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Dear Colleagues,
It’s been said a million times by now, but in this virtual Davos week it’s probably good to say it one more time, loud and clear. Paraphrasing this Oxfam blogger, Anthony Kamande, who didn’t mince words: “Davos, Inequality and Covid: It’s time to Beat back the Billionaire Variant” (#BBB).
Just a few stats from the latest Oxfam report perhaps to set the global picture, two years into the pandemic: “ …Taken together, the world’s billionaires saw their wealth increase by $5.2 trillion to $13.8 trillion between March 2020 and November 2021. This is more than it did in the past 14 years combined. And a new billionaire was created every 26 hrs. To give you some idea, this means that the combined wealth of these 2660 billionaires is now about the same amount as the whole Chinese economy, the world’s second largest.”
Against this infuriating backdrop, if too many of the global health “bigwigs” continue to be happy with peanuts and crumbles, largely playing along with the Davos capitalist game, it’s perhaps time to call global health for what it is: a charade. By way of (a sad) example, the global health powers that be apparently still see “investment opportunities”, 2 years into the pandemic. This week’s Gavi COVAX AMC Investment Opportunity claims an additional $5.2 billion is needed to continue to deliver vaccines at scale, given that more than 3 billion people in the world have yet to receive their first dose. So far only 192 million has been raised. Framing wise, that’s not an ‘investment opportunity’, I’d say. It’s a bloody disgrace. See the trillions mentioned in the first paragraph. And there are many more examples of vastly underfinanced GPGs.
Time for far more ambition. As Jayati Ghosh said at a WHO webinar on financing common goods for health earlier this week, “We need to fix the global regulatory architecture otherwise we won’t be able to deal with any of the wicked challenges in the 21st century, whether it’s the pandemic, the climate crisis, …. There’s been more than enough money in this pandemic. But the financing is going in the wrong way. Too much of the public financing (tax payers) is going to private profiteers. “ Already there’s the risk of another lost decade for developing countries.
Which brings me to Davos. This year’s Davos agenda, as always arguing for a ‘Great Reset’ (whereas ‘The Great Takeover’ feels more like it 😊), proposed among others “Renewing the Global Social Contract”. But as we like to say in this part of Belgium, in bad English: “We don’t want any more eggs from that farmer”(in this case, the farmer would be the WEF’s Klaus Schwab). Put in slightly more diplomatic terms, by J Neidleman, “Real justice demands democratization of the process by which the terms of the social contract are formulated”. Like him and many others, I’m sick and tired of the global elite “inviting the world to a new global social contract”. By the way, you don’t have to be whip-smart to see how much this (global elite) distrust already plays out in the current Covid pandemic, with conspiracy theories all around, fueling antivaxx sentiment. The distrust due to gross inequities also has major political ramifications, which I’m afraid we’ll see play out once again in 2024. Not looking forward.
In other words, if ‘Global Health as we know it’ continues to be largely on the wrong side when it comes to tackling global inequality (with its current “appeasement” of Big Pharma’s ways as one of its most politically dangerous stances – see the BMJ’s (accurate) assessment of Big Pharma as “the least trusted industry” ), assisting in this way in fueling radical and populist right, we might as well shut up the global health shop. In spite of all the lofty rhetoric and piece-meal “innovative mechanisms” aiming for ‘solidarity’.
A number of enlightened millionaires seem to grasp this fundamental truth better, arguing that “the current tax system is rigged in their favour and needs to be rewritten to make taxation fairer for hard-working people and restore trust in politics”. So it’s high time Farrar, Hatchett, Berkley and other Bills raise the level of ambition drastically on global inequality, and align with these people, instead of populating endless Davos panels while whining about “global solidarity that has collapsed”.
Anyway. In other important news, “Omicron is all around” now (yes,you are allowed to hum the cheesy all-purpose Wet Wet Wet song ), although WHO sees some positive signs on the Omicron wave. Some (like Chris Murray) even think “the end of the pandemic is near”. In spite of the enormous havoc Omicron is wreaking around the world, it does feel like we “dodged a bullet” this time. Chances are the Covid pandemic is anything but over yet, but just in case, there’s already the “overlooked pandemic of antimicrobial resistance” waiting in the corridors. The 150th WHO EB meeting is also approaching fast now (with among others, health emergency governance discussions as a major focal agenda point), and last weekend COVAX reached the milestone of delivering 1 billion doses.
On the downside, I don’t have to tell you how tricky the current geopolitical situation is (in the words of David Fidler, it’s “a Munich moment for global health”), and also ‘fuel stress’ has become sort of a trendy term these days.
Which brings me to one of the few ‘advantages’ of our “perfect storm” times. While before there was typically a “cycle of panic & neglect”, we don’t have to worry about that anymore, as now it’s just “endless cycles of panic” one after another (as well as simultaneously). #Late-capitalist “Progress” 😊!
Enjoy your reading.
Kristof Decoster
· Preliminary time table: https://apps.who.int/gb/ebwha/pdf_files/EB150/B150_DIV2-en.pdf
· Provisional agenda: https://apps.who.int/gb/ebwha/pdf_files/EB150/B150_1(annotated)-en.pdf
· Documentation: https://apps.who.int/gb/e/e_eb150.html
Via HPW : https://healthpolicy-watch.news/report-on-pandemic-response-is-slashed-ahead-of-who-board-meeting/
“The agenda of EB, meeting for the 150th time, has been organised around four pillars: One billion more people benefitting from universal health coverage; One billion more people better protected from health emergencies; One billion more people enjoying better health and well-being; More effective and efficient WHO providing better support to countries. … A significant focus of the board meeting will be on non-communicable diseases (NCDs). By Wednesday, the EB is expected to have adopted a “draft implementation road map 2023–2030” to prevent and control NCDs. …”
https://healthpolicy-watch.news/report-on-pandemic-response-is-slashed-ahead-of-who-board-meeting/
Bodes ill, to say the least.
“One of the more complicated tasks facing next week’s World Health Organization (WHO) Executive Board (EB) is how to take forward negotiations on an ‘instrument’ to address future pandemics – and even the report to the board about this has been slashed. The past two years of vaccine hoarding, nationalism and fights about the origins of SARS-CoV2 have made it plain that finding global agreement on how to address future pandemics might be impossible. Although the special session of the World Health Assembly late last year agreed that the WHO would actually try to do this, the working group charged with trying to develop a negotiation plan has struggled to find consensus.”
“The EB report from the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGSWP) was nine pages at the start of the group’s meeting last week – but the latest version is down to six pages. The entire clause that suggested that the WHO should have speedy access to disease outbreak sites has been removed – at the insistence of China, diplomatic sources told Health Policy Watch.”
“The report identifies two key priorities to frame future pandemic response – equity and building systems and tools, including strengthening the International Health Regulations (IHR) and adopting a ‘One Health’ approach…. … The WGSWP report, part of EB agenda item 15 on public health emergencies preparedness and response, is due to be addressed on the first day, Monday 24 January. The board will be expected to “provide further guidance” on the report. It will also consider the creation of a Standing Committee on Pandemic and Emergency Preparedness and Response “to provide guidance and, as appropriate, make recommendations to the Board regarding ongoing work on policy proposals on pandemic and emergency preparedness and response”….”
P Patnaik; G2H2
This was last Friday’s Deep Dive (on the same working group meeting). “If the WGPR meeting was any indication, the coming year will witness a decisive fight between competing interests on safeguarding equity in global health. “
“This week countries tried to agree on a work plan for the next few months that will see the building blocks for new rules on governing health emergencies put into place. Therefore much is at stake on how to design this process and the resulting negotiations across different forums on a range of issues including incorporating meaningful equity considerations, the strengthening of the International Health Regulations, among others. This in essence is what was discussed at the Sixth Working Group on Strengthening WHO Preparedness and Response to Health Emergencies….”
“… There are several simultaneous processes underway including, the informal consultations on the IHRs led by the US, the discussions in the working group on sustainable financing, and the establishment of a new inter-governmental negotiating body. All of these are taking place, and will take place in addition to the discussions within the WGPR. In addition, there are parallel technical processes within the WHO that will shape governance and financing outcomes overall. The upcoming meeting of the 150th Executive Board will review some of these processes including those of the WGPR.”
“… During the meeting, countries weighed in on a host of issues including, equity, the access to outbreak sites, the access to information and resulting benefits, and the process on IHR amendments….”
Nithin Ramakrishnnan and K M Gopakumar; https://www.twn.my/title2/health.info/2022/hi220105.htm
“– The Austrian proposal for the establishment of a Standing Committee on Pandemic and Emergency Preparedness and Response (SCPPR) consisting of select members of the WHO Executive Board (EB) raises concerns on health emergency governance….”
https://www.weforum.org/agenda/archive/davos-agenda-2022
See also this week’s intro. Below a mix of reports, news snippets, panel sessions…
See WEF - Davos Agenda 2022 to Mobilize World Leaders around Global Challenges
The Davos Agenda virtual event took place from 17-21 January 2022.
“….It [will] feature heads of state and government, CEOs and other leaders to address critical challenges. The event will also mark the launch of several Forum initiatives including efforts to accelerate the race to net-zero emissions, ensure the economic opportunity of nature-positive solutions, create cyber resilience, strengthen global value chains, build economies in fragile markets through humanitarian investing, bridge the vaccine manufacturing gap and use data solutions to prepare for the next pandemic….” See https://www.weforum.org/
Coverage of Oxfam’s annual global inequity report, published in the run-up to (virtual) Davos.
“The 10 richest men in the world have seen their global wealth double to $1.5tn (£1.01tn) since the start of the global pandemic following a surge in share and property prices that has widened the gap between rich and poor, according to a report from Oxfam. Urging governments to impose a one-off 99% wealth tax on Covid-19 windfall gains… “
“Oxfam projects that by 2030, 3.3 billion people will be living on less than $5.50 per day. … The charity urged governments to levy taxes on capital and wealth in a report – Inequality Kills – intended to coincide with the now-postponed gathering of the global elite at the World Economic Forum in Davos. Oxfam said a one-off 99% windfall tax on the Covid wealth gains of the 10 richest men could pay for enough jabs to vaccinate the entire world and provide the resources to tackle climate change, provide universal healthcare and social protection, and address gender-based violence in 80 countries. Even after a 99% levy, the top 10 billionaires would be $8bn better off between them than they were before the pandemic, the charity said.”
· Full report: “Inequality kills : The unparalleled action needed to combat unprecedented inequality in the wake of COVID-19.
· Coverage also via Devex - Inequality a factor in 21,000 deaths per day, says Oxfam
“Global inequality has contributed to the deaths of at least 21,300 people every day, according to an Oxfam report. Oxfam said the deaths — which it declared a “conservative” estimate — were caused by “hunger in a world of plenty, the denial of access to quality healthcare in poor countries, and gender-based violence faced by women,” along with climate “breakdown.” The report branded inequality as “economic violence” because “structural and systemic policy and political choices that are skewed in favor of the richest and most powerful people result in direct harm to the vast majority of people around the world.””
“….The report made a number of recommendations to governments, including higher taxes on billionaires, waiving intellectual property rules for COVID-19 vaccines, ending laws that discriminate against women, and strengthening workers rights.”
