts alone if we are to achieve the World Health Organization’s goal of “Health for All.” As the WHO’s Independent Panel on Pandemic Preparedness and Response concludes, we need a globally coordinated, end-to-end innovation system in which intellectual property (IP) rules and fiscal policies are designed to support collaboration between the public and private sectors. The quantity and quality of financing must be restructured around the overriding goal of delivering essential health technologies as a global common good.”
“…To that end, we cannot continue merely to correct market failures through donations, voluntary sharing mechanisms like the COVID-19 Technology Access Pool (C-TAP), or restrictive voluntary licenses. We must go beyond marginal fixes and imagine a new health innovation system, as outlined by the WHO Council on the Economics of Health for All…..”
Rob Yates; https://www.chathamhouse.org/publications/the-world-today/2021-12/covids-solidarity-failure
“Pledges of ‘vaccines for everyone’ may have gone unfulfilled but the case for universal health reforms is gaining ground, writes Rob Yates.”
“…. history shows us that although the behaviour of richer nations may be damning, the outcome need not be. The crisis and the lack of solidarity from wealthier nations could lead to universal health reforms in some countries using domestic resources. … So might the Covid pandemic trigger a new generation of universal health reforms especially in middle-income countries with the fiscal space to cover their entire population. Politically this would appear a smart move for leaders keen to improve access to health services while improving the financial wellbeing of their people. Indeed there are already signs of leaders adopting this strategy, with Cyril Ramaphosa, the president of South Africa, and Imran Khan, Pakistan’s prime minister, both announcing they will launch universal publicly financed health systems…..”
N Lee et al ; https://www.cgdev.org/publication/mdb-covid-19-crisis-response-where-did-money-go
Check out the key messages.
https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates
“Our daily estimate of excess deaths around the world”
As of 5 December: “Although the official number of deaths caused by covid-19 is now 5.2m, our single best estimate is that the actual toll is 17.6m people. We find that there is a 95% chance that the true value lies between 11m and 20.5m additional deaths…..”
Includes a map with death rate per country.
N Saadi et al ; https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02190-3
“How best to prioritise COVID-19 vaccination within and between countries has been a public health and an ethical challenge for decision-makers globally. We reviewed epidemiological and economic modelling evidence on population priority groups to minimise COVID-19 mortality, transmission, and morbidity outcomes. …The evidence supports WHO SAGE recommendations on COVID-19 vaccine prioritisation. There is, however, an evidence gap on optimal prioritisation for low- and middle-income countries, studies that included an economic evaluation, and studies that explore prioritisation strategies if the aim is to reduce overall health burden including morbidity….”
https://www.nature.com/articles/d41586-021-03592-2
“The data are growing that booster jabs enhance protection — but their durability, impact and ability to quash the new variant are unknown.”
https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-021-00425-x
By M A A Ahmed et al. “For almost a decade now, Mali has been facing a security crisis that led to the displacement of thousands of people within the country. Since March 2020, a health crisis linked to the COVID-19 pandemic also surfaced. To overcome this health crisis, the government implemented some physical distancing measures but their adoption proved difficult, particularly among internally displaced people (IDPs). The objective of this study is to identify the challenges relating to the implementation and adoption of physical distancing measures and to determine the main mitigation measures taken by IDPs to adjust to these new policies.”
“Efforts to recover from the COVID-19 pandemic across the African continent, have been met by formidable hurdles. The Mo Ibrahim Foundation report, released Monday, examines these challenges through the lens of governance performance in 54 African nations between 2010 through 2019, marking gains and losses during that time frame….”
See also Reuters - 'Extreme' vaccine discrimination risks leaving Africa behind - report
“ Africa has little chance of overcoming the COVID-19 pandemic unless 70% of its population is vaccinated by end-2022, yet "extreme vaccine discrimination" is leaving the continent behind, a report published on Monday said. …. Yet only five of Africa's 54 countries are on track to reach a World Health Organisation target of fully vaccinating 40% of the population by end-2021, the Mo Ibrahim Foundation said in a report on COVID-19 in Africa.
