IHP News 596 : Re-Imagining the Post-Trump World

IHP news 596 : Re-imagining the post-Trump world

( 6 Nov 2020)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

This week’s intro is from my colleague Willem van de Put. He comments on the turbulent past week.

“The past week was a good one – if only for the entertainment it brought. For the first time in ages the news was not fully dominated by the virus, because democracy was at its best: enormous turnouts in the US helped Trump to become the 13th president out of 45 to not make it into a second term. Yes, he may be disappointed not to join the ranks of Ivory Coast President Alassane Ouattara, Conde of Guinea and Nkurinziza of Burundi who recently won their third term (of course harshly criticised by real Trumpean heroes like Teodoro Mbasogo of Equatorial Guinea, Paul Biya of Cameroon, Denis Nguesso of the Congo Republic of Congo, Deby of Chad, Museveni of Uganda and Kagame of Rwanda – who have not given up so easily with an average reign of about 40 years instead of a meagre 4). And that’s only for Africa, there are plenty of other countries in the world where leaders love to rig elections to stay in power. Anyway, now that Donald is entering his Hall of Fame with Jimmy Carter, George Bush Sr and Gerald Ford, let’s take him out of the equation, give and take a few months.

Now we need to start thinking and acting on the post-Trump era. Biden will not bring back old securities for Europe to hide behind. Europe may reinvent itself, China is on the move, and new (and fierce) debates have started on #BLM, global and transgenerational solidarity, climate and Covid, … you name it. So we need to fill the Corona and post-Corona times agenda just like we need to fill the - so far quite empty - agenda of Joe Biden. We need to tackle challenges such as how to forge new relations with the other half of the USA that did vote for Trump (of whom only 14% took the coronavirus pandemic as the deciding factor to vote). We can think about countries where laws meant to protect people against the virus are used to continue political repression (like Zimbabwe). And of course there is the challenge of the syndemic.

But there is hope – as always! Last Wednesday, people at the G2H2 talked about getting away from all this suffocation ( “Covid-19, in a world that cannot breathe” ). Why not look a bit more at what Latin America has to offer ? More than you would think, if you only follow the headlines on Bolsonaro and other Ortega’s. Now that the loudest science-sceptic is off the stage, who helped us realize how fragile the input of science is, we need to stop the polarization – without being afraid of being laughed at. “

Enjoy your reading.

The editorial team

Featured Article

The World Health Assembly during a lockdown

Priti Patnaik (founding editor of Geneva Health Files, a journalistic initiative that tracks the governance of global health)

The 73rd World Health Assembly resumes virtually next week at a time when large parts of Europe including Switzerland are locked down. What’s more the Director General of WHO, Tedros Adhanom Ghebreyesus is currently in self-quarantine after coming in contact with a COVID-19 confirmed case. It is as somber a milieu that one could be faced with, when 194 countries come together to work through health challenges in the midst of this pandemic.

And yet, despite the limitations, a fairly productive week awaits the global health community. It is understood countries continue to discuss with WHO on the ways of engagement including special rules, for the forthcoming assembly, given the particular circumstances as a result of the pandemic.

WHO is planning on having a full assembly including three kinds of meetings as is usual - Committee A, Committee B and the general committee. The virtual format will be a test of how WHO and members will juggle through these various meetings, experts say.

The Director-General is also expected to announce a new framework for “Universal Health Review” (a proposal by Benin) at the Assembly next week, Zsuzsanna Jakab, Deputy Director-General, World Health Organization said at an event today.

PROCEDURES AROUND A VIRTUAL ASSEMBLY The immediate local circumstances have had a physical impact on the proceedings in the run up to the Assembly scheduled to take place next week 9th-14th November 2020.

It appears not all member states are aware of what to expect from the Assembly and believe that the current situation has contributed for inadequate transparency and consultations in the proceedings around the Assembly.

The Assembly is expected to be in a fully virtual format. This is different from May 2020, where it was a hybrid format with a mix of online and in-person consultations among member states.

A decision adopted by WHO Executive Board (EB 147/8) recognized that the possibility of limitations to physical meetings over the coming months could impact the Executive Board meeting in early 2021 and the 74the World Health Assembly in May 2021. It empowers the Executive Board “Officers of the Board, in consultation with the Director-General” to make adjustments to the arrangements for these governing bodies meetings. (Also keep in mind that there have been calls for making the EB a more meaningful governance body able to set the agenda more effectively.)

It reads thus:

The Executive Board decided that in the event that limitations to physical meetings preclude the holding of the Seventy-fourth World Health Assembly, the 148th session of the Executive Board and the thirty-third and thirty-fourth meetings of the Programme, Budget and Administration

Committee of the Executive Board in 2021 as envisaged, adjustments to the arrangements for these governing bodies meetings should be made by the Executive Board or, exceptionally, by the Officers of the Board, in consultation with the Director-General.

In terms of procedure, the pandemic has inevitably impeded the usual consultations by member states. In May 2020, the Assembly had already adopted a written silence procedure. This allowed for decisions for approval by the Assembly as having tacit approval from member states, unless, countries broke the silence procedure on particular proposals, by submitting written objections to proposals within a limited time frame. (It is understood that about 20 decisions have been adopted in this manner)

Typically, the silence procedure follows formal and informal consultations on various proposals between countries. (Some civil society stakeholders believe that it contributes to opacity in discussions between countries and other actors.)

As per special procedures adopted to regulate the conduct of the de minimis Assembly session in May 2020, it was decided that “The first day of the resumed session of the Health Assembly shall be regarded as the first day of the session for the purposes of Rule 49, by which date formal proposals relating to items of the agenda may be introduced.”

Gian Luca Burci, Adjunct Professor, International Law; Academic Advisor, Global Health Centre and former legal counsel for WHO, clarified at an event today, that special procedures have to be adopted for the virtual assembly next week.

It seems that there are concerns on the feasibility of conducting a roll-call of countries if a vote is needed on some of the political issues such as Taiwan and Palestine, Jakab of WHO said.

Finally, it seems that unlike before, delegations will have limited and specified opportunities to make interventions. (Each country will have only limited number of opportunities to participate per “pillar”, observers said.)

DECISIONS MADE In early August 2020, WHO published a list of decisions proposed to the World Health Assembly in May, which were adopted by member states using the "Written Silence Procedure". (An earlier decision states that the adopted proposals will be referred to the Health Assembly at its resumed session for information only.)

The proposals relate to: strengthening global immunization efforts; cervical cancer prevention and control; a global strategy for tuberculosis research and innovation; eye care - including preventing vision impairment and blindness; strengthening efforts on food safety, a global strategy and plan of action on public health, innovation and intellectual property; a decade of healthy ageing; and influenza preparedness, WHO has said.

BETTER NON-STATE ACTOR REPRESENTATION? Stakeholders in civil society have been somewhat assuaged that they will be allowed to formally present oral and written statements at the Assembly, unlike at the recently concluded Executive Board meeting in October 2020. In a letter to non-state actors in official relations with WHO, the secretariat said “Considering the specific arrangements set for the Seventy-third World Health Assembly, Non-State actors in official relations with WHO that have registered to participate may request to make statements through a dedicated video connection, during the meetings of Committee A and/or B of the World Health Assembly, under a technical item in which the non-State

actor has a particular interest.” (Only statements presented orally at the invitation of the Chairperson will be considered in WHO’s official records, the letter clarified.)

WHAT TO EXPECT? Given the ongoing changes in geopolitics including a potentially new administration in the U.S. (votes were still being counted when this story went to print), the implications of how this plays out at the World Health Assembly, will be interesting to see.

In parallel, discussions on WHO reform are gathering steam, including a new proposal by U.S. and Brazil, as reported in the newsletter. WHO has asked member states to come together with their proposals to build on existing WHO reform processes, top officials said. These reform proposals are expected to come up at the margins of the assembly.

Will we see a repeat of the recent Executive Board, where countries sought greater transparency and consultations on new governance mechanisms? Watch this space for more.

Highlights of the week

Pre-launch 6th global HSR symposium (5 Nov)

COVID-19 exploiting inequalities in our societies and health systems, says WHO Director General https://healthsystemsglobal.org/news/covid-19-exploiting-inequalities-in-our-societies-and-health- systems-says-who-director-general/

Some info on dr Tedros’ opening address, at this launch event, that also featured Emerging Voices for Global Health. You can re-watch the launch event here. (With EVs from minute 24 on)

The symposium (1st stage) takes place next week, from 8-12 November.

US election (& global health/development/climate change)

I won’t try to interpret the US polarization here, there’s plenty of analysis around. My quick & dirty take: Polarization is a global phenomenon now, but in the US, the respective camps really resemble fanatical “derby” football fans now. I always wondered how on earth it was possible that Dolf (with that silly moustache of his) could convince so many Germans of his paranoid xenophobic world vision, but I know better now. Amartya Sen’s speech on the “pandemic of authoritarianism” from a few weeks ago feels very timely.

So just a few links perhaps:

• HPW - US election: Identity Politics Overwhelms COVID Pandemic

“The United States election came just as the country was racking up some of the highest-ever daily rate of new coronavirus infections in the world. But in comparison to the economy, COVID-19 and health care issues have still ranked lower on Americans’ priorities than the economy when people finally turned out to the polls. All in all, the pandemic threat has failed to generate the kind of landslide support for the Democratic contender Joseph Biden that some had hoped for, or even anticipated. Instead, “identity politics” – including a gaping rural-urban divide – remain more dominant factors in the campaign than the COVID- issues that have transfixed the world. Nor did health care seem to rate as high a concern either – even though some 20 million Americans stand to lose their health care coverage if the Affordable Care Act is finally overturned by a second-term Trump administration either through action in the Supreme Court or Congress….”

• Stat - ‘Science was on the ballot’: How can public health recover from a rebuke at the polls?

Don’t think all Trump voters rejected public health (and the corona pandemic threat) (trade-off with pandemic response impact on economy probably also plays a role), but important read nevertheless.

“Even without a presidential winner, one thing is already certain: The 2020 election results were a disaster for public health. Results from Tuesday and early Wednesday underscore just how many Americans agree with a president who has called the nation’s top scientists “idiots,” openly mocked mask-wearing, and has insisted states must be “liberated” from lockdowns. No matter who wins the presidency, more than 67 million Americans already seem to have sided with Trump on public health. In preliminary exit polls, just 14% of Republican voters surveyed said the coronavirus pandemic was the deciding factor in who they voted for, despite the fact that the virus has killed more than 233,000 Americans and is spreading unabated across the nation. That leaves public health officials to grapple with hard, existential questions: How can they forge new relationships with this huge swath of the country as the pandemic continues to unfold? Where does the public health field go from here?...”

PS: after this week’s election, I wonder a bit more with I Kickbusch how we can ‘pandemic proof’ democracies. Let alone, as she stressed in a nice Lancet lecture, ‘pandemic proof’ multilateralism.

Devex - Would Biden's foreign aid approach be progressive, or bipartisan? https://www.devex.com/news/would-biden-s-foreign-aid-approach-be-progressive-or-bipartisan- 97987

“Since Joe Biden secured the Democratic presidential nomination, the party’s progressive wing has sought to push the candidate and his team to the political left on a wide range of issues. While foreign policy has been one arena for these intraparty negotiations, questions about global development, global health, and humanitarian assistance — perhaps unsurprisingly — have not risen to the same level of attention. … it may not be surprising that they have not been subject to the same level of debate between progressives and moderates. One result of that, however, is that if Biden wins the Nov. 3 presidential election, and if left-leaning elements of the Democratic party are successful in pushing his administration to adopt more progressive positions, it is not entirely clear what that might mean when it comes to global development…”

Devex - Opinion: What the US election could mean for global COVID-19 vaccine access A Glassman; https://www.devex.com/news/opinion-what-the-us-election-could-mean-for-global- covid-19-vaccine-access-98474

“U.S. presidential candidate Joe Biden has already announced his plan to rejoin the World Health Organization if elected, but there is another strategic decision on which the candidate has remained mum — U.S. participation in COVAX, the international effort to pool funding for advance purchase of an eventual COVID-19 vaccine. Here, the Biden and Kamala Harris plan is a single sentence: “Accelerate the development of treatment and vaccines.”…”

Glassman reckons the US should “join and allocate funding to both the COVAX AMC and the COVAX Facility as a matter of priority for U.S. national security and U.S. global health leadership.”