· And via F2P blog - Four ways that inequality kills (by D Abed)
“Oxfam’s Dana Abed on the four great global injustices behind our Davos report headline that inequality contributes to one death every four seconds.”
· Related link: Guardian - Covid created 20 new ‘pandemic billionaires’ in Asia, says Oxfam
“Twenty new “pandemic billionaires” have been created in Asia thanks to the international response to Covid-19, while 140 million people across the continent were plunged into poverty as jobs were lost during the pandemic, according to Oxfam. A report by the aid organisation says that by March 2021, profits from the pharmaceuticals, medical equipment and services needed for the Covid response had made 20 people new billionaires as lockdowns and economic stagnation destroyed the livelihoods of hundreds of millions of others. From China, Hong Kong, India and Japan, the new billionaires include Li Jianquan, whose firm, Winner Medical, makes personal protective equipment (PPE) for health workers, and Dai Lizhong, whose company, Sansure Biotech, makes Covid-19 tests and diagnostic kits….”
“More than 100 members of the global super-rich called on Wednesday for governments around the world to “tax us now” to help pay for the pandemic response and tackle the gulf between rich and poor. The group of 102 millionaires and billionaires, including Disney heiress Abigail Disney, said the current tax system is rigged in their favour and needs to be rewritten to make taxation fairer for hard-working people and restore trust in politics.”
“… The super-rich signatories, who brand themselves as “patriotic millionaires”, called for the introduction of “permanent wealth taxes on the richest to help reduce extreme inequality and raise revenue for sustained, long-term increases in public services like healthcare”. “Restoring trust requires taxing the rich,” they said in the letter, published as world leaders and business executives meet for a virtual Davos World Economic Forum. “The world – every country in it – must demand the rich pay their fair share. Tax us, the rich, and tax us now.”…”
From the opening day at (virtual) Davos.
“International financial institutions need to extend widespread debt relief to developing countries, and private sector companies need to mend “social contracts” with societies, and in order to “beat climate, beat COVID” fight hunger – and global financial instability, said UN Secretary General António Guterres, on the opening day of the World Economic Forum, held online for a second time this year, rather than at the posh Alpine ski resort of Davos. “I’ve been calling it a new global deal – the reform of international financial institutions and the way that international finance works,” Guterres said in a keynote address Monday evening…”
PS: “… Gutteres also called for expanding partnerships between the pharmaceutical industry and lower-income countries to transfer valuable medical know-how needed not only to fight this pandemic – but to prepare better for the future. But he suggested that should be done voluntarily, through pharma’s voluntary expansion of licenses for vaccines and medical technologies. …”
Coverage of a panel on Monday.
“As the coronavirus continues to wreak havoc, an expert panel at the World Economic Forum delivered a mix of good news and bad news on Monday: More variants will emerge, but vaccine production is accelerating and research is progressing toward a combined shot that may be able to attack these different variants….”
Public health experts say vaccine equity a must to end pandemic | Reuters
“Vaccine equity is the best way to get out of the current pandemic phase of the coronavirus epidemic, the world's top public health experts said in a panel at Davos on Tuesday.”
With views of Mike Ryan, John Nkengasong & Seth Berkley.
See also HPW on this Tuesday panel - COVID-19 Vaccine Inequity Represents the ‘Complete Collapse of Global Solidarity’, World Economic Forum Told
Also with the view of Gabriela Bucher, Executive Director of Oxfam International.
PS: ““Adar Poonawalla CEO of the Serum Institute of India (SII), said that his company had 1.5 billion vaccine doses in the past year, and “actually have to stop production in December because we had 500 million in stock”. “Vaccine supply is no longer a constraint,” said Poonawalla. “We’ve supplied vaccines to the African continent and it supported over the last many decades. We are ready to support you again. Please get in touch.” SII was supposed to be the key supplier for COVAX of a generic version of the AstraZeneca vaccine, but stopped its supply to attend to India’s domestic vaccine needs. This generated bad blood between the company and African countries. However, according to Poonawalla, the SII will “probably supply a billion-plus doses in the first quarter of 2022 through COVAX to the African continent.”
“China will provide another one billion COVID-19 vaccine doses to African countries, including 600 million doses as donation, Chinese President Xi Jinping said during his speech at a virtual session of the 2022 World Economic Forum. Xi said China will also donate 150 million doses to members of the Association of Southeast Asian Nations. China has already sent over two billion vaccine doses to more than 120 countries and international organizations….”
PS: “More than 180 million doses of China's Sinopharm and Sinovac COVID-19 vaccines have been shipped to 49 countries through COVAX…”
https://www.tni.org/en/publication/the-great-takeover
See also a related webinar that took place on Wednesday. “This book The Great Takeover: Mapping of Multistakeholderism in Global Governance represents an important moment on the road to exposing this trend, raised on the international agenda by a group of social movements, networks and organizations who started to walk the journey together a few years ago. The journey has resulted in a deeper analysis of how corporate capture is achieving dominance in world affairs. From health, to food and agriculture, from education to internet, from environment to public services and human rights, the research shows that decisions made in these Multistakeholderism mechanisms as well as in captured multilateral institutions, have direct impact on people’s health, children’s education, digital rights, access to basic public services and human rights in the territories, including the right to a healthy environment. By dislocating the locus of key policy decisions from the multilateral system into mixed mechanisms where the private sector rules–with the support of some states, international institutions, and big philanthropists–the phenomenon of “multistakeholderization” of the global governance has become systemic.”
“This trend has emerged in the nexus of relationships between the World Economic Forum (WEF), the Davos Class and the United Nations (UN) – more noticeably since the establishment of the Global Compact (2000) – a non-binding agreement giving Corporations access to the UN. …”
PS: from p. 115 - …. A chapter on “The Ebbing Influence of WHO: Rise of Multistakeholderism Madhuresh Kumar”.
https://www.thelancet.com/lancet/article/S0140-6736(22)00091-5
Editorial linked to a new AMR study (see below).
Final paragraph: “…One immediate opportunity must be seized. Later this year, The Global Fund to Fight AIDS, Tuberculosis and Malaria will hold its Seventh Replenishment meeting. The focus for inviting donor investment is likely to remain on the three diseases that have been the hallmark of its success. However, the Fund is actively considering how to broaden its remit in response to a very different global context—notably, the need for further measures to strengthen pandemic preparedness and create resilient health systems in an era of climate crisis. 2022 is also the 20th anniversary of The Global Fund’s inception. Now is the right moment to review its fundamental purpose. The Fund was established to invest in programmes to end the infectious diseases that cause the greatest burden of illness and death, especially in low-income and middle-income countries. It has proven itself a highly effective instrument for protecting susceptible populations from preventable and treatable diseases. The existing burden of AMR and its future threat should be an urgent stimulus to revise and widen The Global Fund’s mission. It is now time for the Fund to embrace AMR as one of its core responsibilities. And donors should invest generously in such a renewed and reinvigorated Fund. “
“Global health charities the Bill & Melinda Gates Foundation and Wellcome Trust each pledged $150 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to fund its COVID-19 pandemic response and help put it on better footing for future major health crises…..”
See also FT - Bill Gates warns of pandemics potentially far worse than Covid
“Bill Gates has issued a warning of pandemics far worse than Covid-19 as he called on governments to contribute billions of dollars to prepare for the next global outbreak. The philanthropist said that while the Omicron and Delta variants of coronavirus were some of the most transmissive viruses ever seen, the world could have had to face a pathogen causing a far higher rate of fatalities or severe disease. The Bill & Melinda Gates Foundation and the UK’s Wellcome Trust are giving $300m to the Coalition for Epidemic Preparedness Innovations, which helped form the Covax programme to deliver vaccines to low- and middle-income countries. The CEPI is trying to raise $3.5bn as it aims to cut the time required to develop a new vaccine to just 100 days. Gates said the world’s priorities were “strange” and that it had fallen to philanthropists and rich governments to address vaccine inequity…..” I certainly agree with him that the world’s priorities are “strange” : )
https://www.cidrap.umn.edu/news-perspective/2022/01/report-outlines-8-steps-current-future-pandemics
“A new report from the Center for Strategic and International Studies (CSIS) comments on the "ineffectual and fragmented" US COVID-19 pandemic responses thus far and recommends eight steps to manage the ongoing crisis amid variant fatigue, inflation, and supply chain disruptions. CSIS, a bipartisan, nonprofit policy research organization based in Washington, DC, said it issued the recommendations to secure US global leadership in the next phase of the pandemic response. Among the steps recommended in the "2022 is the year of decision" report are to launch a US international pandemic readiness project and to appoint a presidential global health security envoy… “
“China put up barriers to studying the origins of Covid-19, leading to a conflict that means less scientific collaboration and more mistrust among global powers that must work together to head off the next disaster.”
From just before last weekend.
“Ethiopia demands that the World Health Organization (WHO) investigate its leader for supporting rebellious forces fighting the Ethiopian government, the foreign ministry said. WHO director general Tedros Adhanom Ghebreyesus, who previously served as the Ethiopian health minister and foreign minister, said earlier this week that aid was being blocked from getting through to his home region of Tigray, where rebellious forces are fighting the central government. "Tedros Adhanom's moral, legal and professional standing that threatened WHO's organisational standing," Ethiopia said in a statement late on Thursday. "He has spread harmful misinformation and compromised WHO's reputation, independence, credibility which is evident from his social media postings." The WHO did not immediately respond to a request for comment….”
WHO responded on Sunday. “The World Health Organisation has vowed to continue demanding aid access to Ethiopia's war-ravaged Tigray region despite a complaint against its Ethiopian chief.
… The WHO said on Sunday it was "aware that the Ethiopian Ministry of Foreign Affairs has dispatched a note verbale". But it said the WHO would "continue to ask the Ethiopian government to allow access to deliver humanitarian supplies and services to the seven million people in Tigray, Ethiopia, living under de facto blockade, according to the United Nations, for more than a year".
… The WHO however stressed that Tigray was no different than any other humanitarian setting where it and other UN agencies "require unfettered access to be able to protect and promote the health and well-being of all vulnerable and displaced people."…”
Related: Devex Tigray: The deliberate destruction of a health system
“The war in Ethiopia has persisted for over a year. What was once a model health system in Tigray, is now in a state of collapse — first pummeled with attacks and looting, now by a blockade of medicine and fuel into the region.”
https://www.who.int/publications/i/item/9789240034204
As a reminder. See also the webinar from Tuesday. This Guidance document was published in September 2021. “This document is the product of a collaborative process led by the Department of Health Systems Governance and Financing at WHO headquarters in Geneva, Switzerland. The contents of this document build directly from the special issue of Health Systems Governance and Financing on Financing common goods for health, published in December 2019.”
“Common Goods for Health (CGH) are the core population-based functions or interventions that are essential to the health and well-being of entire societies. They necessitate public financing and public action as they are public goods or have large social externalities, and thus will not arise through market forces alone. The objectives of this guidance document are to clearly define CGH, to connect CGH with other critical health agendas to build more responsive and resilient health systems and to address challenges to financing and prioritizing CGH at national, sub-national and community levels. This document delineates the relevant CGH categories, sub-categories and functions, which can aid in policy discussions, budget dialogues (including prioritization processes in countries) and health expenditure tracking processes as means of monitoring and accountability….”
https://www.ft.com/content/4b5f4b54-2f80-4bda-9df7-9e74a3c8a66a
“World Bank warns of risk of ‘disorderly defaults’ as pandemic-era relief scheme expires.”