One in 15 Africans has been fully vaccinated, against nearly 70% in the G7 group of richer nations, according to data from the foundation…”
“Deliveries of vaccines to Africa have picked up in recent months, but weak healthcare systems and limited infrastructure are holding back rollouts once they arrive, the report said. There has also been confusion over short expiry dates on donated vaccines, which has led to the destruction of some. Monday's report said the pandemic had exposed the weakness of African civil registration capacities, with just 10% of African deaths officially registered. Weak systems raised the possibility that vaccination rates were even lower than official statistics showed. The foundation also said threadbare social safety nets must be strengthened to protect the vulnerable - the average spend in Africa on COVID-19 response measured as a share of GDP excluding healthcare was 2.4%, less than half the global average….”
https://khn.org/news/article/fully-vaccinated-definition-boosters-ambiguity/
“As more indoor venues require proof of vaccination for entrance and with winter — as well as omicron, a new covid variant — looming, scientists and public health officials are debating when it will be time to change the definition of “fully vaccinated” to include a booster shot….” Focus here on the US debate, but obviously with broader relevance.
B Telford et al; https://www.thinkglobalhealth.org/article/global-covid-19-contract-conundrum
Very insightful blog. “The critical role of contracts in determining access to COVID-19 vaccines.”
Concluding paragraphs: “Greater transparency around vaccine contracts and the specific language in these contracts can contribute to greater equity in vaccine distribution. In this spirit, the Global Health Innovation Alliance Accelerator, GHIAA, has developed an online searchable database of contracts and contractual provisions designed to make contract language, including language from current COVID-19 contracts, more accessible to policymakers and others. (The publicly available redacted clauses of the contract between the U.S. government and Moderna, mentioned above, for example, are included in this database.) A multitude of factors contribute to vaccine inequity. The impact of contractual determinants and language in contract provisions, however, should not be underestimated. Development and purchase contracts are just part of a complex web of contracts that ensure safe and effective vaccines reach those in need. Transparency and more sharing of "best practices" may increase the chances of achieving more equitable distribution of vaccine doses during the continuing global pandemic and beyond.
“The Centers for Disease Control and Prevention (CDC) yesterday announced a major initiative to bolster the global response to antimicrobial resistance (AMR). The CDC said it has awarded $22 million to 28 organizations in more than 50 countries through the establishment of two networks—the Global Action in Healthcare Network (GAIHN) and the Global Antimicrobial Resistance (AR) Laboratory and Response Network. The networks will focus on preventing and limiting the spread of drug-resistant infections in healthcare settings, building laboratory capacity to detect and understand emerging resistant organisms in the community and the environment, and developing methods to identify and respond to resistant pathogens more quickly….”
A McDonnell et al ; https://www.cgdev.org/blog/antimicrobial-resistance-advances-we-need-action-stop-predictable-catastrophe
“Antibiotic resistance (AMR) is not a new problem. However, the global community has been slow to implement recommended policy measures and achieve systemic change. CGD will launch a working group on antimicrobial resistance—seeking to improve antibiotic access and R&D in low- and middle-income countries, and reduce unnecessary use.”
Link:
Global Public Health - Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context?
“Inequities have been widely acknowledged as barriers to achieving global and national goals and targets in HIV, TB and malaria programs. However, the magnitude and extent of underlying health inequalities have remained poorly documented and understood. Until those inequalities are better identified, and their consequences better understood, it will be hard for programmes to meet people’s real health needs. Now, for the first time, a new report from the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria, systematically assesses the global State of inequality: HIV, tuberculosis and malaria. The report represents an important step forward in understanding how inequalities are hindering the fight against the three diseases. Using the latest available global data for 32 health indicators up to 186 countries, it shows that while national averages of HIV, TB and malaria indicators have generally improved in the past decade, the poorest, least educated and rural subgroups tend to remain at a disadvantage across most HIV, TB and malaria indicators…..”
Related Comment in the Lancet: Monitoring inequalities is a key part of the efforts to end AIDS, tuberculosis, and malaria “…Four major findings from this report are relevant to the global health community…”
“ The World Health Organization has called for a “massive, urgent” effort to get the new malaria vaccine into the arms of African children, as it warned that about 180,000 more people were dying annually from the disease than had previously been thought. Dr Pedro Alonso, director of the WHO’s global malaria programme, said the RTS,S vaccine, recommended for widespread rollout in October, represented a historic opportunity to save tens of thousands of lives, mostly those of under-fives in sub-Saharan Africa. But he warned that the global community risked “massive failure” if funding commitments aimed at boosting production and helping deployment of the vaccine were not rapidly made….”
“…Last week, the global vaccine alliance, Gavi, said its board had approved an initial $155.7m (£117m) for the rollout of RTS,S. The funding would help the introduction, procurement and delivery of the vaccine for eligible countries in sub-Saharan Africa from 2022 until 2025, it said….”