Devex - Concern about US election integrity will have ripple effects globally, experts say https://www.devex.com/news/concern-about-us-election-integrity-will-have-ripple-effects-globally- experts-say-98427

“"Flashing warning signs" amid the U.S. election are unlikely to fade after all the votes are counted, experts say. The country's reputation as a promoter of democracy and the challenging of other electoral processes are at stake.”

Nature (News) - The US has left the Paris climate deal — what's next? https://www.nature.com/articles/d41586-020-03066-x

The United States officially pulled out of the Paris climate agreement on 4 November. … “Nature examines how the withdrawal will affect global efforts to mitigate climate change. … … “

But of course, the hope is that Biden, if he becomes president, will rejoin the Paris accord. Biden already said that his administration will do so “in 77 days” from now.

Global Tax justice

(UBS) Public paper - Challenges of a fair tax system F Scheuer; https://www.ubscenter.uzh.ch/static/4bd9adc9d5492ad71d23d4b160043d43/UBSC_PP9_taxing_th e_superrich.pdf

“This Public Paper provides an overview of the tax situation the superrich currently face and evaluates various reform proposals. We emphasize that the incomes of the superrich are

qualitatively different from others. Some are “superstars,” for whom small differences in talent are magnified into much larger earnings differences, while others work in winner-take-all markets, meaning that their effort to climb the ladder of success reduces the returns to others. Moreover, the discussion about tax rates must be accompanied by attention to the tax base, with a special focus on capital gains, which comprise a large fraction of the taxable income of the superrich. We also review the pros and cons of wealth taxes versus alternative policies that achieve similar objectives. While a dozen OECD countries levied wealth taxes in the recent past, only three retain them at present. Only Switzerland raises a similar fraction of revenue with its wealth tax as the recent U.S. proposals, therefore serving as a useful example.” + Video summary

And a link: The financial-transactions tax we need in the age of coronavirus (by R Murphy)

“ Five decades on, a ‘Tobin tax’ is no longer fit for purpose. Now what should be taxed, progressively, is all financial flows.” Part of a corporate taxation article series (Social Europe).

Global Health Governance

GAVI - COVAX welcomes appointment of civil society representatives https://www.gavi.org/news/media-room/covax-welcomes-appointment-civil-society- representatives

“As part of the global response to the COVID-19 pandemic, COVAX – the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) – welcomes the appointment of civil society organisation (CSO) representatives to key COVAX working groups. … .. The representatives were selected by a civil society selection committee made up of members from 10 civil society organisations from 7 countries and 4 continents. The ten nominees were selected from a pool of 159 candidates based on a range of criteria… … The selected representatives will be involved in a number of key groups contributing to the only global solution for equitable access to COVID-19 vaccines for the most vulnerable groups around the world. The ten civil society and community representatives will provide valuable technical expertise and use their experiences to play an important role in the success of COVAX.” Check out who they are.

And a tweet by Kate Elder (MSF): “To forego any revisionist history: the inclusion of #civilsociety in *some* parts of #COVAX didn't come easy. It was an uphill struggle with @gavi & @CEPI every step of the way. AND CSOs still are excluded from the #COVAX Facility.”

GAVI - COVAX Facility convenes first meeting of COVAX Shareholders Council https://www.gavi.org/news/media-room/covax-facility-convenes-first-meeting-covax-shareholders- council

“The COVAX Shareholders Council, composed of all self-financing participants, forms a key component of Facility governance. The AMC Engagement Group, a second governance body

comprising economies that are eligible for COVID-19 vaccines through the Gavi COVAX Advance Market Commitment (AMC) will also meet in November. … … Gavi, the Vaccine Alliance, in its capacity as the legal administrator of the COVAX Facility, yesterday convened the first meeting of the COVAX Shareholders Council. The COVAX Shareholders Council, which is comprised of all self- financing participants and will be self-organising, is a key component of Facility governance. More than 200 participants from 67 countries joined the half-day virtual meeting. It was chaired by Ngozi Okonjo-Iweala and Andrew Witty. …”

Quick side comment perhaps: For the time being, COVAX feels very much like the Paris agreement: nowhere near enough to tackle the challenge it pretends to tackle (resp access to a vaccine for all, and avert catastrophic climate change). Time to bring in also the Trips Waiver proposal, I’d say…

NYT – In hunt for virus source, WHO let China take charge https://www.nytimes.com/2020/11/02/world/who-china-coronavirus.html?smid=tw-share

Cfr tweet L Gostin: “Meticulous @nytimes piece on #SARSCoV2 origins. We'll likely never know the zoonotic source or early spread.”

“As it praised Beijing, the World Health Organization concealed concessions to China and may have sacrificed the best chance to unravel the virus’s origins. “

Excerpts: “… The search for the virus’s origins is a study in the compromises the W.H.O. has made. … … On the surface, an investigation into the virus’s origin is progressing. Beijing recently approved a list of outside investigators. The health organization has agreed that key parts of the inquiry — about the first patients in China and the market’s role in the outbreak — will be led by Chinese scientists, according to documents obtained by The New York Times. The documents, which have never been made public, show that W.H.O. experts will review and “augment, rather than duplicate,” studies undertaken by China. … … Even as it has heaped praise on the Chinese government, the organization has refused to disclose details of its negotiations with Beijing and hasn’t shared documents with member states outlining the terms of its investigations … … … Internal documents and interviews with more than 50 public-health officials, scientists and diplomats provide an inside look at how a disempowered World Health Organization, eager to win access and cooperation from China, has struggled to achieve either. Its solicitous approach has given space for Mr. Trump and his allies to push speculation and unfounded conspiracy theories, and deflect blame for their own mistakes.”

“The prospect of an apolitical inquiry into the virus’s origins is dwindling. China has extracted concessions from the health organization that have helped the country delay important research and spared its government a potentially embarrassing review of its early response to the outbreak. … … An executive summary of the documents, obtained by The Times, shows that the health organization’s virus origin studies will unfold in two phases. One will look for the first patients by reviewing hospital records and interviewing people who were treated for the virus in December. The team will also investigate what wildlife was sold at the Wuhan market and follow the supply chain, according to the summary. … The W.H.O. has agreed this phase will be led by Chinese scientists, with outsiders reviewing their work remotely. In the second phase, international experts will work with Chinese colleagues to find the virus among animal hosts and a possible intermediate host….”

Independent - EU: WHO should have more power to investigate outbreaks https://www.independent.co.uk/news/eu-who-should-have-more-power-to-investigate-outbreaks- who-world-health-organization-outbreaks-london-countries-b1450182.html

Will be the EU position at the World Health Assembly. “European countries are calling for the World Health Organization to be given greater powers to independently investigate outbreaks and compel countries to provide more data, after the devastating coronavirus pandemic highlighted the agency’s numerous shortcomings.”

See also Reuters - EU urges quick WHO reform, asks for more transparency in pandemics

Related Document: Draft Conclusions of the Council and the Representatives of the Governments of the Member States on the role of the EU in strengthening the World Health Organization

Cfr tweets: #EU Health Ministers today reached unanimous political agreement on "Draft Conclusions of the Council & the Representatives of the Governments of the Member States on the role of the EU in strengthening @WHO". They will be formally adopted on 6 November. “

Ilona Kickbusch: “Next step in strong support of @EuropeanUnion for @WHO under German Presidency.”

Reuters - WHO needs reforms, while preserving 'political independence': panel https://uk.reuters.com/article/us-health-coronavirus-who/who-needs-reforms-while-preserving- political-independence-panel-idUKKBN27L1WA

“…An oversight panel called on Thursday for reforms at the World Health Organization (WHO) including “predictable and flexible” funding and setting up a multi-tiered system to warn countries earlier about disease outbreaks before they escalate. The independent experts said it was essential to preserve the U.N. agency’s “neutrality and political independence” in tackling outbreaks, but did not refer directly to China or the United States. … The oversight panel chaired by Felicity Harvey is due to report to WHO’s annual ministerial meeting that resumes virtually on Monday after a shortened session last May….”

Bloomberg - WHO, Nations’ Covid Response Hampered by Politics, Reviewer Says https://www.bloomberg.com/news/articles/2020-11-03/who-nations-covid-response-hampered-by- politics-reviewer-says

Interview with Helen Clark. “Pandemic may be a ‘Chernobyl moment’ of reckoning for health.”

“The World Health Organization needs greater freedom from politics when it recommends measures to fight global health crises, according to one of the leaders of an independent panel evaluating the response to the Covid-19 pandemic. Concerns about reactions to recommendations like potentially trade-disrupting border closures may undermine the global health agency’s ability to fight new health threats, said Helen Clark, both a former prime minister of New Zealand and administrator of the United Nations Development Programme, in an interview….”

As a reminder: “Both WHO and many of its member countries have been scrutinized for their responses to the pandemic that has struck about 47 million people, killing more than 1.2 million and stifling economies worldwide. Clark and panel co-chair Ellen Johnson Sirleaf, the former president of Liberia, were tapped in July to review the lessons learned from the WHO-coordinated international health response. The WHO has been open to their inquiries, and member states have been “responsive,” Clark said. The panel is slated to present its progress to the World Health Assembly on Nov. 10 and release a full report in May. “

Geneva Health Files (newsletter) – 10th issue

P Patnaik; Geneva Health Files;

One of the two key stories in this week’s issue focuses on: “a new proposal by U.S. and Brazil on WHO’s roadmap on governance reforms. At the cusp of a potentially new administration in the U.S., what does it mean for WHO?”

“The U.S. and Brazil have teamed up to lay out a governance reform proposal for WHO in the context of the urgencies that COVID-19 has wrought upon. The timing of such a proposal is bemusing given the uncertainties around American engagement at WHO. It is expected that this proposal, along with others, will be discussed at the margins of the upcoming World Health Assembly next week… … While there are some convergences with the earlier proposal put forth by Germany and France (such as on independent access to outbreak areas), on certain issues including on funding for WHO emergencies programme or greater transparency for the workings of the IHR Emergency Committees, or “delinking” travel from trade restrictions during health emergencies, for example, there are some new approaches….”

FT - Tech’s power comes with great responsibility in fighting disease https://www.ft.com/content/f98a71db-0a8a-4dc8-a760-2ed780d059a1

On the increasing role of Big Tech in global health (including in WHO corridors). “Digital tools have proved invaluable to health officials, but have led to an unprecedented sharing of personal data.”

“…When World Health Organization officials decided last year to convene a group to advise them on digital health, they were testing the limits of a longstanding taboo just weeks ahead of an impending catastrophe. The UN agency usually maintains its distance from commercial organisations — from food companies to the pharmaceutical industry — to avoid any potential conflicts of interest. Yet, alongside representatives of governments and non-profit groups, the 20-strong digital health technical advisory group includes executives from two of China’s largest tech companies, Baidu and Tencent, and is chaired by Steve Davis, a former McKinsey consultant. The identities of those around the table reflect how far technology has already been intermingling with and disrupting traditional approaches to tackling health and disease. These trends have accelerated since the emergence of the coronavirus pandemic, with the digital world both boosting the virus — through an “infodemic” of fake medical news — and helping to mitigate its spread. … Ilona Kickbusch, co- chair of the FT/Lancet Commission established in 2019 to explore best practice in the governance of digital health, says the pandemic upended the commission’s initial thinking, as well as its working practices. “We’ve got to look at these issues through the lens of Covid. All projections have gone out of the window,” she says….”

Clingendael (Policy brief) – Europeanising health policy in times of coronationalism

L Van Schaik & R van de Pas; https://www.clingendael.org/publication/europeanising-health-policy- times-coronationalism

“The COVID-19 crisis has prompted the European Union (EU) to rethink its health policy, or rather those of its policies that influence the health policies of member states, as those largely comprise a national competence, and sometimes a subnational one. During the pandemic, EU institutions and EU member states identified issues where more EU coordination was desirable, for instance with regard to stockpiling and joint purchasing of medical products. Much is still unclear, however, about how a broadly supported revised EU health policy should look, particularly as this has traditionally been a field where EU citizens and EU member states saw little added value in the EU becoming involved. A newly proposed EU4Health programme saw a setback right at its inception, with its proposed funding being cut drastically by the European Council, even though EU health expenditure will continue to rise. This policy brief explores the future of EU health policy after the COVID-19 pandemic changed conventional thinking.”

Might also have implications for the EU’s (future) global health role.