Excerpts:
“ The world’s poorest countries face a $10.9bn surge in debt repayments this year after many rebuffed an international relief effort and instead turned to the capital markets to fund their responses to the coronavirus pandemic. A group of 74 low-income nations will have to repay an estimated $35bn to official bilateral and private-sector lenders during 2022, according to the World Bank, up 45 per cent from 2020, the most recent data available. … …. About 60 per cent of all low-income countries need to restructure their debts or are at risk of needing to, and fresh sovereign debt crises are likely, the World Bank warned in economic forecasts published last week. Governments and companies in low- and middle-income countries issued bonds worth about $300bn each year in 2020 and 2021, more than a third higher than pre-pandemic levels, according to data from the Institute of International Finance, a financial industry association….”
“… The impending surge of repayments comes despite a pandemic-driven global initiative to relieve poor countries’ debt burdens, which proved a damp squib. The Debt Service Suspension Initiative, launched by the G20 group of large economies in April 2020, aimed to defer about $20bn owed by 73 countries to bilateral lenders between May and December 2020. But despite being extended to the end of 2021, just 42 countries received relief totalling $12.7bn, according to the Paris Club group of creditor nations that helped co-ordinate the initiative along with the World Bank and the IMF. Those countries must now resume repayments this year and start recognising debts that were suspended under the scheme. … … The most indebted nations could seek relief from a scheme intended by the G20 to replace the DSSI. The “common framework” obliges participating countries to first agree terms with bilateral creditors and the IMF, and then to secure the same debt relief from private creditors. However, critics said this risked cutting off countries’ access to capital markets. Only Chad, Ethiopia and Zambia have applied, and negotiations have shown little sign of progress….”
“Of the $35 billion that the world’s 74 lowest-income nations will owe in debt service payments this year, about 37% — or $13.1 billion — is owed to Chinese entities, according to the World Bank. A similar amount, $13.4 billion, is owed to the private sector. Official bilateral debt to countries other than China accounts for only $8.6 billion, World Bank President David Malpass said Wednesday during an event hosted by the Peterson Institute for International Economics. … Malpass said the Paris Club — the group of 22 mostly Western creditors — was once the main holder of lower-income countries’ debt….”
Analysis by Andrew Green. Excerpts:
“…It was another perceived injustice that — alongside persistent disparities in access to COVID-19 vaccines and treatments — prompted calls for governments in the global south to exercise one of the few points of leverage they have left in pursuit of equity: to stop sharing information on the emergence of new COVID-19 strains, including their genomic sequences, or the spread of those that are known within their borders. “They don’t have much other leverage, that’s the reality,” Victoria Fan, an associate professor of health policy at the University of Hawai'i at Mānoa told Devex. She recently co-wrote an article warning African countries to use what advantages they have to bargain for better treatment rather than relying on global solidarity to aid their COVID-19 response.”
“…If researchers choose to opt out of this system, it "would cause chaos," Lawrence Gostin, a global health law expert at Georgetown University, told Devex, even as he warned that there is little to prevent it from happening.”
“… Lessells worries that researchers in some countries, after seeing what happened to South Africa and its neighbors, might be reluctant to share information in the future — whether about COVID-19’s spread and transformation, or about the potential emergence of other pathogens. For Fan, it is not clear what else countries can do besides utilize the advantage they do have to compel a better trade-off between information and fairer treatment in the future. …. … “The only good solution would be an international agreement that promotes scientific sharing by giving more assured access to the scientific benefits of that information and also compensation if there are any travel or trade bans put in place upon the country for doing the right thing,” Gostin said. The current discussions around a global instrument to strengthen pandemic prevention, preparedness, and response offer a potential venue for striking such an agreement. But observers cautioned that it would require a degree of consensus that has yet to emerge in the current crisis.”
https://apps.who.int/gb/COVID-19/pdf_files/2021/25_11/Item2.pdf
Short powerpoint from end of November on this proposed new accountability mechanism (whereby UHC and the Healthier Populations billion goal would also be included in reviewing ‘preparedness’, and perhaps more systematic CSO involvement, more whole-of-society, whole-of-government, multisectoral…)
UHPR will probably be discussed both in the IHR and pandemic treaty processes.
“The COVAX global vaccine-sharing programme has delivered 1 billion COVID-19 vaccine doses, one of the organisations which manages it said on Saturday. … in the last quarter shipments have exponentially increased, allowing COVAX to reach the milestone of 1 billion doses shipped to 144 countries, said Gavi, which co-leads the programme alongside the World Health Organization (WHO)….”
As a reminder: two billion (by now) had been the goal…
· See also WHO – COVAX delivers its 1 billionth COVID-19 vaccine dose
· And for a good overview of COVAX milestones so far: The Telegraph - Highs and lows: Covax hits ‘remarkable milestone’ as billionth vaccine lands in Rwanda
· And HPW - COVAX Delivers One Billionth COVID-19 Vaccine Dose – But 41% of World Remains Unvaccinated
“But the work that has gone into this milestone is only a reminder of the work that remains. As of 13 January 2022, out of 194 Member States, 36 WHO Member States have vaccinated less than 10% of their population, and 88 less than 40%,” said the WHO. “COVAX’s ambition was compromised by hoarding or stockpiling in rich countries, catastrophic outbreaks leading to borders and supply being locked. And a lack of sharing of licenses, technology and know-how by pharmaceutical companies meant manufacturing capacity went unused.”…”
“Dr Seth Berkley, CEO of Gavi – the vaccine alliance that manages COVAX – said he was “proud that nearly 90% of the first billion doses COVAX has delivered have been fully-funded doses sent to the low and lower-middle countries supported by the Gavi COVAX Advance Market Commitment (AMC)”. This had been made possible thanks to donations of over $10 billion to COVAX, added Berkley. “Inequality in vaccination is enormous with 41% of the world not yet vaccinated with even one dose,” added Berkley. “
Covax to Deliver Next Billion Vaccines More Than Twice as Fast
The delivery of the next billion coronavirus vaccines through Covax could take four to five months, according to Seth Berkley.
From late last week. “A new report estimating the cost of delivering COVID-19 vaccines to 70% of target populations in 133 low- and middle- income countries has been released by the COVAX Readiness and Delivery Working Group on Delivery Costing, authored by experts from UNICEF, Bill & Melinda Gates Foundation, Dalberg, and the Harvard T. H. Chan School of Public Health. Using global level assumptions, the total cost of delivering COVID-19 vaccines was estimated at between US$ 2.7 billion and US$ 8.4 billion, depending on scenarios varying the proportion of staff reallocated to the COVID-19 vaccine delivery effort and the proportion of doses delivered at fixed sites and through outreach….”
See also UNICEF - Costs and predicted financing gap to deliver COVID-19 vaccines in 133 LMICs.
Cfr related tweet Amanda Glassman:
“ @UNICEF estimates costs of #vaccine delivery (70% coverage * 2 doses) at US$ 8.4 billion for 133 lower-income countries. Current financing gap (excl India) at $1.8 billion (part of @ACTAccelerator request). Bargain! Now who will finance?”
https://www.gavi.org/sites/default/files/covid/covax/Gavi-COVAX-AMC-2022-IO.pdf
Launched on Wednesday, by the likes of JM Barroso et al. “….To get there, we must urgently secure at least US$ 5.2 billion of new funding for the Gavi COVAX AMC in 2022 to establish a Pandemic Vaccine Pool of a minimum 600 million additional doses, deliver catalytic investment to strengthen countries’ delivery systems and finance essential costs to accompany dose donations.”
“…Using donor funds, committed dose donations and support from multilateral development banks (MDBs), COVAX has secured over 2.8 billion doses for supply by mid-2022. Although COVAX will tailor its support in line with each country’s national strategies and plans, this would allow AMC economies to achieve an average coverage level of around 45% by mid-2022 based on a two-dose vaccine regimen. Supply sourced bilaterally, including by our partner AVATT, the African Union’s African Vaccine Acquisition Task Team, provides countries with further options…”
“…COVAX requires additional upfront financing of at least US$ 5.2 billion by the end of March 2022 to maximise its capacity to respond to the Omicron crisis and prepare for the next one by acting as a global risk aggregator on behalf of AMC countries – in support of each country’s national plans and coverage targets. That funding would provide the Gavi COVAX AMC with the means to pursue a three-pronged strategy: to create a Pandemic Vaccine Pool of a minimum of 600 million additional doses at a cost of at least US$ 3.7 billion to increase coverage and mitigate against demand and supply risks; • to fund critical ancillary costs of dose donations (syringes, safety boxes, no-fault compensation insurance, freight) at a cost of US$ 545 million; and • to build on Gavi, the Vaccine Alliance’s comparative advantages strengthening in-country delivery systems to get shots into arms, with at least US$ 1 billion for COVAX (US$ 600 million raised by Gavi, plus US$ 400 million that will be raised concurrently by UNICEF)….”
Coverage via GAVI - World leaders launch call for renewed support for vaccination in 2022 as part of the global fight against COVID-19
“ To respond to new challenges and support equitable vaccination in countries, Gavi aims to raise at least US$ 5.2 billion in new funding. The goals of this financing are outlined in Break COVID Now, the Investment Opportunity for the Gavi COVAX Advance Market Commitment (Gavi COVAX AMC), and includes US$ 3.7 billion to fund a 600 million dose Pandemic Vaccine Pool, US$ 1 billion to support AMC country readiness and delivery and US$ 545 million to cover costs for rollout of donated doses. Early commitments by donors towards this target are US$ 192 million….” “Additionally, the European Investment Bank is making up to EUR 300 million in financing available to support African countries access additional doses through COVAX….”
https://www.devex.com/news/we-right-now-are-basically-out-of-money-for-covax-says-gavi-102485
“COVAX, the international initiative aimed at ensuring equitable access to COVID-19 vaccines, needs at least $5.2 billion in new funding over the next three months, according to Gavi, the Vaccine Alliance and its partners. “We right now are basically out of money,” said Seth Berkley, chief executive officer at Gavi, during a press conference Wednesday. “That doesn't mean that we don't have money to pay for the doses that we've already ordered; of course we do.” But the additional funding is needed quickly to pay for rollouts of donated doses over the coming months, he said, adding that about 25 countries are lagging behind on their vaccine campaigns, which need additional support. Funds are also needed to give COVAX the flexibility to purchase more vaccines.“We need this money now because we know that without it, we will face further delays in accessing and securing supplies and helping countries delivering vaccines into arms,” Berkley said.”
… Many nations have failed to meet vaccination targets over the past year, including a goal to vaccinate 10% of their populations by the end of September, and 40% by the end of 2021. While a midyear goal for 2022 aims to see all countries vaccinate 70% of their populations, COVAX is more focused on working with nations to meet their own targets, Berkley said.”
“Every country has to judge where they are in their pathway and what their eventual goal is,” said Dr. Soumya Swaminathan, chief scientist at WHO. She added that some nations — particularly on the African continent where the median age is low — might have lower goals than the global target, given that vaccination campaigns often target older members of populations who are at higher risk of developing severe disease.”