“New figures released by the WHO on Monday underlined the scale of the problem, with a new, “more precise” method of counting estimating that 627,000 people died of malaria last year, 180,000 more than the total would have been according to the old methodology. The vast majority of all malaria deaths – 96% – were in sub-Saharan Africa. In its annual malaria report, the WHO said the “doomsday scenario” some had predicted at the beginning of the Covid-19 pandemic – that deaths from malaria would double as a result of disruption to treatment and services – had not materialised. Nonetheless, it said, deaths had risen by nearly 70,000 last year, an increase of 12%, of which nearly 50,000 were attributable to disruptions during the pandemic. One main cause of disruption was that more than a quarter of insecticide-treated bed nets – the backbone of WHO efforts to combat malaria – were not distributed in 2020….”
More coverage via HPW - Global Malaria Targets Are Way Off-Track and no Timeline for Malaria Vaccine Rollout Yet
“ As new malaria cases have increased as a result of COVID-19 and key global targets have been missed by miles, the World Health Organization (WHO) is calling for new approaches and tools to better implement the current ones in place in the 2021 WHO Malaria Report released on Monday….”
“…Less than half of the target US$ 6.8 billion was invested in 2020 for the control and elimination of malaria. To reach global malaria targets, annual investments will need to more than triple by 2030 to $10.3 billion per year. Currently, the biggest funders are the US, and national malaria programmes which together account for 70% of the total funding in the world towards malaria eradication. The report also pointed towards accelerated need of financial and technological aid to roll out Malaria vaccines across high-burden regions, and the further use of diagnostics and treatments in these regions….”
WHO press statement - More malaria cases and deaths in 2020 linked to COVID-19 disruptions
“As the 21st International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) opens in Durban, South Africa, UNAIDS is calling for urgent measures to be taken to reduce the inequalities fuelling the twin pandemics of HIV and COVID-19. The mainly virtual event is being held against the backdrop of increasing COVID-19 infections driven by the new omicron variant of the coronavirus identified by South African researchers last month…..”
F M Knaul et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02755-0/fulltext
“Universal health coverage (UHC), the dominant approach to health system strengthening, is grounded in equity and guaranteeing health for all. Yet, UHC is partly built on a flawed and unjust human resource model: whether complacently or complicitly, in concept and in practice, all health systems normalise and perpetuate underpaid and unpaid health work, exploiting women….”
“At the Nutrition for Growth Summit in Tokyo on 7 – 8 December 2021, the World Health Organization has announced six new commitments to accelerate progress on the 2025 nutrition targets which have been pushed even further off course during the pandemic. These include: Expand initiatives to prevent and manage overweight and obesity; Step up activities to create food environments that promote safe and healthy diets; Support countries in addressing acute malnutrition; Accelerate actions on anaemia reduction; Scale up quality breastfeeding promotion and support; and Strengthen nutrition data systems, data use and capacity….”
““Today, less than 1% of global development assistance focuses on nutrition,” said Dr Francesco Branca, Director of WHO’s Department of Nutrition and Food safety….”
https://www.devex.com/news/nutrition-for-growth-garners-27b-in-commitments-102294
“More than $27 billion has been committed to address global malnutrition and improve nutrition outcomes, according to organizers of the 2021 Nutrition for Growth Summit held in Tokyo this week. …. The pledging event came as global hunger numbers — which had already been moving in the wrong direction — are skyrocketing due to the COVID-19 pandemic and exacerbated by climate change and conflict. Compared with 2019, an estimated 118 million more people were experiencing hunger last year amid the pandemic, and one-third of all people in the world suffer from at least one form of malnutrition. Current projections indicate that by 2025, 1 in 2 people will be malnourished, while an estimated 40 million children will be obsese or overweight in the next 10 years….”
https://www.devex.com/news/uk-commits-nothing-at-nutrition-for-growth-summit-102283
“…The lack of a financial pledge is being seen as another step backwards for the U.K. as a development leader….”
PS: (via Devex) “The United States made a large commitment …., but one that comes with fine print: USAID will “invest up to $11 billion over three years, subject to Congressional appropriations.” The agency also announced efforts to expand large-scale food fortification — sounding incredibly similar to plans announced at September’s U.N. Food Systems Summit….”
N Freudenberg et al ; https://ajph.aphapublications.org/doi/10.2105/AJPH.2021.306491
“….By tracing the origins of this concept over 2 centuries of interactions between market forces and public health action and research, we propose an expanded framework and definition of CDoH. This conceptualization enables public health professionals and researchers to more fully realize the potential of the CDoH concept to yield insights that can be used to improve global and national health and reduce the stark health inequities within and between nations. It also widens the utility of CDoH from its main current use to study noncommunicable diseases to other health conditions such as infectious diseases, mental health conditions, injuries, and exposure to environmental threats….” “We suggest specific actions that public health professionals can take to transform the burgeoning interest in CDoH into meaningful improvements in health.”