Next week: (resumed) 73rd World Health Assembly

WHO - World Health Assembly charts course for COVID-19 response and global health priorities https://www.who.int/news/item/05-11-2020-world-health-assembly-charts-course-for-covid-19- response-and-global-health-priorities

“As health leaders prepare to gather for a virtual session of the resumed 73rd World Health Assembly (WHA), WHO has three messages to share….”

“First, we can beat COVID-19 with science, solutions and solidarity. …. Second, we must not backslide on our critical health goals. The COVID-19 pandemic is a sobering reminder that health is the foundation of social, economic and political stability. It reminds us why WHO’s ‘triple billion’ targets are so important, and why countries must pursue them with even more determination, collaboration and innovation. Since May, Member States have adopted a number of decisions – the Immunization Agenda 2030, the Decade of Healthy Ageing 2020-2030, as well as initiatives to tackle cervical cancer, tuberculosis, eye care, food safety, intellectual property and influenza preparedness. The resumed session will discuss a 10-year-plan for addressing neglected tropical diseases, as well as efforts to address meningitis, epilepsy and other neurological disorders, maternal infant and young child nutrition, digital health, and the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010.”

“Third, we must prepare for the next pandemic now. … The WHA will consider a draft resolution (EB146.R10) that strengthens Member States’ preparedness for health emergencies, such as COVID-19, through more robust compliance with the International Health Regulations (2005). This resolution calls on the global health community to ensure that all countries are better equipped to detect and respond to cases of COVID-19 and other dangerous infectious diseases….”

See also UN News - Ahead of global health assembly, WHO stresses need for solidarity, preparation

“The COVID-19 pandemic can be defeated through science, solutions and solidarity, the World Health Organization (WHO) said on Thursday, underlining one of its core messages throughout the crisis….”

Global health funding

FT – Vaccine bond sale raises $500m to fund immunisation programmes https://www.ft.com/content/08c50fd5-1e6d-4d83-b1ca-196362711f02

From las week: “Proceeds earmarked for vaccine procurement and access in world’s poorest countries.”

“…A vaccine bond has raised $500m from investors in a sale that garnered strong demand to fund immunisation programmes in developing countries, including efforts to combat the coronavirus pandemic. The money was raised for Gavi, the UN-backed vaccines alliance, by a financing vehicle, the International Finance Facility for Immunisation. The deal on Thursday attracted more than $1.5bn of orders for the three-year debt, and offered investors a yield of 0.44 per cent. …. GAVI said the proceeds would also be deployed for vaccine procurement and access “in the context of Covid- 19”. Doris Herrera-Pol, a member of IFFIm’s board of directors, said the deal marked the start of a “significant financing programme”. … IFFIm has raised more than $6bn with its vaccine bonds since 2006, and has so far provided $2.6bn of funding to Gavi. The debt allows it to “front-load” contributions from donor countries by swiftly disbursing cash raised on capital markets. The borrowing is backed by legally binding pledges from governments to gradually reimburse investors with contributions from their aid budgets. …. . IFFIm’s credit rating — AA with S&P, Aa1 with Moody’s and AA- with Fitch — is closely linked to the creditworthiness of the UK and France, its two largest contributors. “

Lancet Comment – Strategy, coordinated implementation, and sustainable financing needed for COVID-19 innovations V Dzau et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32289-3/fulltext

Dzau et al advocating for sustainable financing for Covid-19 innovations (scale-up): « …. Although such innovations are encouraging, they are insufficient if not deployed in a strategic and scalable way that targets areas of greatest need. A central strategy at the national and global levels and financial resources are required to direct, evaluate, coordinate, prioritise, and integrate the innovations for effective implementation. Furthermore, an overarching national or global command centre would be useful for all COVID-19-related innovations. … Globally, there is inadequate financing to sustain a coordinated strategy for COVID-19 innovations. The ACT-Accelerator, for example, brings together governments, health organisations, scientists, businesses, civil society, and foundations to accelerate development, ensure equitable allocation, and scale up delivery of new COVID-19 tools. But the ACT-Accelerator is principally dependent on funding from donor countries and foundations, which is an insufficient and unsustainable way to finance a global public good. The ACT-Accelerator will require long-term, predictable, and sustained financing based on global

solidarity. Innovation to tackle COVID-19 must be centred within strategy, command, coordination, and sustainable financing. »

PS: As for the sustainable financing, one advice, Victor: tax Bezos et al. Properly.

Planetary Health

WHO Bulletin - Intergovernmental engagement on health impacts of climate change

N Dasandi et al; https://www.who.int/bulletin/online_first/BLT.20.270033.pdf?ua=1

The authors examined “ … countries’ engagement with the health impacts of climate change in their formal statements to intergovernmental organizations, and the factors driving engagement.” They “obtained the texts of countries’ annual statements in United Nations (UN) general debates from 2000 to 2019 and their nationally determined contributions at the Paris Agreement in 2016.”

“For both UN general debate statements and nationally determined contributions, low- and middle-income countries discussed the health impacts of climate change much more than did high- income countries. … … Our analysis indicated a higher engagement in countries that carry the heaviest climate-related health burdens, but lack necessary resources to address the impacts of climate change. These countries are shouldering responsibility for reminding the global community of the implications of climate change for people’s health.”

Lancet Planetary Health – November issue https://www.thelancet.com/journals/lanplh/issue/vol4no11/PIIS2542-5196(20)X0012-X

Start with the Editorial - Picking winners. On the need for really systematic change.

Guardian – Global food production emissions 'would put Paris agreement out of reach' https://www.theguardian.com/environment/2020/nov/05/global-food-production-emissions- would-put-paris-agreement-out-of-reach

“Study calls for more focus on farming and food waste, behind a third of greenhouse gas production.” Based on a new study in Science.

“If emissions from food production are to be cut to safe levels, diets heavy in meat, dairy and eggs in rich countries need to change, says the study’s lead author. Our diets and agricultural production around the world are so carbon-intensive that emissions from the global food system alone would be enough to put the Paris climate goals out of reach, even if all the other major sources of emissions were closed down, research has shown….”

Covid key news – Yet another ‘critical moment’ for action

As usual, with focus on key trends & WHO messages, in this section.

Cidrap News – UN to host pandemic summit https://www.cidrap.umn.edu/news-perspective/2020/11/global-covid-total-passes-48-million- greece-locks-down

“The United Nations General Assembly today voted unanimously, with three abstentions, including the United States, to hold a 2-day summit on the COVID-19 response to begin on Dec 3, the Associated Press reported. The meeting will include speeches from world leaders and a discussion led by World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD….” There are more than 48 million cases now (see Cidrap New ).

(Nov 2) “At a media briefing today, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the continuing spike in cases in some European countries and in North America are "another critical moment for action."

See also Al Jazeera - Critical moment’ as Europe, N Africa see COVID-19 surge: WHO

VOA – World Surpasses 1.2 Million COVID-19 Confirmed Fatalities https://www.voanews.com/covid-19-pandemic/world-surpasses-12-million-covid-19-confirmed- fatalities

“The global death toll from the coronavirus pandemic has surpassed 1.2 million people, according to data collected by the Johns Hopkins University Coronavirus Resource Center. “

Cidrap News - WHO extends COVID-19 emergency as global total tops 45 million https://www.cidrap.umn.edu/news-perspective/2020/10/who-extends-covid-19-emergency-global- total-tops-45-million

Update from late last week.

“At a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said the agency's COVID-19 emergency committee wrapped up its fifth review of COVID-19 developments and unanimously agreed that the situation still warrants a public health emergency of international concern (PHEIC) under the International Health Regulations (IHR). … … As part of its review, the committee also tweaked its temporary recommendations. Didier Houssin, MD, who chairs the panel, said the main recommendations were for the WHO to update its travel

recommendations as more countries make use of testing to assist with safe travel and for member countries to avoid politicizing the virus. In another development, WHO officials said an international expert group met virtually with Chinese counterparts today in advance of a joint effort to investigate the origin of SARS-CoV-2, the virus that causes COVID-19….”

See WHO –As COVID-19 spread accelerates, IHR Emergency Committee urges focus on measures that work

And full statement Statement on the fifth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

UN News - Long-term symptoms of COVID-19 ‘really concerning’, says WHO chief https://news.un.org/en/story/2020/10/1076562

Tedros again paid attention to the long-haulers. “With some COVID-19 patients reporting long-term symptoms, including damage to major organs, the World Health Organization (WHO) urged Governments to ensure they receive necessary care. “Although we’re still learning about the virus, what’s clear is that this is not just a virus that kills people. To a significant number of people, this virus poses a range of serious long-term effects,” said WHO chief Tedros Adhanom Ghebreyesus, speaking in Geneva on Friday during the UN agency’s latest virtual press conference….”

See also a WEF blog - WHO warns against 'natural herd immunity'

“World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus has issued a warning about pursuing natural herd immunity, after speaking with patients struggling with long-term effects of COVID-19. Their stories show people need time and care to recover, Tedros said. "It also reinforces to me just how morally unconscionable and unfeasible the so-called ‘natural herd immunity’ strategy is," he added. "Not only would it lead to millions more unnecessary deaths, it would also lead to a significant number of people facing a long road to full recovery. Herd immunity is only possible with safe and effective vaccines that are distributed equitably around the world."

Euronews - Coronavirus: Doctors, nurses and health workers 'burning out', warns WHO https://www.euronews.com/2020/10/29/coronavirus-doctors-nurses-and-health-workers-burning- out-warns-who

Message by Kluge (WHO Euro).

Guardian - Covid lockdowns are cost of self-isolation failures, says WHO expert https://www.theguardian.com/world/2020/nov/02/covid-lockdowns-are-cost-of-self-isolation- failures-says-who-expert

“Lockdowns affecting entire populations is a price countries pay for failing to ensure people with coronavirus and their contacts self-isolate, according to an expert from the World Health Organization….”

UHC 2030 - Lives and livelihoods: a decision framework for social and movement measures during the COVID-19 pandemic https://www.uhc2030.org/blog-news-events/uhc2030-news/related-news/lives-and-livelihoods-a- decision-framework-for-social-and-movement-measures-during-the-covid-19-pandemic-555426/

Deadline for the consultation: 15 November:

“The World Health Organization (WHO) is developping a decision-making framework in collaboration with other partners. It will be launched during the UN General Assembly special session on COVID-19 which will be held in early December 2020.”

“Addressing the health crisis while considering the socio-economic outcomes of social and movement measures is a complex decision to be made by policy makers, and a systematic and inclusive framework for decision making that considers present and future implications for both lives and livelihoods is needed. The WHO Secretariat will coordinate the development of a decision framework that incorporates public health, economic and procedural dimensions to support policy makers address these complex decisions to respond to COVID-19. Where possible, the framework will be supplemented by testimonials from policy makers who have been involved in making decisions involving social and movement measures to respond to COVID-19 in order to illustrate contextual and practical experiences. The decision framework will be launched during the UN General Assembly special session on COVID-19 which will be held in early December 2020.”

Covid access to vaccines, medicines, …

HPW - Corporate Charity – Is The Gates Foundation Addressing Or Reinforcing Systemic Problems Raised By COVID-19?

R Malpani, B Baker & M Kamal-Yanni; https://healthpolicy-watch.news/gates-foundation-address- systemic-covid-19/

The read of the week.

“Two competing approaches to promote access to medicines were born during the HIV/AIDS pandemic in the year 2000. Today, at the height of the COVID-19 pandemic, these same approaches are once more on a collision course. On the one side is the ‘international’ COVID response, led in name by WHO, but in fact by what is now the world’s largest and most powerful global health institution, the Gates Foundation – with the backing of the pharmaceutical industry and high-income countries. On the other side is the access-to-medicines movement, led by civil society alongside low- and middle-income countries (LMICs) such as India and South Africa, with the backing of hundreds of grassroots, civil society groups and non-governmental organisations that are challenging monopolies on medicines and promoting generic competition to successfully

expand supply and lower prices of COVID-19 drugs, tests and equipment, and future vaccines. These groups argue that meeting the COVID-19 pandemic requires broad use of the same strategies that revolutionized access to antiretroviral medicines (ARVs) during the AIDS crisis. Can we learn from the successes and mistakes made the last time around?...”