Related: The Telegraph (op-ed by Seth Berkley) We can stop the cycle of new variants continuing indefinitely with a pandemic vaccine pool
“….Covax is calling on governments to support the creation of a pandemic vaccine pool, a buffer to protect its supply in the face of any bottlenecks and meet the emerging needs of countries. Without this, we could face further delays in the global rollout and risk the gulf between the vaccine haves and have nots widening. This would allow the pandemic and the cycle of new variants to continue indefinitely. The only way to avoid this is through equitable access. This week’s billionth dose milestone proves that Covax can make this possible, and with more than four billion doses allocated through 2022, along with new vaccines added to its supply from Novavax and Clover, it should also be able to return to its original model of relying mostly on its own supplies, rather than on donations.”
https://www.politico.com/newsletters/global-pulse/2022/01/20/unicefs-vaccination-relay-495778
“As the world works to vaccinate 70 percent of the population by mid-2022, Global Pulse will interview leaders at the COVAX vaccine facility and other large humanitarian organizations about the race to get more shots into arms in low- and middle-income countries. This week, Erin Banco speaks to Benjamin Schreiber, deputy chief of UNICEF's global immunization program, about the race to help countries increase capacity to absorb doses ahead of the July deadline and about the impact of Covid-19 on women and children across the world.”
With global trends, key WHO/Africa CDC messages, …
“Global COVID-19 activity jumped 20% last week compared with the week before, amid surges across multiple regions, the World Health Organization (WHO) said yesterday in its weekly update on the pandemic. …. The robust jump last week, however, was smaller than that of the previous week, which saw the world's cases rise 55%. The WHO said cases last week rose in all regions, except for Africa.
“….Deaths were up slightly, with 45,543 fatalities reported last week, the WHO said. Maria Van Kerkhove, PhD, the WHO's technical lead for COVID-19, said on Twitter about the deaths, "Far far too many when tools can prevent.”
“The WHO's emergency committee met for the 10th time on Jan 13 to discuss the latest pandemic developments, and today it detailed its deliberations, which included a unanimous agreement that the situation still warrants a public health emergency of international concern under the International Health Regulations (IHR).”
https://news.un.org/en/story/2022/01/1110012
“Omicron continues to sweep the world, but cases seem to have peaked in some countries, which gives the head of the World Health Organization (WHO) hope that the worst of this latest wave of COVID-19 is over. “
“Briefing journalists in Geneva, Tedros Ghebreyesus said that more than 18 million cases were reported last week, and the pandemic itself is far from over, so no country is out of the woods yet. The number of deaths remains stable, but the agency is concerned about the impact the variant is having on already exhausted health workers and overburdened health systems. “I remain particularly concerned about many countries that have low vaccination rates, as people are many times more at risk of severe illness and death if they’re unvaccinated”, Tedros said. Omicron may be less severe, but for the WHO chief “the narrative that it is mild disease is misleading, hurts the overall response and costs more lives.” Tedros noted that the virus is circulating “far too intensely with many still vulnerable” and argued that, for many countries, the next few weeks remain critical…..”
“If the Food and Drug Administration decides to update Covid-19 vaccines to take better aim at Omicron or other variants, it is unlikely to go it alone. Instead, a senior FDA official told STAT, the agency expects to take part in an internationally coordinated program aimed at deciding if, when, and how to update Covid-19 vaccines. The approach would ensure decisions are not left solely to individual vaccine manufacturers. …. … The approach will likely be modeled on — though perhaps not identical to — a program used for decades to decide which strains should be included in influenza vaccines, the official said, speaking on condition of anonymity.”
“….The World Health Organization has been working to organize such a process for Covid-19 vaccines for some time. Last week, regulatory agencies from around the globe met to discuss, among other things, what would be required to update the vaccines…..”
“A World Health Organization committee urged COVID-19 vaccine manufacturers on Tuesday to provide it with the data it requires in order to list their shots for emergency use, saying the delays were affecting equitable vaccine access.”
“An emergency use listing with the U.N. agency means shots can be shipped to multiple developing nations that rely on WHO guidance for their regulatory decisions. It also allows them to be used by the COVAX vaccine-sharing programme that aims to ramp up vaccinations in poorer countries. "The Committee recognized the challenges posed by some manufacturers’ delayed submission of vaccine data to WHO," its Emergency Committee said in a statement, urging vaccine producers to supply the data as soon as possible. The statement, the outcome of a closed-door meeting held last week, did not clarify which manufacturers had not yet submitted data. A WHO document dated Dec. 23 listed the Sputnik V vaccine, produced by the Gamaleya Institute, as having submitted incomplete data….”
https://healthpolicy-watch.news/who-is-tracking-covid-19-in-animals/
“World Health Organization (WHO) researchers and partners are “constantly looking at” animals’ susceptibility to COVID-19, and transmission both from humans to animals and vice versa, WHO’s Dr Maria van Kerkhove told the global body’s weekly briefing on Tuesday. ….… However, she added that there needed to be better surveillance of which animals are susceptible, tracking this and infected animals over time.”
“There is no evidence at present that healthy children and adolescents need booster doses of COVID-19 vaccine, the World Health Organization's chief scientist Soumya Swaminathan said on Tuesday….”
https://healthpolicy-watch.news/93170-2/
“The World Health Organization’s COVID Emergency Committee has once again re-asserted its recommendation to abolish vaccine requirements for international travel – going well against the grain of current trends – particularly in light of the brouhaha seen recently over the deportation of Serbian tennis star Novak Djokovic recently from Australia. The Committee also recommended that all restrictions on international travel between countries be removed – or at least eased – saying that “they do not provide added value and continue to contribute to the economic and social stress” of various WHO member states….”
“Africa's top public health bodies on Thursday called for donated COVID-19 vaccines to come with a shelf life of three to six months so countries could plan their rollouts and avoid a situation where doses expire. John Nkengasong, director of the Africa Centres for Disease Control and Prevention (CDC), said 2.8 million doses of vaccine had expired on the continent, roughly 0.5% of the 572 million doses delivered to date. He said 10.4% of Africans were fully vaccinated….”
“…Nkengasong said the expired doses were mostly among those donated by individual countries or via the global vaccine-sharing scheme COVAX, and that they had arrived with "very short notice". In contrast, doses of the Johnson and Johnson (JNJ.N) vaccine acquired by African countries via a scheme organised by the 55-member African Union and delivered with a longer shelf life had not expired, he said. He said some countries were now refusing to accept vaccines when they saw that the shelf life was only one or two months….”
“…Nkengasong said a focus on the continent this year should be the logistics of moving vaccines from the airports where they arrive to where they are used….”
See also WHO Afro - Cases drop for first time as Africa’s fourth COVID-19 wave ebbs (20 Jan)
“… The Omicron-fuelled pandemic wave has resulted in the lowest cumulative average case fatality ratio—the proportion of deaths among confirmed cases—to date in Africa, standing at 0.68% compared with the three previous waves during which the case fatality ratio was above 2.4%. The Omicron variant has now been reported in 36 African countries, and 169 globally.”
https://www.bmj.com/content/376/bmj.o102
Hard-hitting Editorial. “Data should be fully and immediately available for public scrutiny.”
“The errors of the last pandemic are being repeated. Memories are short. Today, despite the global rollout of covid-19 vaccines and treatments, the anonymised participant level data underlying the trials for these new products remain inaccessible to doctors, researchers, and the public—and are likely to remain that way for years to come. This is morally indefensible for all trials, but especially for those involving major public health interventions.”
“… Big pharma is the least trusted industry. At least three of the many companies making covid-19 vaccines have past criminal and civil settlements costing them billions of dollars. One pleaded guilty to fraud. Other companies have no pre-covid track record. Now the covid pandemic has minted many new pharma billionaires, and vaccine manufacturers have reported tens of billions in revenue. … The BMJ supports vaccination policies based on sound evidence. As the global vaccine rollout continues, it cannot be justifiable or in the best interests of patients and the public that we are left to just trust “in the system,” with the distant hope that the underlying data may become available for independent scrutiny at some point in the future. The same applies to treatments for covid-19. Transparency is the key to building trust and an important route to answering people’s legitimate questions about the efficacy and safety of vaccines and treatments and the clinical and public health policies established for their use.”
“Combined vaccine should be ready in time for winter infectious season in 2023, says drug firm’s chief executive.”
“Moderna is aiming to launch a single booster vaccination that will protect against both Covid-19 and flu within two years, its chief executive has said. Stéphane Bancel said that the combined vaccine – which will protect against Covid-19, influenza and RSV, a common respiratory virus – could be available before the winter infectious season in 2023. “Our goal is to be able to have a single annual booster so that we don’t have compliance issues where people don’t want to get two to three shots a winter,” he said at a panel session at the World Economic Forum in Davos. “The best-case scenario would be the fall of 2023.”…”
'We know it's possible but how do we put that knowledge into a vaccine?'
“A vaccine that provides broad protection against many different Covid variants is at least two years away, a vaccine expert has warned. Dr Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations (Cepi), an organisation that has helped fund several Covid jabs, told an online press briefing that there were “core scientific challenges” to developing a vaccine that could protect against many different mutations of the virus. Dr Hatchett said that broadly protective vaccines were “at least a couple of years away”. If a new variant emerged that acted in a significantly different way to omicron and other variants “plausibly we could have another Covid epidemic”…..”
https://www.politico.eu/article/macron-eu-africa-seek-vaccine-deal-february-summit/
“The French President says he is in favor of a global license for coronavirus vaccines that would remove intellectual property barriers.”
“Addressing the European Parliament, Macron said leaders aimed to present a deal at the EU-African Union summit next month. He said he hoped that EU leaders would agree to a global license for coronavirus vaccines, clearing the barriers to gaining the capacity, intellectual property and technology Africa needs to manufacture its own vaccines….”
https://euobserver.com/democracy/154121
“Text messages between European Commission president Ursula von der Leyen and the CEO of giant pharmaceutical company Pfizer should be made available to the public, MEPs and NGOs said on Tuesday (18 January). The demand came after the EU commissioner for transparency and values, Věra Jourová, said that text messages do not fall under the scope of EU transparency rules on access to documents….”
“The Coalition for Epidemic Preparedness Innovations (CEPI) and the Institut Pasteur de Dakar (IPD) have signed a Memorandum of Understanding (MoU) to formalize the partnership between the two organizations to advance IPD’s MADIBA project, a regional manufacturing hub for COVID-19 and other vaccines in Dakar, Sénégal. In its initial phase, IPD’s new modular facility will manufacture up to 300 million doses of COVID-19 vaccine annually for use in Africa…..”
“India's Gennova Biopharmaceuticals is working on an Omicron-specific mRNA COVID-19 vaccine candidate, it told Reuters on Monday, after a person with direct knowledge of the matter said the product could be ready in a month or two.”
“U.S. biotech billionaire Patrick Soon-Shiong launched a plant that will produce a billion Covid-19 vaccine doses a year in Cape Town by 2025, which would make it the biggest such factory in Africa and could help the least vaccinated continent tackle the pandemic.”