“….By locating the concept of CDoH in its historical context and proposing a framework for research and action, we seek to ground the ideological, political, and economic debates about commercial influence in empirical evidence….”
“….Informed by our review of the historical evolution of the term, and addressing some of the questions earlier definitions leave unresolved, we define the commercial determinants of health as the social, political, and economic structures, norms, rules, and practices by which business activities designed to generate profits and increase market share influence patterns of health, disease, injury, disability, and death within and across populations….”
D Vervoort; https://www.ghspjournal.org/content/early/2021/12/03/GHSP-D-21-00145
“Open access publishing is steadily growing but associated with high article processing charges that exacerbate disparities between funded and unfunded researchers. Early-career and underrepresented researchers often are not eligible for waivers or discounts, thus resulting in either publishing barriers or financial hardship. Journals should adopt equitable solutions that enable every author to pursue open access publishing regardless of one’s funding status or affiliation. Publishing companies should rethink open access publishing models to reduce the financial barriers for readers and authors alike.”
M Mohsin; https://www.bond.org.uk/news/2021/12/is-now-the-time-to-rename-aid-2
“Last week, I had the honour of joining well-esteemed panellists at an event hosted by The Kampala Initiative, asking whether now is the time to rename "aid”. Some of the points that emerged over the discussion were so powerful they needed to be shared. My caveat to everything that follows is that language is only one part of the bigger picture when it comes to building global solidarity, tackling racism, and confronting and owning our colonial past. But it’s not a bad place to start….”
“At a critical time for reproductive rights, health, and justice, current and former staff say discrimination and a longstanding white feminist ethos have pushed out BIPOC, caregivers, and disabled workers.”
https://news.un.org/en/story/2021/12/1107422
“The COVID-19 pandemic is rolling back progress on key childhood challenges such as poverty, health and access to education, the UN Children’s Fund (UNICEF) said in a new report on Thursday, representing the biggest global crisis for children since the agency was founded 75 years ago. “
“The report, Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people, was issued ahead of UNICEF’s landmark anniversary on 11 December. COVID-19 has pushed a staggering 100 million more children into poverty: a 10 per cent increase since 2019. This corresponds to nearly two children every second since mid-March of last year, when the pandemic was declared. UNICEF said even in a best-case scenario, recovery to pre-pandemic levels will take up to eight years. Furthermore, some 60 million children are now living in “monetary poor” households, and more than 23 million have missed out on essential vaccines, the highest number in more than a decade. …”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02781-1/fulltext
“16 Days of Activism against Gender-Based Violence, an annual, global civil society campaign calling for the prevention and elimination of violence against women and girls, ended on Dec 10. This year, the 30th anniversary of the event, carries particular poignancy. Violence against women and girls, already at high levels before COVID-19, has risen markedly during the pandemic and increased in severity, according to Oxfam. Government responses to the pandemic included lockdowns, suspension of social services, and economic hardship, many of which had the consequences of placing women at increased risk of violence, while in many countries, financial and logistical support for violence response services was withdrawn. Violence against women has received a tiny fraction of the attention and funding of the COVID-19 pandemic response, despite the efforts of campaigners….
… For too long violence against women has been positioned as a domestic issue, deflecting attention from the fundamental gender disparities in society as a whole that facilitate and tolerate it. The Lancet Commission Countering the Pandemic of Gender-based Violence and Maltreatment of Young People is working to bring an intersectional and interdisciplinary, gender-identity inclusive, all-of-society approach to understand such violence and how societal norms play a role. The Commission seeks to advance an agenda to address gender-based violence, to review both the economic and health costs, to show the urgency to act, and to recommend effective policies and tools that can be rapidly scaled up….”
https://news.un.org/en/story/2021/12/1107382
“Forty countries now have best-practice trans fat elimination policies in effect, protecting 1.4 billion people from this deadly food compound, according to a report released on Tuesday by the World Health Organization (WHO). … … Around 940 million people living in high-income countries are protected by these policies, but no one living in low-income countries has the same regulatory protection, so far. …”
https://www.theguardian.com/business/2021/dec/07/global-inequality-western-imperialism-super-rich
“Super-rich have grabbed an increasing share of the world’s income, economists’ study finds.”