On the same issue, via a BMJ Global Health blog - How the World Trade Organization could facilitate access to COVID-19 health technologies? (by B Townsend et al)

Quote: “…The WTO proposal is in response to lack of commitment to the WHO’s COVID-19 Technology Access Pool (C-TAP), launched in May to encourage the voluntarily sharing of IP, technologies and data to support global manufacturing and scale up of COVID-19 technologies. So far, no pharmaceutical firm has committed to sharing its IP and technologies in the pool, prompting India to push for the waiver at the WTO.”

Reuters - Under pressure, WHO plans COVID-19 vaccine insurance scheme for poor nations https://www.reuters.com/article/us-health-coronavirus-who-vaccines/under-pressure-who-plans- covid-19-vaccine-insurance-scheme-for-poor-nations-idUSKBN27E2CM

On the liability issue. “A vaccine scheme co-led by the World Health Organization is setting up a compensation fund for people in poor nations who might suffer any side-effects from COVID-19 vaccines, aiming to allay fears that could hamper a global rollout of shots. The mechanism is meant to avoid a repetition of delays experienced a decade ago during the H1N1 swine flu pandemic, when inoculations were slowed down in dozens of low-income countries because there was no clear liability. The scheme is being set up by the promoters of the COVAX vaccine facility, which is co-led by the WHO and GAVI, a global vaccine alliance, a COVAX document published on Thursday said. COVAX aims to distribute at least 2 billion effective shots around the world by the end of next year. The scheme could foot the bill for 92 low-income countries, mostly in Africa and South-East Asia, meaning their governments would face little or no costs from claims brought by patients, should anything go unexpectedly wrong after a COVAX-distributed vaccine is administered. However dozens of middle-income countries, such as South Africa, Lebanon, Gabon, Iran and most Latin American states, would not be offered this protection….”

CNBC - Moderna says it’s preparing global launch of Covid vaccine as it takes in $1.1 billion in deposits https://www.cnbc.com/2020/10/29/coronavirus-moderna-says-it-is-actively-preparing-for-launch- of-vaccine.html

“Moderna is prepping for the global launch of its potential coronavirus vaccine, already taking in $1.1 billion in deposits from governments, the company said Thursday. It said it was in ongoing talks with the World Health Organization-backed COVAX initiative on a tiered pricing proposal for its potential vaccine. Moderna already has supply agreements in North America, the Middle East and in other regions of the world.”

See also FT - Moderna Preps for Global Vaccine Launch

FT - Race to discover pandemic vaccine faces hurdles https://www.ft.com/content/525c935e-7c92-4da2-8525-06eb2f9ffd0c

On the need to temper expectations a bit. “Drug research strategies should be complemented with existing tools to fight outbreak.”

“For anyone pinning their hopes on the rapid delivery of a vaccine to end the pandemic, David Heymann has a sobering message: “We need to learn to live with the virus. We need to act now with the tools we have.” Policymakers in many countries are seeking to buy time with blunt instruments like lockdowns while hoping tools such as vaccines and therapeutics will eliminate Covid- 19. But he warns such strategies should be complemented by existing techniques to mitigate the outbreak. …. … Others are more optimistic that science will provide fresh solutions — whether politicians keen to reassure their citizens, academics and other researchers eager for funding, or pharmaceutical companies hoping to reap financial rewards of developing drugs.”

Quote: “Soumya Swaminathan, the WHO’s chief scientist, says: “We have to really temper people’s expectations. People think there will be a vaccine early next year and life will go back to normal. It’s not going to happen. It will take two years to cover the population. In the short term, our goals should be to minimise transmission. ”There are similar concerns about new medicines, despite a fast-growing pipeline of trials. “Unfortunately, most of the news has been very disappointing,” she says. The most significant hope is for monoclonal antibodies, but testing is still likely to take many months. For now, much of the progress in reducing the Covid-19 burden has come from rising levels of immunity, matched by improved medical approaches with existing tools, from the cheap steroid dexamethasone to more selective use of intubation in intensive care.”

Guardian - Rich states' Covid deals 'may deprive poor of vaccine for years' https://www.theguardian.com/world/2020/nov/03/rich-states-covid-deals-may-deprive-poor-of- vaccine-for-years

“Governments in predominantly wealthy countries are negotiating to buy nearly 8.8bn doses of prospective Covid-19 vaccines in a “frenzy of deals” that could mean many poor countries would not get access to immunisation until at least 2024, a report says. None of the 320-plus potential vaccines in development have been approved for use, but countries have already struck advance purchasing agreements for 3.73bn doses of the most promising candidates, with negotiations underway for another 5bn doses, the study by Duke University’s global health innovation centre calculated. However, manufacturers will only be able to produce so much of the successful candidates, with researchers estimating it could take three to four years to supply enough vaccine to immunise the global population. That means many wealthy countries may be able to vaccinate their entire populations several times over before most people in low-income countries are immunised, the report said….”

See also All Africa : “The Launch and Scale analysis revealed that while it will likely take three to four years to manufacture enough vaccines to cover the world's population, nearly four billion doses of COVID-19 vaccine candidates are already part of bilateral advance purchasing deals involving mainly high-income countries, vaccine developers and global vaccine manufacturers. Another five billion doses are the subject of negotiations among these same parties that have yet to be finalized. Meanwhile, the study found that only enough doses to cover 250 million people have been

confirmed as purchased thus far by COVAX, a global effort involving both wealthy and poor countries that has promised equal access to COVID-19 vaccines globally, regardless of income levels. In fact, the data reveal that several COVAX signatories, including the United Kingdom (UK), the European Union (EU) and Canada, are effectively undermining the pact by negotiating "side deals" for large vaccine shipments that will "result in a smaller piece of the pie available for equitable global allocation."

For the Duke study, see https://launchandscalefaster.org/covid-19

HPW - Distributing Future COVID-19 Vaccines Equitably Could Prevent 60% Of Deaths https://healthpolicy-watch.news/cooperative-vaccine-distribution-could-prevent-60-of-covid- deaths/

“Rather than hoarding vaccine supplies, rich countries that ensure global access to a new COVID- 19 vaccine will pave the way to a larger reduction in pandemic related deaths worldwide, according to a new model developed by the Boston-based Northeastern University. … Researchers at the Northeastern University MOBS Lab created two model scenarios: one in which 2 billion doses of a vaccine is monopolised by 50 high-income countries, and one in which the drug is distributed based on a country’s poupulation. Both scenarios were run with two vaccines: one that had 80% and one 65% efficacy in terms of protective potential. A vaccine with a minimum efficacy of 50% could provide herd immunity, according to a separate study published in The Lancet. The Northeastern University model found that if the 50 wealthiest countries stockpiled a vaccine with 80% efficacy, only 33% of the deaths that would otherwise occur that year could be averted, compared to 61% if the vaccine were to be distributed equitably. The same findings occurred in the case of the less efficient vaccine, where by hoarding would prevent 30% of deaths as compared to worldwide distribution, which would prevent 57% of deaths….”

FT - Coronavirus/mass testing: positive diagnosis https://www.ft.com/content/1162daa1-d50f-40fc-aa60-c2d295a501ae

With one of the most interesting experiments going on in Slovakia, mass testing was the talk of the week. And could turn into a multibillion dollar business.

“Spotting potential ‘spreaders’ could provide a vital route out of the crisis.”

“…The tests, which detect tell-tale proteins known as antigens, are quick and cheap. They are not as accurate as tests that detect the virus’s genetic material. But they can spot people who are at greatest risk of spreading the disease. The tests account for 60 per cent of the total in India. Slovakia used them to screen the bulk of its population last weekend. The World Health Organization plans to make 120m tests available to poorer countries. … … Daily screening using a test devised by US healthcare company Abbott — which correctly identifies Covid cases 95 per cent of the time — did not stop the outbreak in the White House last month. But conducted regularly enough, it could be a valuable tool. That could create a big and possibly lucrative market. Stefan Hamill of Numis estimates the cost at £1 for a test selling for £5. For now at least, demand outstrips supply. Swiss drugmaker Roche said last week the market was “totally sold out” as it ramped up production of

its rapid test, launched in partnership with South Korea’s SD Biosensor. … … “ Hopes of a return to normality have focused on vaccines. But their success is not guaranteed. That justifies a focus on mass testing. This could provide a vital route out of the crisis — and create a multibillion-dollar industry.” …”

See also the Guardian - Half of Slovakia's population tested for coronavirus in one day

SCMP - Coronavirus: international funding boost for Chinese vaccine maker Clover https://www.scmp.com/news/china/society/article/3108311/coronavirus-international-funding- boost-chinese-vaccine-maker

“CEPI earmarks millions of dollars for Chengdu-based firm to advance candidate to next phase of trials; Company also plans to use money to scale up manufacturing of doses.”

“Hundreds of millions of Covid-19 vaccine doses developed by a Chinese pharmaceutical company could be included in a World Health Organization (WHO) plan for fair access to vaccines, following a deal announced on Tuesday. Chengdu-based vaccine maker Sichuan Clover Biopharmaceuticals, Inc will receive up to US$328 million from the Coalition for Epidemic Preparedness Innovations (Cepi), an Oslo-based organisation working with the WHO on vaccine access. …. The US$328 million investment includes the US$69.5 million Cepi earmarked in April and July for the vaccine’s development. Clover’s candidate was one of nine to receive investment from Cepi to speed up the development of a vaccine to counter Covid-19…. Clover is the only candidate from mainland China in the group.”

Reuters - Britain prepares for COVID-19 vaccine as Oxford forecasts result this year https://www.reuters.com/article/health-coronavirus-britain-vaccine/oxford-covid-19-vaccine- results-due-next-month-raising-hopes-of-2021-rollout-idUSKBN27K1CL

“Late-stage trial results of a potential COVID-19 vaccine being developed by the University of Oxford and AstraZeneca could be presented this year as the British government prepares for a possible vaccination rollout in late December or early 2021….”

FT – Covid-19 vaccine market worth $10bn a year, analysts say https://www.ft.com/content/7961437d-33cd-4f47-b190-2be3b571c8e5

“The future Covid-19 vaccine market could be worth more than $10bn a year, generating bumper revenues for pharmaceutical companies that have funded large parts of their research with government money. The calculations by analysts at Morgan Stanley and Credit Suisse assume that people will need to take a Covid-19 vaccine every year, like a flu jab, and are based on projected costs for the shot, currently hovering at about $20 a dose. “My base case assumption right now is that you will need annual vaccinations,” said Matthew Harrison, an analyst at Morgan Stanley. “[Covid-19] is not going to go away.” … … Even taking a “conservative approach” in which only

those people who get a flu vaccine also take one for Covid-19, the market would be worth $10bn across developed countries, he said. Evan Seigerman, an analyst at Credit Suisse, estimated that the market could be even larger and worth $10bn in the United States alone. The size of the market — equivalent to the annual revenue from ten blockbuster drugs — shows the potential opportunity for an industry that has received billions of dollars of government investment in the past eight months and how it could profit from that public funding….”

See also the Guardian - Future market for Covid vaccines 'could be worth more than $10bn a year'

Reuters – Exclusive: WHO-led COVID drug scheme doubles down on antibodies, steroids and shuns remdesivir https://www.reuters.com/article/us-health-coronavirus-who-drugs-exclusiv/exclusive-who-led- covid-drug-scheme-doubles-down-on-antibodies-steroids-and-shuns-remdesivir-idUSKBN27L1OY

“A World Health Organization-led scheme to supply COVID-19 drugs to poor countries is betting on experimental monoclonal antibody treatments and steroids but shunning Gilead’s remdesivir therapy, an internal document shows. The Oct. 30 WHO draft document seen by Reuters says priorities are to secure monoclonal antibodies in a tight market and to boost distribution of cheap steroid dexamethasone, of which it has already booked nearly 3 million courses of treatment for poorer countries. … …. The paper, which for the first time outlines how the scheme would spend donors’ money, does not cite remdesivir among priority drugs - a significant omission as the antiviral is the only other medication alongside dexamethasone approved across the world for treating COVID-19. … … The drug-supply scheme is one of the four pillars of the so-called ACT Accelerator, a WHO-led project which also seeks to secure COVID-19 vaccines, diagnostics and protective gear for poorer countries by raising more than $38 billion by the beginning of 2022. “Immediate priorities for the (therapeutics) pillar are intensifying efforts on monoclonal antibodies while scaling up dexamethasone use,” says the document, which is subject to change but due for publication as soon as Friday….” “The scheme, co-led by the Wellcome Trust, a charity, and Unitaid, a health partnership hosted by the WHO, urgently needs $6.1 billion, $750 million of which by February, out of a total ask of $7.2 billion.”