“…Soon-Shiong’s ImmunityBio Inc. is developing a messenger ribonucleic acid, or mRNA, Covid-19 vaccine that it hopes will be used as a universal booster for earlier shots and may help end the pandemic by targeting the nucleocapsid protein at the core of the coronavirus, which is less prone to mutation than the spike proteins targeted by other shots. His South African venture came about after talks with Cyril Ramaphosa, the president of the country. “We want to manufacture this in Africa for Africa and export it to the world,” Soon-Shiong, who was born in the South African city of Gqeberha, said at a press conference on Wednesday. “President Ramaphosa said ‘come home, we will make this happen.’”
See also HPW - US Billionaire Launches ‘New Generation’ Vaccine Manufacturing Plant in South Africa Based on Cancer Immunotherapy
“South African-born US biotech billionaire Patrick Soon-Shiong launched a vaccine manufacturing plant in the country of his birth on Wednesday, aimed at producing “second generation” vaccines to address COVID-19 and other diseases….”. The vaccine apartheid prompted him.
“…“This new entity, we understand, will collaborate with the [World Health Organization] mRNA hub by providing RNA enzymes they need to produce vaccines.”…”
“…The event also marked the launch of the Coalition to Accelerate Africa’s Access to Advanced Healthcare (AAAH Coalition) which, together with NantSA, “aims to accelerate domestic production of pharmaceuticals, biologics and vaccines that will reach patients across the African continent”, according to the South African Presidency….”
“Kenya has invited firms through a global tender to bid for the construction of a Covid-19 vaccine plant as it enters the homestretch on manufacturing the jab locally. The State is seeking to recruit a consultant and a firm to design, build, commission and maintain a fully-fledged vaccine manufacturing facility. The tender has been floated through an advertisement by the Kenya BioVax Institute, a State-owned commercial and manufacturing firm….”
“ The Institut Pasteur de Dakar aims to produce 300m doses a year, and will use plastic pouches to package the shots rather than glass vials.”
WP - In the wake of unequal vaccine rollouts, countries face a ‘Wild West’ scramble for covid pills
https://www.washingtonpost.com/world/2022/01/14/merck-pfizer-pills-supply/
Must-read. Excerpts:
“Wealthier countries have already advance purchased much of the supply of treatments expected to be available in the first half of 2022. Effective use of the pills — which include Pfizer’s Paxlovid and Merck’s molnupiravir, co-developed with Ridgeback Biotherapeutics and Emory University — also requires access to coronavirus tests, which remain scarce in many places…. However, some signs indicate that the distribution of the drugs, which were shown in studies to be effective in lowering the risk of hospitalization and death, could shake out quite differently than for vaccines. Generic versions are already hitting the shelves in India and Bangladesh, and both Pfizer and Merck have reached deals to share the license for the drugs.”
““It seems more like the Wild West than vaccines did,” said Andrea Taylor, who works with a team at Duke University tracking early orders for the pills. In the early stages at least, inequity is likely to persist. A World Health Organization report produced earlier this month warns of a “high risk of shortages” of Paxlovid for low- and lower-middle-income countries until generic versions are more widely available, which it said was likely to be the second half of 2022….”
“While the MPP deals are ambitious, this won’t immediately lead to a production boom. Drugmakers will need time to draw up manufacturing plans, and the treatments will still be subject to regulatory approval. …. Wealthy nations are buying up the first batches of pills from Pfizer and Merck. So far, a dozen countries have made deals to purchase Paxlovid, according to Duke’s research. The agreements include sales of more than 26 million courses of treatment, including 20 million courses earmarked for the United States, which paid over $10 billion for the drugs.”
“… Multiple groups have stepped in to try to ensure that low-income countries get doses of the antivirals. The Gates Foundation announced last year that it had committed up to $120 million to make molnupiravir available in lower-income countries. The African Union said this week that it is in talks with Pfizer for access to Paxlovid. There are also legal cases in Chile from pharmacist groups and a nonprofit to compel the government to issue a compulsory license for the Pfizer drug…..”
“Nearly 30 generic drugs manufacturers signed an agreement to produce low-cost versions of Merck & Co's (MRK.N) COVID-19 pill molnupiravir, the U.N.-backed Medicines Patent Pool (MPP) said on Thursday.
“Merck & Co Inc (MRK.N) and partner Ridgeback Biotherapeutics said on Tuesday they had signed an agreement with the United Nations Children's Fund (UNICEF) to supply up to 3 million courses of their COVID-19 antiviral pill….”
“Africa's top public health body plans to talk to Merck (MRK.N) about obtaining supplies of its molnupiravir treatment pill for COVID-19, although talks with Pfizer (PFE.N) about its Paxlovid medication were more advanced, it said on Thursday.”
And a link:
CSIS - Call to Action: Global Coordination to Scale Up Access to Covid-19 Therapies (by K Bliss et al)
With among others, some analysis on the meaning of ‘endemic’ and also various hypotheses on what ‘Omicron’ really implies for (the future of) the pandemic. There seem to be “two camps”, by and large.
R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00093-9/fulltext
Words of wisdom from Horton. “….As the pandemic enters its third year, the difficult truth is that the political debate about COVID-19 has evolved into a bitter culture war, where arguments have become struggles between different social groups holding different beliefs about how society should be constructed and governed.”
Conclusion: “…An honest appraisal of the past 2 years of pandemic management might include the conclusion that from the very beginning there has been an over-reliance on mathematical modelling and too little emphasis on the experience of health workers on the front lines of care. Scientific advisers continue to advise caution. They highlight uncertainties. They want more data. They warn against complacency. They draw attention to the ongoing pressures on the National Health Service. They argue that it is too early to conclude that the worst of omicron is over. They predict a summer surge. All reasonable points. Yet we should also acknowledge that this pandemic is now in transition. Governments need to maintain rigorous surveillance for new and more lethal SARS-CoV-2 variants. Vulnerable groups must be protected. Global vaccination efforts should be accelerated. But now countries need to encourage a vigorous debate about a future and fairer vision for their societies. And scientists, clinicians, and public health practitioners should find their voice in this most important phase of the pandemic.”
https://www.orfonline.org/expert-speak/african-countries-respond-to-omicron/
“As the Omicron wave in Africa recedes, hard lockdowns seem to be a thing of the past.”
C Murray; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext
Excerpts:
“Surprisingly, IHME models suggest that the transmission intensity of omicron is so high that policy actions—eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines—taken in the next weeks will have limited impact on the course of the omicron wave. …. … By March, 2022 a large proportion of the world will have been infected with the omicron variant. With continued increases in COVID-19 vaccination, the use in many countries of a third vaccine dose, and high levels of infection-acquired immunity, for some time global levels of SARS-CoV-2 immunity should be at an all time high. For some weeks or months, the world should expect low levels of virus transmission.”
“… I use the term pandemic to refer to the extraordinary societal efforts over the past 2 years to respond to a new pathogen that have changed how individuals live their lives and how policy responses have developed in governments around the world. These efforts have saved countless lives globally. New SARS-CoV-2 variants will surely emerge and some may be more severe than omicron. Immunity, whether infection or vaccination derived, will wane, creating opportunities for continued SARS-CoV-2 transmission. Given seasonality, countries should expect increased potential transmission in winter months. The impacts of future SARS-CoV-2 transmission on health, however, will be less because of broad previous exposure to the virus, regularly adapted vaccines to new antigens or variants, the advent of antivirals, and the knowledge that the vulnerable can protect themselves during future waves when needed by using high-quality masks and physical distancing. COVID-19 will become another recurrent disease that health systems and societies will have to manage. For example, the death toll from omicron seems to be similar in most countries to the level of a bad influenza season in northern hemisphere countries. …. … The era of extraordinary measures by government and societies to control SARS-CoV-2 transmission will be over. After the omicron wave, COVID-19 will return but the pandemic will not.”
Nice and wide-ranging analysis of the “mild theory”.
The conclusion is encouraging, though: “So the hope among scientists is that no matter what the virus throws at us, future waves of COVID-19 will be less deadly and less disruptive, not because the virus itself has changed but because our bodies will be better able to handle the virus.”
“Scientists explain need for 'tighter definition' when describing state of virus, warning there are still some years of uncertainty ahead.”
“Francois Balloux, a professor of computational biology at University College London, was one of the first to talk about Covid becoming an endemic disease and says, "in retrospect, we epidemiologists should have come up with a tighter definition”. He says the common dictionary definition of the word - a disease regularly found among people in a particular area - is misleading. For epidemiologists, the term is more technical and relates to a virus's reproduction value settling at around one….”
Living with endemic Covid does not mean a painless game over | Financial Times (ft.com)
“By some accounts, the season finale of the pandemic approaches. Omicron appears to be less severe than the Delta variant. Some of this will be down to immunity built up through vaccination and infection; research also suggests the variant prospers more in the upper airways than in the lungs. Accordingly, hospital stays are shorter and fewer patients require intensive care. That has framed the belief that Sars-Cov-2, the virus that causes Covid-19, is settling into the background alongside other relatively benign coronaviruses that mostly induce symptoms of the common cold. The sense of an imminent ending is reinforced by the image of a “mild” variant coupled with many references to “endemicity” and “learning to live with the virus”…”
“… Scientists suggest that such framing is misguided. While its exact meaning is debated, “endemic” refers to a disease that is constantly present in a certain area, irrespective of severity. Malaria, for example, is endemic in tropical and subtropical areas, and killed more than 600,000 people in 2020, according to the 2021 World Malaria Report. People live with it — but not painlessly. “Endemicity does not imply mild disease, and mild disease does not imply endemicity,” says Elizabeth Halloran, who directs the Centre for Inference and Dynamics of Infectious Diseases in Seattle. “The move towards endemicity has to do with reaching a dynamic equilibrium where on average one person infects one other person. This could include seasonality or other fluctuations.” The relatively stable presence of an endemic disease is a world away from the unpredictable spikes and surges of the current pandemic….”
“… Other possibilities need communicating, too. There are generally four long-term options for a circulating pathogen: extinction, as is thought to have happened to the less transmissible coronavirus that caused the 2002-3 Sars-1 epidemic, thanks to concerted public health efforts; global eradication, as with smallpox through vaccination; regional or local elimination, as China is trying to achieve with its zero-Covid policy; and endemicity, where the disease is a constant presence….”
Analysis: How Omicron highlights fading hope of herd immunity from COVID | Reuters
“The Omicron variant, which is spreading far faster than previous versions of the coronavirus, is not likely to help countries achieve so-called herd immunity against COVID-19, in which enough people become immune to the virus that it can no longer spread, leading disease experts say.”
“… Disease experts note …. that Omicron’s transmissibility is aided by the fact that this variant is even better than its predecessors at infecting people who were vaccinated or had a prior infection. That adds to evidence that the coronavirus will continue to find ways to break through our immune defenses, they said. “Reaching a theoretical threshold beyond which transmission will cease is probably unrealistic given the experience we have had in the pandemic,” Dr. Olivier le Polain, an epidemiologist with the World Health Organization (WHO), told Reuters. That is not to say that prior immunity offers no benefit. Instead of herd immunity, many experts interviewed by Reuters said there was growing evidence that vaccines and prior infection would help boost population immunity against COVID-19, which makes the disease less serious for those who are infected, or become reinfected. “As long as population immunity holds with this variant and future variants, we'll be fortunate and the disease will be manageable,” said Dr. David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine….”