“Global inequality is as marked as it was in the early 20th century pinnacle of western imperialism after the capture by the super-rich of an increasing share of the world’s income, a new report has shown. A study by a group of economists including Thomas Piketty and Emmanuel Saez said 30 years of the globalisation of trade and finance had widened the gap between rich and poor. Although the World Inequality report found inequalities between nations had declined since the end of the cold war, it said inequality had increased within most countries and had become more pronounced as a result of the global pandemic of the past two years….”
https://www.ids.ac.uk/news/launch-of-the-tax-treaties-explorer-new-data-for-better-negotiation/
“The use of tax treaties by developing countries is controversial: Best case scenario? Tax treaties help attract foreign direct investment by reducing the risk of double taxation. Evidence for this is weak. Worst case scenario? They become a vehicle for multinational tax avoidance leading to huge revenue losses for developing countries.”
“…. The Tax Treaties Explorer is a website that allows you to visualise a new dataset of almost every tax treaty signed by developing countries. It includes over 2,500 bilateral tax treaties, almost 300 amending protocols, 8 multilateral treaties, and certain changes made to these treaties by the Multilateral Convention to Implement Tax Treaty Related Measures to Prevent BEPS (MLI). As far as possible, the dataset covers all treaties signed by 118 countries comprising: those that are or were until recently low and lower-middle income countries, all countries in Africa, and all members of the Intergovernmental Group of 24. …. ….The Tax Treaties Explorer is a project of the International Centre for Tax and Development supported by the World Bank and the G-24, with data visualisations by Agile Collective.”
“The launch event: On the 1 December, the ICTD and the Global Tax Program of the World Bank hosted a webinar to launch the new tool….”
https://www.devex.com/news/usaid-announces-combating-transnational-corruption-grand-challenge-102287
“The U.S. Agency for International Development is launching a Grand Challenge on Combating Transnational Corruption. USAID chief Samantha Power made the announcement Tuesday in the lead-up to U.S. President Joe Biden’s Summit for Democracy. “To truly stamp out dark money is going to take a lot of light from sources we may not have tapped before,” said Power….”
“Survey by Women Beyond Walls finds 70% of groups working with incarcerated women do not receive funds from women’s rights foundations.” “The global feminist movement is failing to support organisations working with women in prison, as donors shy away from funding projects aimed at people with “complicated” narratives, says lawyer and activist Sabrina Mahtani…..”
https://www.thelancet.com/commissions/autism
“Awareness of autism has grown monumentally over the past 20 years. Yet, this increased awareness has not been accompanied by improvements in services to support autistic individuals and their families. Many fundamental questions remain about the care of people with autism—including which interventions are effective, for whom, when, and at what intensity. The Lancet Commission on the future of care and clinical research in autism aims to answer the question of what can be done in the next 5 years to address the current needs of autistic individuals and families worldwide.”
https://www.ncbi.nlm.nih.gov/pmc/issues/394921/
Start with the Editorial - Social participation, universal health coverage and health security (by Helen Clark, Justin Koonin et al)
On the need for a truly inclusive health governance approach (as the pandemic has shown once again).
“…The ability to convene people from diverse backgrounds, deal adequately with conflicts of interest, broker dialogue between people with differing views and – more challengingly – make sense out of sometimes chaotic input emanating from a participatory space, must be promoted. Such ability requires policy-makers to have specific skillsets that need to be fostered, valued and cultivated. This capacity gap is one that the World Health Organization seeks to fill with the recently released publication Voice, agency, empowerment - handbook on social participation for universal health coverage…”
S Witter et al; https://www.tandfonline.com/doi/full/10.1080/23288604.2021.2006121#.YbA7NLv6uIo.twitter
“A debate about how best to finance essential health care in low- and middle-income settings has been running for decades, with public health systems often failing to provide reliable and adequate funding for primary health care in particular. Since 2000, many have advocated and experimented with performance-based financing as one approach to addressing this problem. More recently, in light of concerns over high transaction costs, mixed results and challenges of sustainability, a less conditional approach, sometimes called direct facility financing, has come into favor. In this commentary, we examine the evidence for the effectiveness of both modalities and argue that they share many features and requirements for effectiveness. In the right context, both can contribute to health system strengthening, and they should be seen as potentially complementary, rather than as rivals.”
