IHP News 605 : “The Year of the Variants”, WHO’S 148Th EB Meeting & US Staying in the Family

IHP news 605 : “The year of the variants”, WHO’s 148th EB meeting & US staying in the family

( 22 Jan 2021)

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,

We kick off today by introducing the new (2021) IHP correspondents. They come from all regions in the world, you can find their short bios here. Goran Zangana wrote the first contribution today (see the Featured articles section below) which he coauthored with Lana Koyi.

Over to the global health news then. On Monday, Adam Kamradt-Scott tweeted, correctly, that #EB148 was going to be one of the most important WHO Board meetings ever. Indeed, the stakes are high at the start of a year that is already being labelled as ‘the year of the variants’ (or 'Attack of the mutants' if you want ☹). At a G2H2 webinar last Friday, Björn Kümmel (Deputy Head, Division Global Health Federal Ministry of Health Berlin) pointed out that Covid-19 will probably reorder the global health architecture more than the SDGs, in a way (even if ‘zoom multilateralism’ doesn’t really work, for now). Others talk of a possible “Chernobyl moment” for WHO reform. (don’t know what the ‘real’ Chernobyl protesters who used to pop up in the Geneva surroundings of WHO headquarters think of this metaphor).

With the World Economic Forum coming up, fortunately “re-setted” to just a virtual event this winter, it feels more than appropriate to flag an upcoming webinar (26 Jan) on fighting the “Davos capture of global governance”. The uncomfortably “cosy” relationship between the UN and WEF is well known by now, and so it’s probably also not a coincidence that just this week, two great papers were published, both criticizing the “Multistakeholder governance narrative”, pretty much the dominant 21st century narrative so far - by Priti Patnaik and Judith Richter, respectively.

Back in “multistakeholder” Geneva, both Dr. Tedros & the Independent Panel didn’t exactly mince words this week, in their opening EB address and interim progress report respectively. Two quotes perhaps. Tedros: “….it’s right for countries to prioritize their own health workers and older people first, but not right that younger, healthier adults in rich countries are vaccinated before health workers, older people in poorer countries.” And a quote from the Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board: “We cannot allow a principle to be established that it is acceptable for high-income countries to be able to vaccinate 100% of their populations while poorer countries must make do with only 20% coverage.”

You find much more on the EB meeting in this newsletter issue (and we also have a second Feature article on “the Return of Oral Health”). As HPW rightly noted, lots of global health issues (and governance reforms) are being looked at now through a "Covid lens". Unfortunately, sometimes that lens can be a bit biased (see WHO reform discussions that seem to focus largely on Global Health Security, in spite of all the talk of a ‘syndemic’…).

Finally, as you probably noticed, the Biden Administration has started now, and in spite of the difficult circumstances, domestically and in the world, hopes are running high (for global health, planetary health, and what not). If only because the new US president seems to consistently appeal to the best in human nature and beings (unlike his predecessor). And like dr. Tedros in Geneva, we are happy “the US is staying in the family”, after all. Even if it’s often a dysfunctional one .

PS: On another note, we hope you don’t suffer yet from ‘vaccine envy’!

Enjoy your reading.

Kristof Decoster

Featured Articles

Private-public exploitation? The role of the private sector in Kurdistan in the COVID-19 pandemic

Goran Zangana ( PhD Associate Research Fellow , Middle East Research Institute) & Lana Qasim Koyi (Master of Public Health / Curtin University )

As of January 19th, the Kurdistan Regional Government (KRG) has documented more than 100,000 cases and 3,445 deaths from COVID-19. That is bad enough for the Kurdistan Region of Iraq (KRI) which has about 6 million inhabitants. Unfortunately, that’s not all, however. While the COVID-19 “natural disaster” has been unfolding in the region, a human-made one happened in parallel. The private health sector seized on the pandemic as a great opportunity to amass wealth in an unregulated and out-of-control market. KRG authorities either pretended unawareness or, worse, were sometimes involved in exploiting the pandemic for profit-making private business. In this short piece, we present examples of such exploitation in three COVID-19-related areas: prevention, investigation and treatment.