“The coronavirus isn’t going away, but that doesn’t mean resistance is futile, scientists say.”
“Nations around the planet are making a subtle but consequential pivot in their war against the coronavirus: Crushing the virus is no longer the strategy. Many countries are just hoping for a draw. It’s a strategic retreat, signaled in overt and subtle ways from Washington to Madrid to Pretoria, South Africa, to Canberra, Australia. Notably, few countries today outside of China — which is still locking down cities — cling to a “zero-covid” strategy. …. The phrase often heard now in the United States and many other nations is “live with the virus.” That new stance is applauded by some officials and scientists, and welcomed by people exhausted with the hardships and disruptions of this global health emergency entering its third year. But there are also disease experts who fear the pendulum will swing too far the other way. They worry that many world leaders are gambling on a relatively benign outcome from this omicron variant surge, and sending messages that will lead people who are normally prudent to abandon the social distancing and mask-wearing known to limit the pathogen’s spread. Epidemiologists say the live-with-it strategy underestimates the dangers posed by omicron.
“… The strategic shift toward the live-with-it strategy in many nations, including the United States, has often gone without formal acknowledgment from national leaders. Spain is one of the exceptions: Prime Minister Pedro Sánchez has said he wants the European Union to stop tracking covid as a separate disease and recognize that it is becoming an endemic pathogen….”
“…Rasmussen, the University of Saskatchewan virologist, is among the experts who think people have misunderstood the concept of endemicity — which is the point at which a virus continues to circulate at low levels but is not generating epidemic-level outbreaks. She fears some people hear the “endemic virus” talk as a sign that resistance is futile….”
H Branswell; https://www.statnews.com/2022/01/19/after-omicron-we-could-use-a-break-we-may-just-get-it/
“…the tsunami that is the Omicron wave is tempting us all the same, in large part because of an inescapable fact: By the time it crashes, the immunological landscape in this country — and in much of the world — is going to be profoundly altered. Far more people will have some immunity to Covid-19 than was the case before the wave began. Many will have what is effectively hybrid immunity, from vaccination and infection. As a result, some experts think we may get a bit of a break from the Covid roller coaster after Omicron. It could be a respite, if you will, after the punishing months of the Delta and Omicron waves, with their millions of cases, that began at the beginning of last summer. Caveats abound, and most experts who spoke to STAT weren’t ready to predict that a reprieve, if it comes, will be an actual end to the pandemic — the point where SARS-2 pivots to becomes endemic. But they generally agreed that the accumulation of population immunity could slow things down, at least for a while.”
PS: “… Bhattacharya believes there’s a possibility we’ll get a breather after Omicron. But he, like most of the people STAT spoke to for this story, raised a big caveat — the possibility that another out-of-the-blue variant, with new Houdini-like tricks for evading our amassed immunity, could come hurtling toward us. Bhattacharya had thought the sustained Delta wave would be hard to top. Then came Omicron, evolving from another part of the evolutionary tree of SARS-2 viruses. He and others find this capacity of the virus unsettling — its seeming ability to reach back into its past to produce variants that aren’t offshoots of recent viruses but amplified echoes of ones that circulated earlier.” “Omicron is “not a derivative of Delta and so that’s what makes it a little bit unpredictable as to what’s going to come next,” he said.”
“As the Djokovic saga has shown, countries are increasingly relying on stringent restrictions to push the unvaccinated to take Covid shots.”
“The outlook for jobs globally this year has worsened markedly since last spring as new variants of the Covid-19 virus have slowed growth and restricted hiring, according to a report from the International Labour Organisation. In its latest assessment of the state of the labour market, the Geneva-based ILO said unemployment would remain above 2019 levels until at least 2023 and the damage caused by the pandemic would take years to repair. The ILO said its latest estimates showed there would be the equivalent of 52m fewer jobs globally in 2022 than in the last quarter of 2019, the period immediately before the pandemic struck. That represents a doubling from the 26m in the organisation’s last labour market update in May 2021….”
G Igihozo et al ; https://onehealthoutlook.biomedcentral.com/articles/10.1186/s42522-021-00059-2
Cfr. tweet R Labonté: “The first of a series of country case studies on #OneHealth preparedness and COVID-19: Rwanda. More to come in the months ahead @OneHealthCom.”
“As we approach the third year of the COVID-19 crisis, we deepen our understanding of the pandemic’s impact on poverty and inequality across the globe. One of the many changes prompted by COVID was in the way which we collect data. Conducting household surveys—our main method of data collection before the pandemic—was suddenly not possible in most developing countries, due to social distancing requirements. High Frequency Phone Surveys (HFPSs), conducted by the World Bank in collaboration with national statistical offices, filled the void. These surveys are leaner than the regular household surveys in format and scope, but they provide a window that enables us to analyze the changes in household welfare when other sources of data are unavailable.
The newly published Global Economic Prospects report (see Chapter 4 here, chapter highlights here, and the charts here) and an associated background paper utilize the HFPSs to estimate the impact of COVID on poverty and inequality in 34 countries spread across five geographical regions. This blog contains a summary of those estimates….”
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2788374
Editorial related to a new study. “The study conducted by Nachega et al1 as part of the African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents helps to fill the knowledge gap regarding COVID-19 among children in LMICs. This multicenter multicountry study described COVID-19 illness among hospitalized children in sub-Saharan Africa and was the first, to our knowledge, to collate clinical information from across the African region, providing important data on severity of disease and outcomes. … The authors concluded that COVID-19 was associated with high morbidity and mortality among hospitalized children younger than 1 year and select noncommunicable disease comorbidities, suggesting the pandemic has been more consequential across sub-Saharan Africa than previously recognized. These findings illustrate the value of pan-African collaborations to generate awareness of region-specific COVID-19 outcomes.”
“… One of the most notable statistics from the Nachega et al study was that hospitalized children with COVID-19 appeared to have substantially higher mortality than those in other regions globally, with overall mortality at 8.3% in sub-Saharan Africa vs 1% in the United Kingdom and 0% to 0.7% in the US….children living in the context of inadequate health care infrastructure with limited therapeutic options are more vulnerable than children from regions in which resources are widely available and used…. “
“…Based on available data, it is evident that children in sub-Saharan Africa are at substantial risk of adverse outcomes associated with COVID-19. Beyond the direct impact, many countries across Africa have also reported substantial indirect impacts of COVID-19 for health outcomes among children, including reductions in childhood immunization uptake, disruptions in treatment for common infectious disease such as pneumonia, malaria, and diarrheal disease, and reductions in outpatient and emergency hospital visits, while simultaneously reporting increases in childhood malnutrition. Despite the disproportionate direct and indirect adverse outcomes observed among children in sub-Saharan Africa, resources have not been proportionately distributed to aid in COVID-19 pandemic control. Use of therapeutic and preventive interventions are imperative, yet these tools are lacking in sub-Saharan Africa. In comparison with many high-income countries, in which more than 60% of the population is fully vaccinated, only 15 countries in sub-Saharan African have more than 10% of their populations fully vaccinated against COVID-19. Furthermore, despite potentially higher rates of mortality among children in sub-Saharan Africa, only 6 countries (Guinea, Jordan, Malawi, Morocco, Namibia, South Africa, and Zimbabwe) recommend vaccination of children 12 years and older. Despite these recommendations, vaccines remain largely unavailable to children in many countries. The vaccine equity gap, which has disproportionate consequences for LMICs, remains a major factor associated with the COVID-19 pandemic worldwide.
https://ourworldindata.org/covid-vaccination-global-projections
Cfr tweet: “We now project that 118 countries – including Bangladesh, Egypt, Ethiopia, Nigeria, Pakistan, Russia, and the United States – are not on track for the WHO's target of 70% of the population fully vaccinated by mid-2022.”
M Barber et al ; https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00321-0/fulltext
“When demand exceeds supply, medicines generally go to the highest bidder, regardless of the greatest clinical need." …. …. The volume of ritonavir that could be diverted to the COVID-19 market is large. Pfizer has claimed that they can supply 80 million treatment courses of ritonavir-boosted PF-07321332 by the end of 2022. Ritonavir is used for HIV treatment by over 1 million adults and 500 000 children in LMICs and has wider effects by preventing transmission. Thus, access to ritonavir-boosted PF-07321332 for the treatment of COVID-19 must be pursued alongside maintaining the care for people living with HIV. To ensure anticipation of and planning for potential shortages, we propose the following five actions….”
Q Rafferty et al ; https://www.thinkglobalhealth.org/article/casualties-covid-insulin-and-dialysis
“How the pandemic has been life-threatening to people living with diabetes and chronic kidney disease.”
Cfr tweet: “COVID-19 has stymied access to insulin and dialysis treatment worldwide, putting millions of people at risk for severe complications and premature death. New article in @ThinkGlobalHlth by Quinn Rafferty, Lauryn Stafford, and Dr. Liane Ong @IHME_UW.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext
On the new Global Research on Antimicrobial Resistance (GRAM) report which estimates deaths linked to 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019.
Cfr the press release:
“More than 1.2 million people – and potentially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections, according to the most comprehensive estimate to date of the global impact of antimicrobial resistance (AMR). The analysis of 204 countries and territories, published in The Lancet, reveals that AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria. It shows that many hundreds of thousands of deaths now occur due to common, previously treatable infections – such as lower respiratory and bloodstream infections – because the bacteria that cause them have become resistant to treatment. The report highlights an urgent need to scale up action to combat AMR, and outlines immediate actions for policymakers that will help save lives and protect health systems. These include optimising the use of existing antibiotics, taking greater action to monitor and control infections, and providing more funding to develop new antibiotics and treatments. …”
Linked Comment by Dr Ramanan Laxminarayan: "….From being an unrecognised and hidden problem, a clearer picture of the burden of AMR is finally emerging. Even the lower end of 911,000 deaths estimated by Murray and colleagues is higher than the number of deaths from HIV, which attracts close to US$50 billion each year. However, global spending on addressing AMR is probably much lower than that. This needs to change. Spending needs to be directed to preventing infections in the first place, making sure existing antibiotics are used appropriately and judiciously, and to bringing new antibiotics to market. Health and political leaders at local, national, and international levels need to take seriously the importance of addressing AMR and the challenge of poor access to affordable, effective antibiotics."
· Coverage via the Guardian – Antimicrobial resistance now a leading cause of death worldwide, study finds
· And HPW - More People Die of Antibiotic-Resistant ‘Superbugs’ Than HIV/AIDS In 2019, Sub-Saharan Africa Worst Affected
Excerpt: Poorer countries have it worse: “The study also highlights the large regional disparities in the worldwide scale and spread of bacterial-related AMR. Western sub-Saharan Africa accounted for the highest burden of such resistance with 27.3 deaths per 100,000 directly attributable to the resistance while 114.8 deaths per 100,000 were associated with bacterial AMR. Contrast this with the Australasia region which saw the lowest AMR burden in 2019 at 6.5 deaths per 100,000 attributable to AMR and 28 deaths per 100,000 associated with AMR. The entire sub-Saharan Africa region, and south Asia region had an estimated all-age death rate of 75 per 100,000 associated with bacterial AMR. ….”
https://www.ft.com/reports/future-antibiotics
“This report examines the causes and effects of an increasing global resistance to antibiotics: from the pressures doctors are under to prescribe them even for viral infections, to what new treatments are currently in the pipeline, as well as what role can the consumer play in reducing antibiotic use in the food chain.”