Lancet (Comment) - Emergency use authorisation for COVID-19 vaccines: lessons from Ebola M Smith et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32337- 0/fulltext

“Russia and China have begun COVID-19 vaccinations outside of clinical trials. This move has been met with widespread criticism because the safety profiles of these candidate COVID-19 vaccines remain uncertain without data from phase 3 trials. Emergency use authorisations—a regulatory mechanism that enables the public to gain access to promising investigational medical products when those products have not yet received regulatory approval and licensure—have previously been used for unlicensed vaccines in public health emergencies and can be ethically justified provided that certain conditions are met. So why have the actions of Russia and China drawn such criticism? And how can other national regulatory authorities ensure future emergency use authorisations for COVID-19 vaccines are issued in a way that is scientifically and ethically sound? Experience of emergency use authorisations for investigational Ebola virus vaccines in Guinea and the

Democratic Republic of the Congo (DRC) can elucidate key lessons that can guide ethical emergency use authorisations for COVID-19 vaccines….”

Quick take: for the moment the Russian & Chinese vaccines fail to follow the (exemplary) emergency Ebola vaccine use playbook. Read why, and what needs to be done instead.

Covid funding, debt relief, social protection, …

Let’s start with an update on the ACT-Accelerator:

Tweet Peter Singer: “ACT-Accelerator, which @WHO launched with partners, and COVAX are powerful statements in international solidarity; 186 countries and economies are engaged in COVAX. But we need to fill a $28.5B financing gap with an urgent need for $4.5B. #ACTogether”

NYT - How the Wealthy World Has Failed Poor Countries During the Pandemic https://www.nytimes.com/2020/11/01/business/coronavirus-imf-world-bank.html?smid=tw-share

Recommended helicopter read. “Despite pledges for debt relief and expanded programs, the World Bank and International Monetary Fund have delivered meager aid, say economists.”

Excerpts: “… the World Bank and the I.M.F. have failed to translate their concern into meaningful support, say economists. That has left less-affluent countries struggling with limited resources and untenable debts, prompting their governments to reduce spending just as it is needed to bolster health care systems and aid people suffering lost income. … … “A lost decade of growth in large parts of the world remains a plausible prospect absent urgent, concerted and sustained policy response,” concluded a recent report from the Group of 30, a gathering of international finance experts, including Lawrence Summers, a former economic adviser to President Barack Obama, and Treasury secretary in the Clinton administration. … … The I.M.F. and the World Bank — forged at the end of World War II with the mandate to support nations at times of financial distress — have marshaled a relatively anemic response, in part because of the predilections of their largest shareholder, the United States. … “The World Bank Group intends to respond forcefully and massively,” Mr. Malpass said. At the I.M.F., Ms. Georgieva said she would not hesitate to tap the institution’s $1 trillion lending capacity. “This is, in my lifetime, humanity’s darkest hour,” she declared. …. But the I.M.F. has lent out only $280 billion. That includes $31 billion in emergency loans to 76 member states, with nearly $11 billion going to low-income countries. … World leaders played up the program as a way to encourage poor countries to spend as needed, without worrying about their debts. But the plan exempted the largest group of creditors: the global financial services industry, including banks, asset managers and hedge funds. “The private sector has done zilch,” said Adnan Mazarei, a former deputy director at the I.M.F., and now a senior fellow at the Peterson Institute for International Economics in Washington. “They have not participated at all.”

“The debt suspension was at best a short-term reprieve, delaying loan payments while heaping them atop outstanding bills. Some 46 countries, most of them in sub-Saharan Africa, have collectively gained $5.3 billion in relief from immediate debt payments. That is about 1.7 percent

of total international debt payments due from all developing countries this year, according to data compiled by the European Network on Debt and Development.”

Bloomberg - China Says It Granted More Debt Relief, Backs G-20 Coordination https://www.bloomberg.com/news/articles/2020-10-30/china-says-it-grants-more-debt-relief- backs-g-20-coordination

“China said it has signed more debt-freeze deals with poorer nations and is pushing for closer cooperation between the world’s biggest economies in a bid to ease the fiscal burden of countries wrestling with the coronavirus pandemic. … … In addition, Chinese non-official lenders have also granted holidays to struggling debtor nations in line with the terms of the Group of 20 leading economies’ Debt Service Suspension Initiative, the ministry said. The statement comes two weeks before G-20 finance ministers and central bankers convene for an extraordinary meeting to discuss the next phase of the global debt-relief drive. So far, more than 40 countries have asked to delay $5 billion in official bilateral debt payments, according to the Institute of International Finance.;..”

Eurodad – Development Finance Institutions and Covid-19: Time to reset Eurodad;

“ A new analysis of how Development Finance Institutions are responding to the Covid-19 crisis suggests they are unable to foster inclusive and sustainable businesses and spur a much needed transition to low-carbon economies.”

“…five of world’s largest DFIs – including the World Bank IFC – have directed just 2% of investments to companies based in low income countries since the outbreak of the Covid-19 pandemic. CSOs are calling for a rethink during the virtual Finance in Common (FIC) summit next week, where 400 public development banks, including DFIs, will discuss their role in the Covid-19 recovery effort.

Eurodad - The G20 “Common Framework for Debt Treatments beyond the DSSI”: Is it bound to fail?

“This two-part blog series provides an analysis of the possible structure of the G20 “Common Framework for Debt Treatments beyond the DSSI”. Part I describes the likely structure of the framework. Part II analyses why a Paris Club-based approach to the Common Framework is unlikely to succeed.”

Click here to read part one.

Click here to read part two.

Global Policy - Safety First: Expanding the Global Financial Safety Net in Response to COVID‐19

K Gallagher et al ; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12871

“We call for strengthening the Global Financial Safety Net (GFSN) to manage the economic effects of COVID‐19, in particular the massive capital outflows from emerging market and developing economies EMDEs and the global shortage of dollar liquidity. Both the United Nations (UN) and the International Monetary Fund (IMF) estimate that EMDEs need an immediate $2.5 trillion, yet the financing available to them is just $700 to $971 billion. To meet these immediate needs we propose to: (1) broaden the coverage of the Federal Reserve currency swaps; (2) issue at least $500 billion of special drawing rights through the IMF; (3) improve the IMF’s precautionary and emergency facilities; (4) establish a multilateral swap facility at the IMF; (5) increase the resources and geographic coverage of regional financial arrangements; (6) coordinate capital flow management measures; (7) initiate debt restructuring and relief initiatives; and (8) request that credit‐rating agencies stop making downgrades during the emergency….”

Covid science & innovation

Not our niche, but some reads anyway:

NYT - Pregnant Women Face Increased Risks From Covid-19 https://www.nytimes.com/2020/11/02/health/Covid-pregnancy-health-risks.html

“If symptomatic, they were more likely to develop complications and die than nonpregnant women with symptoms.”

Guardian - Tiny air pollution rise linked to 11% more Covid-19 deaths – study https://www.theguardian.com/environment/2020/nov/04/tiny-air-pollution-rise-linked-to-11-more- covid-19-deaths-study

“A small rise in people’s long-term exposure to air pollution is associated with an 11% increase in deaths from Covid-19, research has found. Another recent study suggests that 15% of all Covid-19 deaths around the world are attributable to dirty air. The available data only allows correlations to be established and further work is needed to confirm the connections, but the researchers said the evidence was now strong enough that levels of dirty air must be considered a key factor in handling coronavirus outbreaks….”

WHO Afro - COVID-19 spurs health innovation in Africa https://www.afro.who.int/news/covid-19-spurs-health-innovation-africa

“The COVID-19 pandemic has galvanized the development of more than 120 health technology innovations that have been piloted or adopted in Africa, a new World Health Organization (WHO)

analysis finds. The study of 1000 new or modifications of existing technologies that have been developed worldwide to target different areas of the COVID-19 response finds that Africa accounts for 12.8% of the innovations. The response areas include surveillance, contact tracing, community engagement, treatment, laboratory systems and infection, prevention and control. In Africa, 57.8% of the technologies were ICT-driven, 25% were based on 3D printing and 10.9% were robotics. The ICT-based innovations include WhatsApp Chatbots in South Africa, self-diagnostic tools in Angola, contact tracing apps in Ghana and mobile health information tools in Nigeria. The countries with the most innovations were South Africa (13%), Kenya (10%), Nigeria (8%) and Rwanda (6%)….”

Guardian - T-cell Covid immunity 'present in adults six months after first infection' https://www.theguardian.com/world/2020/nov/02/t-cell-covid-immunity-present-in-adults-six- months-after-first-infection

“Study suggests white blood cell levels higher in people who had symptoms”. Encouraging news with a view on vaccines.

HPW - Virus Variant Prevalent – But Not Any More Dangerous https://healthpolicy-watch.news/covid-cases-climb-to-record-peaks-ahead-of-us-elections-tuesday/

On how to interpret the key “mutation” (see last week’s IHP news): “… Although speculation has been rife about whetehr the surge is also being fueled by a novel SARS-CoV-2 variant, named 20A.EU1, that has spread widely across Europe in recent months one of the, lead authors of the study on the newly identified variant, said that so far, it does not appear to be any more deadly or infectious. “We do not have any evidence that the new variant is more transmissible or has a different clinical outcome,” Dr. Emma Hodcroft of the University of Basel, told Health Policy Watch. “We think the main factors here were the rising cases in Spain, travel over summer, lack of screening/successful quarantine, and failure of countries to contain rising cases….”

Lancet Comment - Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32318-7/fulltext by Roy Anderson et al.

Cfr tweet Anthony Costello: “Excellent review. We must be cautious about longer term effects of any vaccine, especially if immunity wanes within 1-2y. Also whether repeat infections have greater severity because of immune enhancement, whereby the virus uses antibodies to gain entry to cells for replication.”

Telegraph - WHO urged to set global guidelines on indoor humidity to curb Covid Telegraph;

“The virus spreads more efficiently in dry air, experts say, while our body’s resistance to infection is weaker.”

And some links:

• Cidrap - Eli Lilly's COVID-19 antibody treatment shows promise

• Guardian - Tiny variants in genes may dictate severity of coronavirus

“Scientists are tracking small differences in DNA to explain why the disease has different effects.”

• Reuters- Guidelines for COVID-19 tests for airline passengers could set global bar for reliability, sources say

• Telegraph - Covid sufferers should wear masks at home to stop spread of disease, researchers urge

• Cidrap - Confronting the notion that face masks reduce COVID 'dose' • NYT - Denmark will kill all farmed mink, citing coronavirus infections

“Government officials said on Wednesday that a mutation in the virus could interfere with vaccine effectiveness in humans.”

Via Cidrap: “ Danish government officials announced today that its 17 million mink population will be culled, following the identification of a mutated version of SARS-CoV-2 that passed from animals to people, Reuters reported. The form of the virus was found in both humans and minks and showed decreased antibody sensitivity, which authorities said could reduce the efficacy of future vaccines and spread to other countries.”

Covid analysis

Lancet Editorial – COVID-19 in Latin America: a humanitarian crisis https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32328-X/fulltext

“Latin America has some of the highest COVID-19 death rates in the world. Why? For outsiders, much of the discussion of COVID-19 in Latin America has focused on Brazil and the errors of President Jair Bolsonaro. But the region as a whole is facing a humanitarian crisis borne out of political instability, corruption, social unrest, fragile health systems, and perhaps most importantly, longstanding and pervasive inequality—in income, health care, and education—which has been woven into the social and economic fabric of the region….”

The editorial concludes: “A regional approach may help, but is under threat. While the Latin American Alliance for Global Health facilitates cooperation among academics in the region, national governments have left the PAHO at risk of insolvency through a lack of solidarity. It is imperative that

Latin American countires work to strengthen PAHO. There is also a role for the global health community. Historically, middle income countries, including many in Latin America, have been overlooked in global health. There is an African CDC, but no Latin American CDC, for example. Many global health experts in Latin America feel that the region is too often neglected. To deal with the core drivers of the pandemic in the region, and perhaps to salvage some good from a disaster, global health initiatives need to take Latin America more seriously.”

Lancet – Offline: Managing the COVID-19 vaccine infodemic R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32315-1/fulltext

“COVID-19 vaccine misinformation is not taken as seriously as it should be. That complacency needs to end.” Horton gives some advice, via work/recommendations from O’Connor & Weatherall.