K Lakin et al ; https://www.sciencedirect.com/science/article/abs/pii/S0277953621009680
“Expectations shape how one experiences the healthcare one receives. In this paper we argue that the current conceptualisations of expectations within the healthcare literature have much to gain from the many recent and adjacent conceptual developments in other disciplines. …. An intersectional, translocational and relational analytical approach is proposed…..”
https://www.draliceevans.com/post/ten-thousand-years-of-patriarchy-1
Alice Evans pulls together her current ideas & data on the global history of gender power relations.
“Our world is marked by the Great Gender Divergence. In South Asia and the Middle East, most women remain secluded. Chinese women work but are locked out of politics. Latin America has undergone radical transformation, nearly achieving gender parity in political representation and massive rallies against male violence. Scandinavia still comes closest to a feminist utopia, but for most of history Europe was far more patriarchal than matrilineal South East Asia and Southern Africa. What explains the Great Gender Divergence? It happened primarily in the 20th century, but it has much deeper roots. To answer the question, we need to go back ten thousand years. …”
“The Channel 4 investigation reveals analysis by one biological engineering expert claiming the Pfizer vaccine costs just 76p to manufacture for each shot. It is reportedly being sold for £22 a dose to the UK government.” (on Pfizer’s “war profiteering”, see also https://www.theguardian.com/uk-news/2021/dec/05/wall-of-secrecy-in-pfizer-contracts-as-company-accused-of-profiteering )
“I'd like to see public health researchers referring less to the "Global South" or "developing countries" and more to "decolonising countries", as has @LabonteRonald.”
“If fully vaccinated = 3 doses, vaccine coverage in low income countries is close to 0%.”
“ I’ll tell what is inflaming colleagues around world… #Vaccines arriving nearly expired No #syringes coming w vaccine doses No way to pay thousands of needed extra #vaccination #healthworkers No ultra cold chain capacity for millions of generous mRNA vaccines.”
https://www.chathamhouse.org/publications/the-world-today/2021-12/world-brief-indonesia-host-g20
“Bali to help steer post-Covid recovery.”
“….Given the evolving global disruption caused by the pandemic, the Indonesian government has chosen ‘Recover Together, Recover Stronger’ as the theme for its G20 presidency…..”
M Pisa et al; https://www.cgdev.org/publication/how-can-multilateral-organizations-strengthen-global-data-governance-practices
“This brief is based on a roundtable hosted by CGD as part of the Governing Data for Development project, which explores how governments can use data to support innovation, development, and inclusive growth while protecting citizens and communities against harm. The views expressed here are those of the participants and do not necessarily represent the views of CGD staff. For other briefs in the series, as well as more on the project, visit cgdev.org/governing-data. “
Including WHO’s approach to data. “Last year, WHO adopted five data principles:…”
https://www.devex.com/news/usaid-chief-samantha-power-details-localization-push-102256
“U.S. Agency for International Development Administrator Samantha Power made the case for localization at an event Tuesday, adding a few details to earlier announcements and outlining a role for U.S.-based companies and organizations in the effort. … Several of those statements that made it into her speech were from a localization white paper of recommendations put together by the PSC’s Council of International Development Companies, the group she was addressing….”
G Novovic; https://onlinelibrary.wiley.com/doi/10.1111/dpr.12587
“This article observes policy shifts triggered by Agenda 2030 by analysing its domestication in institutional and national contexts in Kenya, Rwanda, and Uganda. By asking “Can Agenda 2030 bring about localization?” the article examines the policy potential of Agenda 2030 to transform the traditional international development paradigm, as David Slater theorized in 1993….”
Conclusion: “… While triggering meaningful shifts in development agenda-setting, Agenda 2030 has not resulted in political commitments to transform inequitable global development mechanisms that would enable its achievement. Key bottlenecks, in fact, are found not in the insufficient implementation of countries receiving official development assistance, but in the lack of institutional reforms to donor and global governance mechanisms. Political, rather than policy, solutions are required.”
BMJ GH - Does the implementation of UHC reforms foster greater equality in health spending? Evidence from a benefit incidence analysis in Burkina Faso (by M de Allegri et al)
https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00320-X/fulltext
Concluding: “…Many climate activists were bitterly disappointed by the COP26 outcomes, and understandably so; at the same time many with a long-time involvement with the UNFCCC process feel that significant progress was made. Likely both perspectives are partially correct: real progress was made but much more is still needed and must be demanded.”
Check out the whole Lancet Planetary Health December issue.
R Salas, M Neira et al ; https://www.bmj.com/content/375/bmj.n2960
“An engaged health community is finding its voice, and being heard.”
“… COP26 is just the beginning of massive engagement by the health community. We will not rest until countries respond to the climate crisis with the emergent prevention and treatment required to protect the health of our patients and communities.”