“Study calls for cap on production and release as pollution threatens global ecosystems upon which life depends.”
“The cocktail of chemical pollution that pervades the planet now threatens the stability of global ecosystems upon which humanity depends, scientists have said. Plastics are of particularly high concern, they said, along with 350,000 synthetic chemicals including pesticides, industrial compounds and antibiotics… …. The study concludes that chemical pollution has crossed a “planetary boundary”, the point at which human-made changes to the Earth push it outside the stable environment of the last 10,000 years….. Chemical pollution threatens Earth’s systems by damaging the biological and physical processes that underpin all life. For example, pesticides wipe out many non-target insects, which are fundamental to all ecosystems and, therefore, to the provision of clean air, water and food….”
“Their study was published in the journal Environmental Science & Technology…”
“Exclusive: Studies show high temperatures and air pollution during pregnancy can cause lifelong health effects …. …. The climate crisis is damaging the health of foetuses, babies and infants across the world, six new studies have found.”
“Scientists discovered increased heat was linked to fast weight gain in babies, which increases the risk of obesity in later life. Higher temperatures were also linked to premature birth, which can have lifelong health effects, and to increased hospital admissions of young children. Other studies found exposure to smoke from wildfires doubled the risk of a severe birth defects, while reduced fertility was linked to air pollution from fossil fuel burning, even at low levels. The studies, published in a special issue of the journal Paediatric and Perinatal Epidemiology, spanned the globe from the US to Denmark, Israel and Australia….”
“Care International report highlights ‘deep injustice’ neglected by world’s media, as extreme weather along with Covid wipes out decades of progress.”
The Global Research on Developmental Disabilities Collaborators; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00488-5/fulltext
“The likelihood of a newborn child dying before their fifth birthday (under-5 mortality rate) is universally acknowledged as a reflection of the social, economic, health, and environmental conditions in which children (and the rest of society) live, but little is known about the likelihood of a newborn child having a lifelong disability before their fifth birthday if he or she survives. Available data show that globally the likelihood of a child having a disability before their fifth birthday was ten times higher than the likelihood of dying (377·2 vs 38·2 per 1000 livebirths) in 2019. However, disability funding declined by 11·4% between 2007 and 2016, and only 2% of the estimated US$79·1 billion invested in early childhood development during this period was spent on disabilities. This funding pattern has not improved since 2016. This paper highlights the urgent need to prioritise early childhood development for the beneficiaries of global child survival initiatives who have lifelong disabilities, especially in low-income and middle-income countries, as envisioned by the SDG agenda. This endeavour would entail disability-focused programming and monitoring approaches, economic analysis of interventions services, and substantial funding to redress the present inequalities among this cohort of children by 2030.”
https://www.who.int/publications/i/item/9789240038943
“The Global Diabetes Summit, co-hosted by the World Health Organization and the Government of Canada, with the support of the University of Toronto, brought together governments, donors, nongovernmental organizations and people with lived experience of diabetes. The goals of the event, held on 14 April 2021, were to raise awareness of diabetes as a global health issue and to address the need to scale-up prevention and treatment as part of primary health care and universal health coverage. WHO's Global Diabetes Compact, an initiative aiming to reduce the risk of diabetes and to ensure that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable and quality management, was launched during the event. This report summaries the main topics covered and includes the programme of the event.”
“Early data suggests a jump in obesity globally, particularly among children and young people.” “The pandemic may have pushed millions more people into obesity, according to emerging data from around the world. Young people have been particularly badly affected, research from countries including the United States, China and Europe suggests. “
“…Experts said many different factors may be behind the rise, from decreased movement during lockdowns to coping with the added stress of the crisis. Straightened economic circumstances can also push people towards cheaper but unhealthier food choices, exacerbating the problem.
…Nina Renshaw, director of policy and advocacy at the NCD Alliance, described it as a “perfect storm of infectious and chronic diseases meeting head on”. “…A survey in 2020 from Ipsos Mori across 30 countries found that more than a third of respondents across the world reported that they had gained weight during the pandemic. …”
“…It is not just a western or even rich world problem, although data from many low and middle income countries is harder to come by. Many of these countries are also affected by huge rises in the numbers affected by the other end of the scale of malnutrition - hunger and undernutrition. …”
K Yakubu et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2021.2013600#.YeY3daO1HOM.twitter
Conclusion : « Regarding SHW migration governance, the literature reports shared public value propositions for source and destination countries. It also shows how the value-creating process in the management of SHW migration favours destination countries. Future studies will need to explore shared value creation models that ensure equity in the governance of SHW migration.”
L Wallace, K Storenge t al; https://link.springer.com/book/10.1007/978-3-030-84514-8
The first volume focused on the ethnographic examination of global maternal and reproductive health policies.
https://apps.who.int/iris/handle/10665/351108
cfr tweet Sarah Dalglish: “How have countries maintained services for maternal & child health and older people during the #COVID19 pandemic? A comprehensive new @WHO report provides evidence from 19 countries on every continent.”
https://academic.oup.com/ia/issue/98/1
Cfr tweet: “This issue, launching our 100th year, uncovers the colonial basis for knowledge production in IR, and how it impacts both academia and policy today.”
A Filol; https://healthcommunity.nature.com/posts/global-health-what-are-we-talking-about
This text is a translation of a French original text : Ridde, Valery & Fillol, Amandine (2021). Santé Mondiale. Anthropen https://revues.ulaval.ca/ojs/index.php/anthropen/article/view/51161
https://ev4gh.net/wp-content/uploads/2022/01/EV4GH-Newsletter-January-2022.pdf
Just published, with updates on EV F2F Dubai (November 2021), governance updates, and a look ahead to the Colombia EV venture, among others.
https://www.thelancet.com/journals/langlo/issue/current
Many of these papers were already published before, online. Check out, among others:
· Editorial: Withholding liberty, not the right to health
With focus on the health of prisoners in LMICs.
· Comment - The SARS-CoV2 pandemic and routine immunisation
Comment related to a new study in the Lancet GH by Anita Shet and colleagues which studies the impact of the COVID-19 pandemic on routine immunisation and assesses immunity gaps in children and the potential for outbreaks.
· Comment: Challenges on the road to achieving the SDG 3.2 targets in resource-limited settings
Comment to a related new study in the Lancet Global Health by David Sharrow and colleagues
from the UN Inter-agency Group for Child Mortality Estimation who performed a systematic analysis of a global, regional, and national trends in under-5 mortality from 1990 to 2019, with scenario-based projections up to 2030. As a reminder: The second target of SDG 3, achieve good health and wellbeing for all, is to end preventable deaths of newborns and children younger than 5 years, with all countries aiming to reduce neonatal mortality rate (NMR) by 2030 to at least as low as 12 per 1000 livebirths and under-5 mortality rate (U5MR) to at least as low as 25 per 1000 livebirths.
· Comment - Strengthening tobacco control must remain a global health priority (Idem)
P Cairney et al; https://open-research-europe.ec.europa.eu/articles/1-23
Systematic review. Version 2.
“….this review identifies lessons from studies of HiAP and policymaking. It suggests that HiAP advocates produced a 7-point playbook for the wrong game, contributing to a major gap between HiAP commitment and outcomes. Some describe the need to use policy research to produce new ways to promote and evaluate HiAP, but most do not use it effectively. We show how policymaking research helps to explain and understand the meaning of a HiAP implementation gap. Its main lesson is that policy outcomes are beyond the control of policymakers and HiAP advocates. As such, its practical lessons come from critical reflection on power and politics, not the reinvention of a playbook….”
C De Foo et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003899
“…this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings.”
“In addition to country allocations, the Global Fund allocates resources for catalytic investments. This is comprised of matching funds, multicountry grants and strategic initiatives for projects and activities deemed critical to meet the aims of the our Strategy. The Technical Evaluation Reference Group (TERG), an independent evaluation advisory group that evaluates the Global Fund’s activities, evaluated the Global Fund’s multicountry grants and strategic initiatives to measure their effectiveness and ensure their contribution towards the strategic objectives….”
Check out the 2 reports.
R Silverman et al; https://www.cgdev.org/blog/what-were-hearing-potential-pull-mechanism-use-cases-high-value-global-health-innovation
“Last October we asked our readers to weigh in on promising opportunities for pull mechanisms to help drive high-value global health innovation. This blog highlights our interim findings, with great gratitude to the 25+ individuals and groups who took the time for a conversation.”
J Button Zhao; https://www.theglobalfund.org/en/blog/2022-01-13-data-agility-a-fashionable-term-or-a-game-changer-for-global-health/
“…what is data agility? In fact, there is no agreed-upon definition for data agility among global health development partners. Defined here, data agility is about accessing data and the analytical outputs health leaders need for fast decision-making. It is about the time lag between generation of data and decision-making. In short, it is about having the right data, at the right time, for the right level of decision-making…..”
“3.2 billion people are fully unvaccinated. Where do they live? 89% live in developing countries 71% in the poorest half of the world 1 billion in Sub-Saharan Africa 0.8 billion in South Asia https://pandem-ic.com.”
“The issue is not to depolitize health it is to depolitize science Science institutions need a different governance from political institutions History shows there needs to be a firewall between data/science institutions & political institutions.”
“RWANDA rejects 250,000 Covid-19 vaccines from Denmark over claims the donation was attached to Kigali accepting to host asylum centres for Denmark. The two countries officials met in September, 2021 but Kigali has since rejected the vaccines, and proposal-Danish media reports.”
“For the first time in 3 years, I’m revising my slide on the #PlanetaryBoundaries framework. @sthlmresilience has now discovered that we breached a third boundary - chemical pollution including plastic. 3/9 breached, 2/9 soon to be breached. #PlanetaryHealth is in grave danger.”
“Our post omicron world: 1. Omicron goes down 2. It fails to produce herd immunity, durable protection 3. We’ll have 6 mo to vaccinate the world & prevent a new variant from emerging this summer 4. It may not resemble omicron 5. Vaccinating world in next 6 months = our best path.”
D Fidler; https://www.thinkglobalhealth.org/article/ukraine-crisis-covid-19-and-global-health
« The Russian threat to Ukraine has nothing to do with the pandemic, but the situation has implications for global health.”
Global Health in a Munich Moment: “The diplomatic efforts by the United States and its NATO allies to stave off a Russian invasion of Ukraine are laden with fears that come with brinkmanship between rival great powers, including the fear of appeasement. In such moments, warnings about the adverse health consequences of armed conflict and pleas for more international cooperation on COVID-19 and future PPR do not address the central balance-of-power issues driving great-power calculations. The Ukraine crisis crystallizes the sobering realities that global health faces in a geopolitical world, even amidst a once-in-a-century pandemic.”
M Reiss; https://www.bmj.com/content/376/bmj.o127
“Will the creation of a new EU body to tackle cross-border health threats guarantee the bloc will mount a better and more coordinated response to the next pandemic?”
https://www.ft.com/reports/world-2022
“As Covid-19 again forces the World Economic Forum to forgo its annual Davos gathering, this special report looks at the continuing fallout from the pandemic, and at other global challenges, from rising inflation to climate change and US-China rivalry.”