BMJ GH (Commentary) - The urgent need for a global commitment to protect healthcare workers A Talisuna, T Frieden, M Moeti et al ; https://gh.bmj.com/content/5/11/e004077

Very important advocacy.

“Health workers are essential for improved global health, but are at disproportionate risk of contracting COVID-19 as well as experiencing adverse mental health impacts. We must better protect this essential workforce, because when health workers are at risk, their patients and the entire health system are also at risk. All WHO Member States and donor organisations must take immediate and specific action to better protect this essential workforce. A comprehensive approach will be required that involves the full hierarchy of infection prevention controls as well as systematic collection of data on health worker infections.”

Civicus (report) – Solidarity in the time of Covid-19 https://www.civicus.org/index.php/covid-19

“As the COVID-19 pandemic swept the world, civil society stepped up to make a difference. Civil society was a source of vital support, advice and information, a guardian of human rights, an enabler and defender of communities, a determined advocate for inclusive and rights-oriented policies, a corrective to state and market failures, a driver of sustained mobilisation, creativity and innovation, a trusted partner and an essential guarantor of accountability over state and private sector decisions. Drawing from a range of civil society voices, this report outlines some of the many civil society responses to the pandemic, highlights its vital contributions, draws preliminary lessons and makes recommendations for states and other stakeholders to enable and work with civil society, both in pandemic response and recovery and in tackling the underlying issues that the crisis has exposed and deepened.”

Transparency International – How corruption is making people sick https://www.transparency.org/en/news/how-corruption-is-making-people-sick#

“Health care workers around the world report a rise in corruption during COVID-19.”

“…More than 1,800 women and men have contacted Transparency International’s worldwide network of Advocacy and Legal Advice Centres (ALACs) to report corruption and seek assistance for issues related to COVID-19. Our ALACs offer free and confidential advice to victims and witnesses of corruption in more than 60 countries around the globe. These reports show how corruption is increasing the burden on health care systems and impeding people’s access to treatment and personal protective equipment (PPE). Health care workers are being forced to work in unsafe hospitals while corruption networks profit from government contracts and the unlawful and questionable sales of medical supplies. In some cases, patients must pay bribes for PPE and COVID- 19 tests….”

BMJ - Harms of public health interventions against covid-19 must not be ignored https://www.bmj.com/content/371/bmj.m4074

“The harmful consequences of public health choices should be explicitly considered and transparently reported to limit their damage, say Itai Bavli and colleagues.”

BMJ –The democratic, political, and scientific failures of covid-19 K Abbasi; https://www.bmj.com/content/371/bmj.m4277

It’s a dire picture indeed, in many democracies. Abbasi concludes: “Democracies, politicians, and scientists, then, have much to put right before the next pandemic surge arrives.”

Open Democracy - COVID shows that the military-industrial complex can’t keep us safe

P Rogers; https://www.opendemocracy.net/en/covid-shows-that-the-military-industrial-complex- cant-keep-us-safe/

Nice one. “Incompetence aside, establishment concepts of security plus the neoliberal dismemberment of the state leave us poorly protected from pandemics.”

BMJ News – Covid-19: Experts debate merits of lockdowns versus “focused protection” https://www.bmj.com/content/371/bmj.m4263

“Three experts with widely differing viewpoints regarding appropriate public health measures to control the spread of covid-19 weighed in on lockdowns during a debate1 sponsored by Johns Hopkins University. The experts represented viewpoints ranging from advocacy for “focused protection” as described in the Great Barrington Declaration to recommendations for population- wide mandates as described in the John Snow Memorandum….”

Weekly Newsletter Alan Whiteside: Covid-19 Watch - Bleak and Bleaker https://alan-whiteside.com/category/news/

Alan Whiteside’s weekly update on Covid-19, from a global perspective.

This week also featuring a guest contribution by me. See also on my own blog - Polarisation among scientists on Covid-19 responses.

In which I try to offer a meta-view on the fierce discussions between (often likeminded) scientists, 8 months into the pandemic. Whereby many of us try to find the mythical land in between the Great Barrington Declaration & John Snow memorandum. But we still haven’t found what we’re looking for :)

Social Sciences & Humanities Open- Re-thinking global and public health projects during the COVID-19 pandemic context: Considerations and recommendations for early- and not-so-early-career researchers https://www.sciencedirect.com/science/article/pii/S2590291120300644?via%3Dihub

By J Spagnolo, L Gautier et al.

Preprint -Coronaphobia - An Emerging Mental Disorder Super-Spreading Globally by Communication

A Kalk & Wim van Damme; https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3716921

Provocative read. “Communication on the COVID-19 pandemic has been distorting the emerging scientific evidence and has led to the unprecedented closure of societies (‘lockdown’). The ‘collateral damage’ caused by Corona control measures is affecting the lives and livelihoods of billions of people world-wide, especially the vulnerable, and most probably costing the lives of hundreds of thousands. This has promoted a new mental disorder, ‘coronaphobia’, an epidemic of fear, spreading faster than the virus itself, and permitting a surprising degree of acceptance even of very harsh control measures. It is argued that societies’ reaction to epidemics should adapt to the emerging evidence, and that they should more strictly adhere to well-established public health principles.”

K Bertram (blog) - Four Covid19 Failures – and why a health response alone won’t solve our crisis https://katribertram.wordpress.com/2020/10/30/four-covid19-failures/

“Covid19 has shown that a health response alone won’t solve our current crisis. We need to focus on the big picture: political, governance, financing, and civic space issues.”

Disaster Medicine and Public Health Preparedness - Optimizing Pandemic Preparedness and Response Through Health Information Systems: Lessons Learned From Ebola to COVID-19 Arush Lal et al; paper;

“Health information systems (HIS) developed during recent Ebola outbreaks in West Africa and the Democratic Republic of the Congo (DRC) provided opportunities to collect, analyze, and distribute data to inform both day-to-day and long-term policy decisions on outbreak preparedness. As COVID- 19 continues to sweep across the globe, HIS and related technological advancements remain vital for effective and sustained data sharing, contact tracing, mapping and monitoring, community risk sensitization and engagement, preventive education, and timely preparedness and response activities. In reviewing literature of how HIS could have further supported mitigation of these Ebola outbreaks and the ongoing COVID-19 pandemic, 3 key areas were identified: governance and coordination, health systems infrastructure and resources, and community engagement. In this concept study, we outline scalable HIS lessons from recent Ebola outbreaks and early COVID-19 responses along these 3 domains, synthesizing recommendations to offer clear, evidence-based approaches on how to leverage HIS to strengthen the current pandemic response and foster community health systems resilience moving forward.”

The Conversation - COVID stress syndrome: 5 ways the pandemic is affecting mental health

G Asmundson; https://theconversation.com/covid-stress-syndrome-5-ways-the-pandemic-is- affecting-mental-health-147413

“…. Supported by funding from the Canadian Institutes of Health Research and the University of Regina, we conducted a longitudinal population-based survey of a large sample of Canadian and American respondents, with surveys administered in late March, mid-May and early July of 2020. Based on this data we determined that the mental health impact of COVID-19 is best understood as a multi-faceted syndrome comprising a network of interconnected symptoms….”

Global Public Health - Multi-dimensional effects of the COVID-19 pandemic considering the WHO’s ecological approach

P Tabari et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1839934

“…. Self-isolation and quarantine as key strategies to overcoming the spread of the disease have had major, micro, and macroscopic consequences. This commentary, therefore, seeks to review critical factors impacting the COVID-19 pandemic through the spectrum of levels, categorising effects in the WHO’s ecological framework (individual, relational, community, and societal aspects). We further describe the management of the crisis at each level to help guide health personnel, communities, governments, and international policymakers in understanding how their actions fit into a larger picture as they seek to manage the crisis.”

Beyond Biomedical and Statistical Approaches in COVID-19: How Shoe-leather Public Health Works

R Priya et al; https://www.epw.in/journal/2020/44/special-articles/beyond-biomedical-and- statistical-approaches-covid.html

Focus on India here, but with broader lessons. “The evolving COVID-19 pandemic requires that data and operational responses be examined from a public health perspective. While there exist deep contestations about the epidemic control strategies to be adopted, past experience seems to be corroborated in the present epidemic that a contextually rooted “shoe-leather public health” approach provides the most effective interventions and operational strategies, more so in a society as diverse as ours. Drawing from this, an analysis of the COVID-19 situation in India is put forth, and debates on mitigation strategies, optimisation of testing, and the essential steps for a comprehensive set of interventions in order to minimise human suffering are addressed.”

And some quick bits & pieces:

Via Stat - Ashish Jha on Covid-19, pandemic fatigue, and when we’re getting back to normal

On the US: “We mentioned pandemic fatigue, but there’s also a term that Dr. Mike Osterholm at the University of Minnesota calls pandemic anger. Up to a third of the country, in his estimation, believes the pandemic is a hoax or isn’t as serious as people like you are telling us it is.”

Covid impact on other global health programmes

HPW - COVID-19 hits life-saving health services in Africa https://healthpolicy-watch.news/covid-19-hits-life-saving-health-services-in-africa/

Via WHO Afro’s Mrs Moeti. “The COVID-19 pandemic has dealt a heavy blow to key health services in Africa, raising worries that some of the continent’s major health challenges could worsen. The preliminary analysis by the World Health Organization (WHO) of five key essential health service indicators that include outpatient consultation, inpatient admission, skilled birth attendance, treatment of confirmed malaria cases and provision of the combination pentavalent vaccine in 14 countries finds a sharp decline in these services between January and September 2020 compared with the two previous years. The gaps were the widest in May, June and July, corresponding to when many countries had put in place and enforced movement restrictions and other social and public health measures to check the spread of COVID-19. During these three months, services in the five monitored areas dropped on average by more than 50% in the 14 countries compared with the same period in 2019….”

TGH - The Double Threat of COVID-19 in Africa Tom Frieden & John Nkengasong; https://www.thinkglobalhealth.org/article/double-threat-covid- 19-africa

“Deaths from health-care disruptions due to COVID-19 are almost certain to outnumber deaths from the coronavirus itself.”

“… My group (T.F.), Resolve to Save Lives, an initiative of Vital Strategies, has joined with WHO and the Africa Centers for Disease Control and Prevention as well as key nongovernmental organizations, including the World Economic Forum, in a public-private Partnership for Evidence- Based Response to COVID-19 (PERC) to reduce the pandemic’s impact in Africa. This partnership recently released a status report showing how the pandemic continues to affect communities, including disrupting essential health services. … The PERC report supports the troubling concern that the COVID-19 control measures quickly implemented by many African Union (AU) member states are now causing secondary impacts that will be far greater than the disease itself….”

Global Fund update

GFO – Increase in domestic health financing in Africa will be hard amid Covid-19 https://www.aidspan.org/en/c/article/5385

Must-read Analysis from the new GFO issue. By Tom Hart (ODI)

“The COVID-19 pandemic is leading to the first recession in Africa in two decades, at a time when there is a need to increase health spending.”

In the same GFO issue, do read also:

The GF’s ombudsman calls for increased diversity and inclusion in the organization

The GF's 44th board meeting will discuss its next strategy and business continuity among covid-19.

PHC & UHC

WHO Bulletin theme issue - Primary Health Care – Realizing the vision https://www.who.int/bulletin/volumes/98/11/en/

With a number of absolute must-read editorials and articles. Many were already published in recent weeks, online.

Via one of the Editorials - Primary health care: realizing the vision: In this theme issue, … “The articles present evidence, strategies and practical implementation considerations for policy reforms and health system transformations needed to attain UHC through primary health care. Articles consider various aspects of the science and practice of primary health care: an examination of the primary health-care approach after the Declaration of Astana and in the context of COVID-19, the

potential and limitations of primary health care to contribute to the SDGs, the role of communities in primary health care and UHC, the role of primary health care in addressing the climate crisis, a call for global health donors to reorient their financial support towards primary health care and the testing of a monitoring framework for primary health care. The issue also highlights issues of integrated health service delivery, focusing on primary care: utilization patterns for health services that can be delivered in primary care, the role of pharmacists in primary care delivery, the delivery of essential surgical services by family doctors, important linkages between primary care and emergency, critical and operative care, the role of primary care in addressing the social determinants of health and strategies to retain rural health workforce. The issue further includes description of country progress towards primary health care, including Ethiopia’s implementation of primary health care towards UHC, and a synthesis of twenty country case studies…”

Coming up - Primary Health Care Research Week: 18-20 November 2020 https://www.who.int/alliance-hpsr/events/2020/primary-health-care-research-week/en/

Via WHO’s Alliance. Check out what’s on the menu.