J-M Bonvin et al ; Cambridge press
« In this article we explore the potential of the capability approach as a normative basis for eco-social policies. While the capability approach is often interpreted as a productivist or maximalist perspective, assuming the desirability of economic growth, we suggest another understanding, which explicitly problematises the suitability of economic growth and productive employment as means for enhancing capabilities. We argue that the capability approach allows rejecting the identification of social progress with economic growth and that it calls for democratically debating the meaning of wellbeing and quality of life. We analyse the implications of this conceptualisation for the design of welfare states. »
In case you missed this, news from last week’s FOCAC meeting in Senegal.
“China has “trumped” western countries by pledging to redirect a quarter of its IMF pandemic recovery boost to African countries – more than any other nation. In his opening speech to the Forum on China-Africa Cooperation (Focac) in Senegal, president Xi Jinping pledged to donate 600 billion doses of Covid-19 vaccines and redistribute $10 billion worth of rare IMF reserve assets, known as special drawing rights (SDRs), to African countries. China’s allocation of 29bn SDRs is worth about $40bn….”
“….Earlier this year, France committed to redirect 20% of its SDRs to African countries. Italy and the UK both pledged to return 20% to their allocation to vulnerable low and middle-income economies. Meanwhile Joe Biden’s administration has asked the US Congress to approve the donation of $21bn of the $113bn it received – around 18.6% of its share, Caliari said….”
https://www.science.org/content/article/panel-calls-2-5-billion-ocean-geoengineering-research
“Technologies to store carbon in the ocean would stave off climate change, but studies needed to understand their consequences.”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000061
Review.
https://www.hhrjournal.org/volume-23-issue-2-december-2021/
Check it out.
https://www.devex.com/news/what-you-should-know-about-cepi-s-expanded-vaccine-testing-network-102210
“The Coalition for Epidemic Preparedness Innovations has recently decided to expand its vaccine testing network, which was established over a year ago to assess COVID-19 vaccines. The expansion means CEPI will now also support assessments of vaccine candidates for other diseases, including chikungunya, Lassa fever, MERS, Nipah, Rift Valley fever, and “Disease X,” a name given by the World Health Organization to a potential disease threat caused by an unknown pathogen.
The support comes in the form of financing and technical assistance. CEPI provides the methodology in analyzing vaccines, as well as supporting laboratories in its network to purchase the instruments needed to do the testing and the software to analyze the data. They also pay for the actual testing of the samples from vaccine developers too….”
“… The truth is that even before the advent of COVID, donors had begun to exit HIV programmes with increasing frequency. I have been tracking decisions donors have been making around HIV programmes in Uganda, and conducting research on their impact for over seven years….”
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00548-9/fulltext
Linked to a new Lancet GH study: Global estimates of paediatric tuberculosis incidence in 2013–19: a mathematical modelling analysis
https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00232-1/fulltext
“In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. … This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.”
Global Public Health – ‘We like things tangible:’ A critical analysis of menstrual hygiene and health policy-making in India, Kenya, Senegal and the United States
BMC Health Services - Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review
“World Bank Doing Business Report to be relaunched in about two years; Civil society concerned that changes fail to address underlying structural issues exposed by the scandal; Report's relaunch illustrates institution's unwillingness to consider its private sector bias.”
“Leaders of the world’s largest economies hailed a recent agreement to overhaul global corporate tax rules as key ensuring multinationals paid their fair share of tax. … But some companies could still use Ireland to reduce their tax bills even after the agreement takes effect, according to tax specialists and a Reuters review of corporate filings. That’s because the new agreement won’t stop companies benefiting from a strategy widely implemented in recent years that reduces taxes over a period of up to a decade or more. Ireland’s relatively generous tax allowances permit multinationals with a presence in the country to sell intellectual property, such as patents and brands, from one subsidiary to another to generate deductions that can be used to shield future profits from tax. Companies that have generated deductions to reduce their taxable income by more than $10 billion each in recent years via this tax-minimizing strategy include U.S. technology companies Adobe Inc(ADBE.O) and Oracle Corp(ORCL.N), corporate filings show…. … The Irish finance ministry said Ireland’s tax treatment of intellectual property transactions is in line with other OECD countries….”
“In response to Reuters’ questions, the OECD acknowledged that companies could continue to benefit from profit-shifting strategies already in place but that it expects companies to be unable to build up such tax shields in the future. The approach typically relies on a company also having a subsidiary in a country with a corporate income-tax rate of zero, such as Bermuda, that enables the company to conduct the sale tax free. By phasing out zero-tax jurisdictions for multinationals, the OECD expects the global minimum tax of 15% will make the strategy no longer attractive. … Malta is another country that permits multinationals to minimize taxes via intra-company intellectual property sales…..”