But first a word or two on the private sector in Kurdistan. It is difficult to assess the size of the private sector in KRI due to the lack of accurate information. However, the sector consists of an extensive network of private doctors’ clinics, laboratories and pharmacies. Doctors usually engage in dual practice both in the private and the public sector.

What has a substantial part of the private sector been up to, in their Covid-19 pandemic “response”?

As for prevention, private retailers increased the prices of masks, gloves and other essential equipment for prevention early on in the pandemic. Several herbal medicines were promoted as effective prophylaxis against COVID-19, and their prices went up. Private pharmacies also increased the prices of Vitamins, particularly Vitamin D, Vitamin C and Zinc. These substances are promoted as preventative medicines against COVID-19, and their prices escalated.

On the investigation/examination front (i.e. tests & diagnostics), the private sector in KRI also made significant profits over the last year. In a classic example of supply-induced demand, patients with even mild symptoms of COVID-19 were referred for CT scan tests of their lungs. Private hospitals didn’t hesitate much to increase the prices of doing such tests. Meanwhile, and rather mysteriously, the few CT scan machines available in the public sector suddenly “stopped” working. To make matters worse for patients, some hospitals require patients to have CT scans before admitting them in their COVID-19 units. But the exploitation was not only limited to radiological testing, also other COVID-19- related investigations were affected. All of a sudden, tests such as CRP, D dimer and Ferritin (all nonspecific markers of inflammation) became the ‘gold standard’ for almost every patient with suspected COVID-19. And guess what, the prices of those non-specific tests also went up. Some private laboratories intentionally abused the similarity between CRP and PCR to sell the former as diagnostics for COVID-19.

Finally, treatment. The most extensive exploitation of the COVID-19 outbreak arguably happened in this area (of medicines and presumed therapeutics). The prices of many medicines promoted as ‘treatment’ for COVID-19 went up substantially, in some cases even skyrocketing. These included medicines with no evidence for their effectiveness (such as Hydroxychloroquine, Azithromycin, Famotidine, Ivermectin) and ones where the evidence base is ambiguous or still in RCTs (like Tocilizumab, Favipiravir and Remdesivir). They all became part of an informal protocol that the majority of doctors treating COVID-19 prescribed. As for the prices, well, you know the pattern by now. For example, according to receipts from a private pharmacy, a single vial of Tocilizumab was sold for $3000. Awamedeica, a local pharmaceutical company, sold one box (containing 40 tablets) of Favipiravir for $200 to the Ministry of Health. And unsurprisingly, oxygen cylinders became another “commodity” with escalating prices for those who decided to treat their family members in their own homes.

In short, in an unregulated private health market like the one in KRI, the way in which some actors are ‘tackling’ the pandemic can be even worse than the natural disaster itself, certainly financially. The exploitation of the COVID-19 pandemic by the private market (in the KRI and many other LMIC settings with similar problems) highlights the need for strengthening the health system, legal frameworks and governance. It also underscores the need for the involvement of international organisations such as WHO in coordinating national efforts to help improve effective governance in the health sector, including regulation of the private health market towards Universal Health Coverage.

The return of oral health to global health - Reflections on the 148th WHO Executive Board meeting

Habib Benzian is research professor and co-director of the WHO Collaborating Center Quality Improvement & Evidence-based Dentistry at the College of Dentistry, New York University, USA. ([email protected])

Without doubt, this was a remarkable week for global oral health. During the 148th meeting of the WHO Executive Board, oral health was among the items discussed, initiated by a group of member states led by Sri Lanka and others. The last time the WHO governing bodies adopted a resolution regarding oral health was in 2007, which is ancient in a fast-paced global health context. Why should oral health be of interest at all for global health?

The question is easily answered – oral diseases are among the most common of mankind, with more than 3.5 billion people suffering from dental caries, severe periodontal disease, tooth loss and oral cancer. Inequalities in oral health are global, with people in low- and middle-income countries carrying the biggest share. Billions of people have no sustained and affordable access to even basic oral healthcare. Less than 20% of humanity (largely from high-income countries) benefit from almost 80% of direct oral healthcare expenditures, amounting to more than $350 billion USD (2015). The limitations of dental services or even loss of insurance coverage during the COVID-19 pandemic highlighted the daily challenges that millions are facing when seeking dental care in times without a pandemic.