SRHR

Plos Med Editorial - Revisiting child and adolescent health in the context of the Sustainable Development Goals Z Bhutta et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003449

“In a forthcoming PLOS Medicine special issue, we are inviting impactful research in this important area on strategies to monitor and combat child mortality globally from birth through adolescence, school-age health and welfare, marginalised populations, and the environmental impacts on children’s health. We hope that this special issue will help to redirect attention to child and adolescent health in years to come….”

Launch of new website Centre for Gender and Global Health http://www.ighgc.org/

Check it out.

Mental health

Lancet Comment – Announcing the Lancet Commission on stigma and discrimination in mental health

G Thornicroft et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32203- 0/fulltext

Announcement of a new Lancet Commission with six aims. Do also check out the Commissioners.

“Stigma and discrimination against people with mental ill health are global problems and have severe consequences in terms of social exclusion. Such social exclusion is associated with barriers to health care, increased unemployment, and premature mortality. Evidence is clear from high-income countries, and is emerging from low-income and middle-income countries (LMICs), that interventions can be effective in reducing such stigma and discrimination. We now need a reappraisal of this field and a set of radical and practical recommendations to guide action locally, nationally, and globally to address mental health-related stigma and discrimination.”

World Cities Day (31 October)

UN News - Sustainable urbanization critical to COVID-19 recovery, better quality of life https://news.un.org/en/story/2020/10/1076532

“Cities will be critical for the world to recover from the COVID-19 pandemic and the worst recession for decades, according to the latest report published by UN-Habitat, the UN agency working on urban issues. The World Cities Report 2020, released on Saturday, showcases the value of sustainable urbanization and how it can contribute to global efforts to build back better after the crisis….”

Arise Consortium (blog) - Secondary impacts of COVID-19 on informal urban settlements http://www.ariseconsortium.org/informal-settlement-urban-covid-19-world-cities-day/

“This blog was written for World Cities Day, 31 October 2020. The theme this year is Valuing Our Communities and Cities. People in informal urban settlements deserve our support and solidarity. In the blog we explore how they are experiencing some of the secondary effects of COVID-19 and mechanisms that could strengthen the ways that they are involved in the pandemic response.”

Coming up: BMJ - Healthy Dry cities collection (16 Nov) https://www.bmj.com/healthy-dry-cities

“Increases in water scarcity and urbanisation are two of today’s great global health challenges. Dryness, a longstanding reality in much of the world, is becoming increasingly severe and widespread. It is in these contexts that cities face other challenges related to climate change, public health threats such as covid-19, and gaping inequalities in wealth and health. To maximise the physical, mental and social wellbeing of all their inhabitants, dry cities must optimise their physical and social environments and community resources. This collection, commissioned for the 2020 Virtual WISH summit, shows that healthy dry cities are eminently achievable with the right policies, institutions, technologies, and space for innovation…”

Check out the first article in the Collection: Protecting health in dry cities: considerations for policy makers

“Increasing health and wellbeing in cities that experience water scarcity presents challenges, but can be done, say Howard Frumkin, Maitreyi Bordia Das, and colleagues.”

Some papers and reports of the week

WHO (policy brief) - Value based health services https://www.who.int/choice/publications/value_based_health_services/en/

“Health policy makers around the world have long shown interest in the value created by health systems and this preoccupation will likely only intensify in the current context of the COVID-19 pandemic and the ensuing global recession. Yet, there remains much confusion about what value actually means and none of the existing approaches has looked at value holistically, from the perspective of the entire health system. Value in health has been identified as a priority area for the G20 nations in 2020, under the Presidency of the Kingdom of Saudi Arabia (KSA). A key initiative within this remit, which has been welcomed by Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), is the establishment of a dedicated platform for sharing knowledge to improve value in health - the G20 Global Innovation Hub for Improving Value in Health.”

“… To support the development of the Knowledge Hub, WHO has developed a briefing note highlighting existing WHO work that contributes to Value Based Health Services. The policy brief explicitly looks at how to value health, and how to work through three levers to improve value in health care - setting a health benefits package, strategic purchasing and integrated people- centred health services. The brief identifies practical approaches to how these levers could be leveraged to advance the UHC objectives. For example, it highlights the “3D” (Data, Dialogue, Decision) approach to priority setting for benefits package selection and showcases tools, such as the “UHC Compendium” that can support certain aspects of this approach. At the same time, it stresses the importance of aligning the various policies, thus corroborating the argument made in the first policy brief.”

Policy brief - From value for money to value-based health services: a twenty-first century shift

The Lancet - Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31859-6/fulltext

Via the press release:

“Most comprehensive global study to date suggests concerning height and BMI trends among school-aged children and adolescents”

“New global analysis charting child and adolescent physical growth trends in 200 countries over past 35 years reveals wide variations in height and BMI among school-aged children, and faltering growth in many countries—most likely due to lack of adequate and healthy nutrition during school years. Average height gap of 20 cm between tallest and shortest nations in 2019, and BMI difference of 9–10 kg/m² (equivalent to around 25 kg of weight) between highest and lowest countries at 19 years of age. Over the past 35 years, unhealthy growth trends—with too little height gain and/or excess weight gains—were seen in New Zealand, the USA, Malaysia, Mexico, and sub-Saharan Africa. … … Authors call for global health and nutrition programmes to be extended to school-aged children and adolescents to enable healthy growth throughout development. …”

“Children in some countries grow healthily to the age of 5 years, but cease to do so as they get older, raising concerns about access to nutritious food and a healthy environment during school years, according to a new global analysis of trends in child and adolescent height and obesity in 200 countries, published in The Lancet.

BMJ GH - Bringing a health systems modelling approach to complex evaluations: multicountry applications in HIV, TB and malaria David E Philips et al ; https://gh.bmj.com/content/5/11/e002441

“Understanding how to deliver interventions more effectively is a growing emphasis in Global Health. Simultaneously, health system strengthening is a key component to improving delivery. As a result, it is challenging to evaluate programme implementation while reflecting real-world complexity. We present our experience in using a health systems modelling approach as part of a mixed-methods evaluation and describe applications of these models. We developed a framework for how health systems translate financial inputs into health outcomes, with in-country and international experts. We collated available data to measure framework indicators and developed models for malaria in Democratic Republic of the Congo (DRC), and tuberculosis in Guatemala and Senegal using Bayesian structural equation modelling….”

“the DRC model indicated a strong relationship between shipment of commodities and utilisation thereof. In Guatemala, the strongest model coefficients were more evenly distributed. Results in Senegal varied most, but pathways related to community care had the strongest relationships. In DRC, we used model results to estimate the end-to-end cost of delivering commodities. In Guatemala, we used model results to identify potential bottlenecks and understand mediation. In Senegal, we used model results to identify potential weak links in the cascade of care, and explore subnationally.

Conclusion This study demonstrates a complementary modelling approach to traditional evaluation methods….”

Some blogs and other mainstream news of the week

LSE – Cutting edge issues in development: panel on China in Africa https://blogs.lse.ac.uk/internationaldevelopment/2020/11/04/cutting-edge-issues-in-development- panel-on-china-in-africa/

“On Friday 30 October, guest lecturers Deborah Brautigam, Folashade Soule-Kohndou and Shirley Ze Yu delivered an online lecture on “China in Africa” as part of the department’s Cutting Edge Issues in Development lecture series. MSc International Development and Humanitarian Emergencies student, Otobong Mmah tells us what she took away from the lecture.”

LSE - What we know about the academic journal landscape reflects global inequalities K Bell et al; https://blogs.lse.ac.uk/impactofsocialsciences/2020/10/12/what-we-know-about-the- academic-journal-landscape-reflects-global-inequalities/

“Over the past sixty years, there has been an exponential growth in the global scholarly publishing landscape. Mapping or capturing it, however, is a difficult task as dominant databases only cover a small proportion of published journals. Kirsten Bell and David Mills offer their own cartographic visualisation of the global scholarly publishing landscape. They argue that the little that is known about scholarly production outside the English-speaking world is revealing about the inequalities of dominant knowledge practices. Moreover, what we do know- the characterisations of non-Western publishers as ‘predatory’- is a conceit which reaffirms colonial hierarchies. They urge readers to explore whole ‘unknown’ publishing continents: non-indexed publications, non-English journals, and non-mainstream journals….”

Tweet of the week

Dr Tedros “The need for a #COVID19 vaccine is very real. But it will not fix the vexing vulnerabilities afflicting us all. There’s no vaccine for poverty, hunger, inequality, climate change or misguided nationalism. Global commitment to end these scourges is urgently needed.”

Global health events

Re-watch: some sessions from the 4th Global Health Policy research forum https://globalhpr.org/forum

Recordings from opening plenary and plenary 1 are already available.

This week, the third panel discussion took place, on “Donor-government tensions in health policy”.

Re-watch: The Academy of Medical Sciences and The Lancet International Health Lecture 2020 https://acmedsci.ac.uk/policy/policy-projects/international-health-lecture-2020

“2020's lecture was presented by three speakers: Professor Gabriel Leung, Professor Robin Shattock FMedSci and Professor Ilona Kickbusch, under the title: Learning from crisis: building resilient systems to combat future pandemics. “

Recording available now. The lecture took place on Monday morning.

Coming up next week - WTO’S General Council meeting: 9 November Via Geneva Health Files: “The appointment of Ngozi Okonjo-Iweala for WTO’s top job will be discussed at the meeting. It is not clear if the appointment will be approved assuming full consensus will have been negotiated by then, or whether the process will be stalled till a new American president assumes office in January 2021.”

Coming up next week - the Finance in Common Summit Check out this Briefing - The flaws of the billions to trillions approach

“Hundreds of development banks are convening next week at the Finance in Common Summit, the first global meeting of all public development banks. The aim of this meeting is ambitious: both discussing the public banks’ role in countering the COVID-19 pandemic and designing ‘a financial system whereby public development banks would have the ability to reorient and leverage all financial flows in the direction of climate and the Sustainable Development Goals (SDGs)’….”

See also a CGD Analysis - Use First-Ever “Finance in Common Summit” to Propel Global Action for COVID-19 Recovery (by M Ahmed)

Global governance of health

HPW - Nigeria’s Iweala Is Majority Choice Of WTO Members & Well Qualified To Lead – WHO Africa Regional Director https://healthpolicy-watch.news/nigeria-okonjo-iweala-wto-who-africa-dg/

Mrs Moeti (WHO Afro) fully backs Ngozi Okonjo-Iweala as the next WTO boss.

Quote: “Shy of an all-out public confrontation with the US government, African governments and key stakeholders across the continent are subtly pushing back on the decision of representatives of the Trump-led administration to oppose the declaration and emergence of Dr Ngozi Okonjo-Iweala as the elected Director General of the WTO….”

Guardian - Women Deliver racism investigation verdict described as a 'slap in the face' https://www.theguardian.com/global-development/2020/oct/30/women-deliver-racism- investigation-verdict-described-as-a-slap-in-the-face

“The results of an investigation into allegations of racism and harassment at one of the world’s most high profile women’s rights organisations has been described as a “slap in the face” to those who complained. Investigators concluded this week that no single person was responsible for the “challenges” at the group, Women Deliver, which had undergone a period of rapid growth “during which its policies and practices lagged behind”. The report added the workplace culture had been “too demanding, urgent, and high-pressure”….”

See also a Lancet World Report – Report released on Women Deliver allegations

“An investigation into accusations of discrimination at advocacy group Women Deliver has said that rapid growth was a major cause. Talha Burki reports.”