B Bedasso; https://www.cgdev.org/blog/good-monitoring-and-evaluation-secret-success-world-bank-programs
Cfr tweet by the author: “My take on the role of M&E in World Bank project performance: project-specific M&E is by far more predictive of project success than state capacity of the recipient government. This is more so in human development programs such as education and health.”
“New variant is better at evading immunity from past infection—and perhaps from vaccination.”
https://www.bbc.com/news/world-59506339
Doing what the title promises.
https://www.ft.com/content/689c4c92-c67e-4e4e-94fd-33b18a43c852
“Brazilians largely welcome inoculations despite scepticism of leader Jair Bolsonaro.”
“….Following a slow start and initial supply shortages, 64 per cent of Brazil’s 213m population is now fully inoculated, ranking well above the world average of 44 per cent and second place among the ten most populous nations. The number of doses administered is the fourth-largest of any country, according to Our World in Data database. Over three-quarters of Brazilians have had at least one dose. … Widespread acceptance of vaccines has played a big part. A survey by the World Bank and the UN found just three in every 100 Brazilians did not intend to get inoculated, the lowest rate in Latin America and the Caribbean, where the average was 8 per cent…..”
“China’s top health expert identified two conditions for the country to return to “normality,” and maintained that authorities should stick to their Covid Zero policy in battling the omicron variant. Prerequisites for getting back to normal include fatalities from Covid-19 needing to fall to a rate of 0.1% -- similar to influenza’s -- said Zhong Nanshan, who heads China’s Covid task force, according to the state-backed Global Times. That’s still a far-off target, as the global death rate stands at over 1.9%. The virus’s reproduction rate -- a measure of how many people one patient can transmit the virus to -- also needs to remain within a range of 1 to 1.5, according to Zhong. To reach those goals China needs to fully vaccinate its population to establish herd immunity to Covid, normalize prevention and control in communities and develop therapeutic drugs, Zhong said in a speech to the Greater Bay Area Vaccine Summit over the weekend, the newspaper said….”
https://gh.bmj.com/content/6/12/e007980
Commentary by C Collins et al.
C Hanson et al ; https://gh.bmj.com/content/6/12/e006691
“The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 response of Germany, Sweden and the UK in 2020. We mapped legitimacy, interdependence, knowledge generation and the capacity to deal with uncertainty…..”
https://www.ft.com/content/7b65c385-4147-492a-a946-30f98e59d8b0
Of course, that’s what you would expert Bourla to say.
“A third shot of the BioNTech/Pfizer Covid-19 vaccine offers protection against the Omicron coronavirus variant while just two doses show significantly reduced effectiveness against it, according to a preliminary study conducted by the vaccine makers. Pfizer said in a statement on Tuesday that a third booster dose of the vaccine resulted in a 25-fold increase in the neutralising antibodies that attack the virus, compared with the original strain of the virus detected in China. However, two doses may still induce protection against severe disease and the company is continuing to monitor the real-world effectiveness against Omicron. Pfizer said it was developing a new vaccine targeted specifically at Omicron and expected to have it available by March, in the event that additional protection is required to combat the variant. “Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is maximised with a third dose of our vaccine,” said Albert Bourla, Pfizer’s chair and chief executive. “Ensuring as many people as possible are fully vaccinated with the first two-dose series and a booster remains the best course of action to prevent the spread of Covid-19.”…”
https://www.bmj.com/content/375/bmj.n2965
“Novavax had a vaccine with big promise. Its more traditional technology and easy storage attracted big global investment but, as year two of the pandemic draws to a close, the company struggles with regulators, disappoints hopeful governments, and lags far behind its competitors. Is there still hope, ask Serena Tinari and Catherine Riva.”
https://www.ft.com/content/03881432-554a-47f5-b7c0-e78abb672885
“Pre-Omicron study shows Medicago jab with GSK adjuvant is up to 88% effective against coronavirus.”
“Canadian biotech Medicago and GlaxoSmithKline are pushing for regulatory approval of the world’s first plant-based vaccine after positive results against a number of coronavirus variants in a late-stage trial….”
https://www.science.org/content/article/how-pandemic-pressure-re-engineering-clinical-trials
“COVID-19 spurred nimbler trials that demand less of patients—and many changes may stick.”