Check out in particular: FT Pandemic exposes a world of healthcare inequalities
https://link.springer.com/article/10.1007%2Fs11558-021-09449-7
This new article by Professor Mette Eilstrup-Sangiovanni tackles the increasing complexity of global governance of critical issues like global health, intellectual property rights, climate change.
Introduction to a special issue.
“This special issue examines the nature and consequences of institutional complexity in global governance, by which we understand the growing number, diversity and interconnectedness of institutions and actors involved in governing global policy issues. Specifically, we explore how variation in the structures of complex governance systems may produce variation in governance outcomes. … To explore variation in institutional complexity, we introduce the concept of a global governance complex (GGC) which we define broadly as a system of overlapping institutions and actors that govern a particular global policy issue…”
“… Our three-dimensional concept of global governance complexity allows us to compare GGCs according to their scale, diversity and density. Importantly, it also allows us to focus on change within governance complexes over time. … “
https://www.devex.com/news/is-america-back-grading-one-year-of-global-development-under-biden-102251
“President Joe Biden promised his administration would restore U.S. global leadership on COVID-19, climate change, and other development challenges. One year after his inauguration, experts say more needs to be done.”
http://sdg.iisd.org/news/2030-agenda-statistics-group-takes-stock-of-cape-town-plan/
“The UN’s High-level Group for Partnership, Coordination and Capacity-Building for Statistics for the 2030 Agenda for Sustainable Development met to review implementation of the Cape Town Global Action Plan for sustainable development data. A new framework for the Global Action Plan will be reviewed during the 54th session of the UN Statistical Commission in March 2022. The HLG also discussed the Bern Data Compact for the Decade of Action on the SDGs.” Action on the“This week, the U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) signed a five-year Memorandum of Understanding (MOU). The agreement continues EPA-WHO collaboration on a wide range of specific and crosscutting environment and health issues, particularly air pollution, water and sanitation, children’s health, and health risks due to climate change. The updated agreement includes exciting new actions on crosscutting issues including infrastructure and environmental justice.”
Important piece. Even if one doesn’t like to read/imagine it.
Speaking of which. “A global coalition of over 60 senior climate scientists and governance scholars have launched a global initiative calling for an International Non-Use Agreement on Solar Geoengineering. They argue that deployment of solar geoengineering – speculative technologies that aim to lower global temperatures by artificially intervening in our climate systems – cannot be fairly governed globally and poses an unacceptable risk if implemented as a future climate policy option.”
C Dorninger et al ; https://www.sciencedirect.com/science/article/abs/pii/S0921800920300938
“We provide empirical evidence that supports the theory of ecologically unequal exchange. High-income nations are net importers of embodied materials, energy, land, and labor. High-income nations gain a monetary trade surplus via this resource appropriation. Lower-income nations provide resources but experience monetary trade deficits. The observed inequality is systemic and hampers global sustainability in multiple ways.”
https://www.economist.com/science-and-technology/2022/01/22/a-field-test-for-malaria-resistance
Ron Dzikowski and Eylon Yavin of the Hebrew University in Jerusalem have come up with a trick which they think could be turned into a cheap and deployable detector for drug resistance.
HP&P - Using gender analysis matrixes to integrate a gender lens into infectious diseases outbreaks research (by R Morgan et al)
International Journal of Behavioural Nutrition and Physical Activity - Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review CAS study.
https://www.devex.com/news/imf-charts-path-to-rechanneling-sdrs-through-50b-trust-102494
“The International Monetary Fund is set to relax financing terms and expand access eligibility for a new $50 billion trust that will channel Special Drawing Rights, a type of reserve asset, from wealthy nations to more vulnerable states. About three-quarters of IMF members may be able to tap funding in the form of loans from the Resilience and Sustainability Trust, wrote IMF economists Ceyla Pazarbasioglu and Uma Ramakrishnan in a blog post Thursday. This would include all low- and middle-income countries whose gross national incomes are below roughly $12,000 per capita. The goal is to win IMF board approval for the trust at the Spring Meetings in April. The G-20 group of nations has backed IMF’s plan so far….”
On an upcoming ODI webinar (27 Jan) and related working paper. “How is employment income taxed in low- and middle-income countries, how has this evolved over time, and how has it shaped taxpayer behaviour? Until now, there has been a scarcity of research regarding these questions. The new TaxDev employment income taxes dataset (EITD) aims to fill this gap and will provide a key resource for researchers and policymakers working on personal income taxation in low- and middle-income countries. The first iteration of the EITD includes comprehensive data for African countries; we aim to achieve global coverage in the near future.
ODI's Kyle McNabb and Hazel Granger will present the EITD and how to use it, and then explore the tax burdens facing salaried employees in African countries and how these have evolved over the past 25 years. ….. Read the accompanying working paper, Employment income tax in Africa: findings from a new dataset. “
D Sridhar; https://www.theguardian.com/commentisfree/2022/jan/19/science-covid-ineradicable-disease-prevention
Devi Sridhar’s take on where things stand now in rich countries. Excerpt:
“There are now clearly three camps of scientists voicing opinions on what is happening and what to do in the coming weeks. This can be confusing for the public. The first group still seem to see the virus as the same deadly one of March 2020, despite the massive scientific progress in managing it, and they suggest extremely cautious measures. The second say they’ve been right all along in that mass infection is unavoidable; this is the “let it rip” group. They ignore the dramatic difference that mass vaccinations and treatments have made – avoiding serious illness from Covid-19 now is wholly different from 2020. The third group – where I sit – have evolved their position as the data and tools, namely vaccines and therapeutics, have also evolved to transform Covid-19 into something more akin to other infectious diseases that we control and manage. My analysis has consistently responded to the latest evidence.”
“… Slowing the spread of Sars-CoV-2, even stopping it completely in certain countries, helped save lives. It allowed two transformative antiviral pills to be made available. It allowed doctors to develop better ways of treating patients, and to understand what we’re facing. It allowed a better understanding of transmission and risk. But now, two years into this pandemic, we need to find a better way of living alongside Sars-CoV-2 using the tools we have. We have created ways to minimise the impact of Covid-19. And now is the time to start to recover and heal as a society and move forward, treating this virus like we do other infectious disease threats.”
“Pharma executive warns policymakers may be incapable of preparing the public for next pandemic.”
“One of America’s top pharmaceutical executives has warned that a growing climate of anti-intellectualism is blighting the global response to Covid-19, and questioned whether policymakers are capable of preparing the public for the next pandemic. David Ricks, chief executive of Eli Lilly, said this was especially true in the Anglo-Saxon world where scepticism about expertise had become a driving force behind vaccine hesitancy and a failure to implement proper controls to tame the pandemic, including mask wearing. “All this vaccine hesitancy, climate hesitancy you know, it’s all anti-intellectualism, really, anti-expertise. And in a world filled with too much information and people not equipped to digest it, maybe that’s where we land. I don’t know. I mean, it’s kind of sad,” he said….”
https://www.vox.com/22878133/omicron-coronavirus-covid-19-immunity-antibodies-vaccine
“Antibodies aren’t the whole story.”
“…The immune system draws on stem cells living in bone marrow to produce an array of components that we don’t hear as much about. They form many kinds of white blood cells that jump into action right away when they encounter a virus for the first time, and that essentially take notes to start planning for the next infection. It’s this immune system memory that’s key to long-term protection against Covid-19. What’s reassuring is that as white blood cells get more practice against SARS-CoV-2, they seem to get better at containing the virus — even when it evolves into new variants. That appears to be happening in the omicron wave of Covid-19.”
https://www.weforum.org/agenda/2022/01/omicron-immunity-booster-research-vaccine-variant-covid-19/
“Traditional regimens of COVID-19 vaccines do not neutralize the fast-spreading Omicron variant according to an MGH, MIT, and Harvard study. Individuals who received three doses of the mRNA vaccine had very significant neutralization against the Omicron variant, as opposed to those with two doses.”
“An additional “booster” dose of Moderna or Pfizer mRNA-based vaccine is needed to provide immunity against the Omicron variant of SARS-CoV-2, the virus that causes COVID-19, according to a study by researchers at the Ragon Institute of MGH, MIT and Harvard. The results of this study, reported in the journal Cell, indicate that traditional dosing regimens of COVID-19 vaccines available in the United States do not produce antibodies capable of recognizing and neutralizing the Omicron variant….”
Covid passes boosted economies and vaccine uptake, study shows | Financial Times (ft.com)
“European countries that introduced Covid passes increased uptake for vaccines and improved public health and economic performance, potentially helping to avert lockdowns, according to a new study. Covid certificates in France, Germany and Italy increased the vaccination rate in those countries by 13, 6.2 and 9.7 percentage points respectively, researchers at Bruegel and the French Council of Economic Analysis said in a paper published on Tuesday….”
“Countries have reported some five million COVID-19 deaths in two years, but global excess deaths are estimated at double or even quadruple that figure.” With some discussion (and even criticism) of some of the estimates and modelling by the Economist, IHME, … Some of the methods being use are: machine learning; surveys; counting graves. None is perfect.
https://www.ft.com/content/3ddc21de-885d-43cc-b9d5-87693e03f500
“…. an important divergence over how to cope with the pandemic has emerged between China and the world’s other big economies — which may grow in significance over the course of 2022. China remains determined to pursue a zero-Covid strategy. By contrast, the US, the EU and most of the large Asian economies are having to learn to live with Covid-19….”
“… The broader danger for the international system, though, is that Covid will widen the existing economic and geopolitical divides between Beijing and the west. That, in turn, could add to strains on the world trade system — as well as increasing the danger of military tensions over Taiwan and the South China Sea….”
“New data released Wednesday showed that both vaccination and prior infection offered strong protection against infection and hospitalization from Covid-19 during the Delta wave — and that case and hospitalization rates were actually lower among people who had recovered from Covid-19 than among those who had been vaccinated. The data, released by the Centers for Disease Control and Prevention and health agencies in California and New York, are sure to inflame arguments from those who insist they don’t need to be vaccinated if they can show they’ve recovered from Covid-19. But the data contain many caveats that health officials stressed pointed to the value of vaccination, even on top of prior infection….”
“Levels of some immune molecules are unusually high in people with persistent symptoms after infection with SARS-CoV-2.”
https://covid19crc.org/wp-content/uploads/2022/01/Vaccine-Access-Report_6-January.pdf
“Following a workshop on access to COVID-19 vaccines, experts from the Global Health Strategy Group for Digital Health and AI for health (an initiative of the University of Oxford), and the Supply & Market Dynamics; Medicine Quality Working Group of the COVID-19 Clinical Research Coalition just issued a report capturing challenges affecting supply, distribution, and access issues for people in low-resource settings. The report features the Abujah principles, developed thanks to insights provided during the workshop, and aims to guide policymakers as well as developers and implementers of digital, Artificial Intelligence (AI), and Geographic Information Systems (GIS) technologies to ensure access to quality COVID-19 vaccines for all. The report also includes a presentation of various initiatives where digital, AI and GIS tools helped strengthen vaccine access, traceability, and product safety.”
“Brain fog, headaches, blood pressure swings are being probed by NIH and other researchers.”