The Telegraph - How Trump undermined U.S. aid — but still spent billions in ‘transactional’ approach https://www.telegraph.co.uk/global-health/climate-and-people/trump-undermined-us-aid-still- spent-billions-transactional/

“When Donald Trump became president in 2016, his victory was based on an ‘America First’ platform. In the administration’s debut budget in 2017, that looked like catastrophic news for those who came in second: the rest of the world, particularly low- and middle-income countries. The budget initially proposed a cut of around 30 percent to foreign assistance, a slash-and-burn approach that left those in the sector aghast. … … But in a pattern that has been repeated every year since, Congress — where foreign aid has bipartisan support — rejected the cuts … . … Foreign aid also became a bargaining chip under President Trump…”

World Development - Public Support for Development Aid during the COVID-19 Pandemic

Y Kobayashi et al ; https://www.sciencedirect.com/science/article/pii/S0305750X20303752

“Worries about the impact of COVID-19 on the country’s finances reduce support for aid while worries about its impact on personal finances do not. Messages emphasizing that aid to developing countries helps weaken the next wave of the pandemic at home significantly increase support for aid. Messages stressing how COVID-19 might harm developing countries barely change attitudes toward aid.”

BMJ GH - Health system governance in strengthening International Health Regulations (IHR) compliance in Myanmar T Pyone et al ; https://gh.bmj.com/content/5/11/e003566

“… . Multisectoral, collaborative working within and across sectors is fundamental to improving IHR (2005) compliance, and for that, governance is the best lever of the health system. This paper highlights the importance of the relationship between governance and IHR in the context of Sustainable Development Goals (SDGs) which follow the fundamental principle of interdependence; SDGs interlink with one another. We consider governance (SDG 16) and how it influences the IHR capacity of SDG 3 (health and well-being for all at all ages). This paper considers the successes of the Myanmar Ministry of Health and Sports thus far in improving IHR compliance and highlights that an even greater focus on health system governance would lead to more sustainable outcomes. ….”

And a Lancet Profile - Roopa Dhatt: advancing gender equality in global health leadership

UHC

WB (Investing in Health) blog - Health financing resilience during a pandemic: Fifth Annual Health Financing Forum, part 2 https://blogs.worldbank.org/health/health-financing-resilience-during-pandemic-fifth-annual- health-financing-forum-part-2

“… Health financing resilience is the focus of this year’s Annual Health Financing Forum (AHFF) . Health financing resilience is the ability of countries to respond to unexpected health shocks that suddenly increase the need for health spending and/or reducing governments’ revenues. … … Part 1 of the AHFF, which took place in July 2020, explored key areas of this theme through a series of virtual sessions. Discussions included a look at developments in government revenue mobilization, public financial management strategies to move funds more rapidly and flexibly to frontline services, financing arrangements to ensure that non-COVID-19 essential health services are maintained, changes in purchasing arrangements to assure a rapid scale-up of health service capacity, such as the increased use of telemedicine, and the impact of COVID-19 on financial protection. The second part of the Forum, taking place November 9 to December 10, 2020, will continue these conversations and take them a step further building on the experiences of the last few months….”

Plos Med - Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003357

“Expanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008….”

Health Affairs - Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries

J Mcinko et al ; https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01570

“… important population groups such as older adults are rarely examined as part of Sustainable Development Goals monitoring and evaluation efforts. This study uses recent (2014–16) high- quality, individual-level data from several aging cohorts representing more than 100,000 adults ages fifty and older in twenty-three high- and middle-income countries. After individual characteristics and health needs were controlled for, national rates varied up to tenfold for poor access (no doctor visit) and threefold for potential overutilization (fifteen or more doctor visits and multiple hospitalizations) in the past year. Catastrophic expenditures (25 percent or more of household income spent out of pocket on health care) averaged 9 percent, with the highest rates observed in middle-income countries and among sicker populations in some high-income countries. Strengthening universal health coverage for older adults will require greater tailoring and targeting of benefits to meet this population’s health needs while protecting them from catastrophic health expenditures.”

Infectious diseases & NTDs

UNAIDS – Highly effective HIV prevention option not reaching those who need it https://www.unaids.org/en/resources/presscentre/featurestories/2020/november/20201102_prep

“Pre-exposure prophylaxis (PrEP), an HIV prevention option whereby someone who is HIV-negative takes antiretroviral medicines prior to possible exposure to HIV, has been shown to be highly efficacious across all populations. The offer of PrEP as part of a combination approach to HIV prevention has been recommended by the World Health Organization for all people at substantial risk of HIV since 2015. The number of people reported to have received PrEP at least once in the previous year has increased dramatically in recent years, from fewer than 2000 in 2016 to more than 590 000 in 2019. In several cities in North America, Europe and Australia where PrEP is widely available, this relatively new prevention tool has contributed to steep reductions in HIV infections among gay men and other men who have sex with men. Global coverage, however, is still far short of the 2020 target of 3 million people receiving PrEP.”

CDC – Progress Toward Global Eradication of Dracunculiasis, January 2019–June 2020 CDC;

Update on progress against Guinea worm eradication.

“Human dracunculiasis (Guinea worm disease) cases have decreased from an estimated 3.5 million in 1986 to 54 in 2019. Guinea worm infection in dogs has complicated eradication efforts. During January–June 2020, the number of human dracunculiasis cases reported decreased to 19 in four countries (Angola, Chad, Ethiopia, and Mali) with one case in Cameroon in a patient possibly infected in Chad; South Sudan reported no human cases. In addition, 1,063 infected animals were

reported Infected dogs, especially in Chad, and impeded access because of civil unrest and insecurity in Mali and South Sudan remain challenges to interrupting transmission.”

NCDs

NCD Alliance - Landmark agreement between Sida and NCDA will help combat NCDs in LMICs https://ncdalliance.org/news-events/news/landmark-partnership-between-sida-and-the-ncdalliance-will-help-to-combat-ncds-in-lmics

“The Swedish International Development Cooperation Agency (Sida) announced today a three-year partnership with the NCD Alliance for a total of 15,000,000 SEK (US $1.6 million) to support the response to noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). This landmark partnership forms part of Sweden’s strategy for global development cooperation in sustainable social development, which has at its centre the 2030 Agenda for Sustainable Development and Sustainable Development Goal 3 on health and wellbeing….” “As the first major partnership for Sida on NCDs, it reinforces its’ position as a leader in global health and a frontrunner of development agencies to invest and combat NCDs in developing countries….”

Sexual & Reproductive / maternal, neonatal & child health

Global Public Health – Impacts of the Global Gag Rule on sexual and reproductive health and rights in the Global South: A scoping review S Lane et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1840611

Making the link with the Decolonize Global Health Movement: “…To capture the effects of the policy to date, we conducted a scoping review in April 2020. Forty-eight articles met our eligibility criteria, and were analysed thematically, noting the effects on: the operations of non-governmental organisations; maternal health; sexually transmitted infections; marginalised groups; reproductive rights. We found that the policy increased the abortion rate and had a negative impact on maternal health, STIs, and the health of marginalised groups. We conclude that the policy amounts to the neocolonial co-optation of sexual and reproductive health in the Global South to advance an ideological agenda in the Global North. We urge that the policy be repealed as part of the broader project of protecting and decolonising sexual and reproductive health globally.”

Global Health Promotion - Maternal and child health: is making ‘healthy choices’ an oxymoron? F Low et al; https://journals.sagepub.com/doi/full/10.1177/1757975920967351

“The right to exercise choice is fundamental to the Universal Declaration of Human Rights, and it is assumed that all individuals generally enjoy freedom of choice in managing their health. Yet closer

examination of this assumption calls into question its credibility and validity, especially with regard to maternal and child health around the globe. We argue that the concept of individual ‘healthy choice,’ particularly as applied to those with inadequate support and who are relatively disempowered, is flawed and unhelpful when considering the wider social, economic, and political forces underlying poor health. We instead propose that the realistic promotion of healthy choices requires acknowledging that agency lies beyond just the individual, and that individuals need to be supported through education and other structural and policy changes that facilitate a genuine ability to make healthy choices.”

Access to medicines

The Conversation - Indian pharma is being squeezed – and it’s bad news for drug access in developing countries T Arun et al ; https://theconversation.com/indian-pharma-is-being-squeezed-and-its-bad-news-for- drug-access-in-developing-countries- 149122?utm_source=twitter&utm_medium=bylinetwitterbutton

« India’s pharmaceutical industry is renowned for selling medicines to the world at reasonable prices, especially developing countries. This has helped Africa in its fight against HIV/Aids, for instance. Such endeavours have earned India a reputation as the “pharmacy of the world”.

« Now, the advantages that have enabled India to play this role are in danger of being eroded. Not only would this be bad news for India’s economy, it could make it harder for developing countries to access the medicines they need – threatening the UN Sustainable Development Goals in the process. »

… Once challenge is coming from China… …. Another challenge to India is wealthy countries protecting their pharma industries to ensure drug security. In August, President Trump issued an executive order that called for the elimination of drug imports, both as active ingredients and formulations. France and Germany look to be heading in a similar direction. … ;.. If the US order is strictly adhered to, it will heavily affect Indian pharma. More than half of India’s pharma sales are from exports, and by our calculations, the US has bought 37% of them over the past three years….”

Global Health Action - Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators K Perehudoff et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1699342

“Access to essential medicines for the world’s poor and vulnerable has made little progress since 2000, except for a few specific medicines such as antiretrovirals for HIV/AIDS. Human rights principles written into national law can create a supportive environment for universal access to medicines; however, systematic research and policy guidance on this topic is lacking. “ We aimed “to examine how international human rights law and WHO’s essential medicines policies are

embedded in national law for medicines affordability and financing, and interpreted and implemented in practice to promote universal access to essential medicines….”

Results: “Some, but not all, of the 12 principles from human rights law and WHO’s policy are embedded in national UHC law and medicines policies (part 1). Even the most rights-compliant legislation for access to medicines is subject to the unique and inconsistent interpretation of domestic courts, which may be inconsistent with the right to health in international law (part 2). Many national health systems for which data were available still fail to meet the official targets for eight indicators of access to medicines (part 3).”

BMJ GH - Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries https://gh.bmj.com/content/5/11/e002640

The authors aimed “to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low- income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.”

Conclusion: “Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.”

Human resources for health

Human Resources for Health - The COVID-19 pandemic presents an opportunity to develop more sustainable health workforces I L Bourgeault et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960- 020-00529-0

“This commentary addresses the critically important role of health workers in their countries’ more immediate responses to COVID-19 outbreaks and provides policy recommendations for more sustainable health workforces. Paradoxically, pandemic response plans in country after country, often fail to explicitly address health workforce requirements and considerations. We recommend that policy and decision-makers at the facility, regional and country-levels need to: integrate explicit health workforce requirements in pandemic response plans, appropriate to its differentiated levels of care, for the short, medium and longer term; ensure safe working conditions with personal protective equipment (PPE) for all deployed health workers including sufficient training to ensure high hygienic and safety standards; recognise the importance of protecting and promoting the psychological health and safety of all health professionals, with a special focus on workers at the point of care; take an explicit gender and social equity lens, when addressing physical and psychological health and safety, recognising that the health workforce is largely made up of women, and that limited resources lead to priority setting and unequitable access to protection; take a whole of the health workforce approach—using the full skill sets of all health workers—across public health and clinical care roles—including those along the training

and retirement pipeline—and ensure adequate supervisory structures and operating procedures are in place to ensure inclusive care of high quality; react with solidarity to support regions and countries requiring more surge capacity, especially those with weak health systems and more severe HRH shortages; and acknowledge the need for transparent, flexible and situational leadership styles building on a different set of management skills.”

Miscellaneous

BMJ - The concept of “fatigue” in tackling covid-19 https://www.bmj.com/content/371/bmj.m4171

Interesting read. “Instead of using the concept of “fatigue” to understand a lack of adherence to covid-19 rules, we should focus on—and tackle—people’s capability, opportunity, and motivation, say Susan Michie, Robert West, and Nigel Harvey.”

Politico – Europe is living a coronavirus flashback, plus a backlash https://www.politico.eu/article/europe-is-living-a-coronavirus-flashback-plus-a-backlash/

“Social unrest grows as second pandemic wave crashes over Europe.”

See also the Guardian - Latest coronavirus lockdowns spark protests across Europe.

Research

IJHPM - Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review B Verboom et al; https://www.ijhpm.com/article_3946.html

“The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing ‘barriers and facilitators’ related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature.”

International Health - A disparity in the number of studies related to COVID-19 and SARS-CoV-2 between low- and middle-income countries and high-income countries T Usuzaki et al ; https://academic.oup.com/inthealth/advance- article/doi/10.1093/inthealth/ihaa088/5948141?searchresult=1

Conclusion: “There was a disparity in the number of articles related to COVID-19 and SARS-CoV-2 between LMICs and HICs.”