Since the late 1990ies, oral health as a programmatic area barely survived changing WHO priorities and funding cuts. Reduced to a one-person unit and sidelined in the organizational structure, limited visibility and internal leverage led to rather faltering and half-hearted reactions to well-intended integration efforts with the nascent momentum for non-communicable diseases. The small global oral health community was unsuccessful in advocating for inclusion or alignment with the SDGs, thereby limiting traction in global health. Luckily, oral health was maintained within the organigram of WHO and has recently become part of the NCD department.

The UHC agenda provides a new opportunity for global oral health. The WHO Director-General’s report with the lengthy title “Achieving better oral health as part of the universal health coverage and noncommunicable disease agendas towards 2030” sets clear directions and does not shy away from listing massive challenges: lack of political priority, inadequate technical oral health capacity within governments, dominance of expensive curative treatment models despite largely preventable diseases, or data limitations for planning equitable services. Additional barriers include the dominating private, dentist-centred delivery mode of oral healthcare, and an oftentimes lackadaisical engagement to tackle the sugar industry and commercial determinants of oral health.

WHO and Member States have now been tasked to develop a long-overdue global strategy, action plan and monitoring framework for oral health, aligned with UHC and NCD agendas. The entire global (oral) health community should promote strong stakeholder engagement and ensure adequate financial resources from governments and development partners. An ideal long-term policy outcome would be the inclusion of oral health as a sixth major disease area of the NCD family and full integration in UHC programming.

Other initiatives, such as the Lancet Commission on Oral Health established last year, will hopefully muster the courage for candid problem analysis and provide tangible recommendations for innovative policy and action; inspired by a recent Lancet paper that called for “ending the neglect of global oral health – time for radical action”. The FDI World Dental Federation’s timely release of its Vision 2030 – Delivering Optimal Oral Health for All report is a step in the right direction of profound reform. Later this year, the U.S. Surgeon-General will publish a new report on oral health in America and the WHO is preparing a Global Oral Health Report – 2021 promises to be the year when oral health returns to the global health arena. After all, there is no global health without oral health.

Highlights of the week

WHO 148th EB meeting (18-26 Jan): Main coverage https://www.who.int/about/governance/executive-board/executive-board-148th-session

Key documents: WHO

Integrated PHM Commentary (on all items): People’s Health Movement Background and commentary on items before EB 148.

As there’s plenty of news from the EB meeting, we split things up.

In this first section we’ll focus on the coverage (mostly via HPW). In a second section related to the EB meeting (below), we cover some reports, analyses etc. (PS: for the diehards, you also find some more EB related stuff & analysis in the separate (extra) GHG section )

Reuters - Vaccine nationalism puts world on brink of 'catastrophic moral failure': WHO chief Reuters;

Coverage of Tedros’ opening speech at the EB meeting.

“The world is on the brink of “catastrophic moral failure” in sharing COVID-19 vaccines, the head of the World Health Organization said on Monday, urging countries and manufacturers to spread doses more fairly around the world.”

• Do read his opening remarks in full: WHO Director-General's opening remarks at 148th session of the Executive Board

Themes were the world’s “me-first approach” (on Covid vaccines). Tedros also announced the theme for World Health Day this year - health inequality. And he announced the “One Health High-Level Expert Council.”

A few excerpts from this hard-hitting speech:

“It’s right that all governments want to prioritize vaccinating their own health workers and older people first. But it’s not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries. … More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25. … … I need to be blunt: the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries. …. … Even as they speak the language of equitable

access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. …. The situation is compounded by the fact that most manufacturers have prioritized regulatory approval in rich countries where the profits are highest, rather than submitting full dossiers to WHO. This could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption….”

“My challenge to all Member States is to ensure that by the time World Health Day arrives on the 7th of April, COVID-19 vaccines are being administered in every country, as a symbol of hope for overcoming both the pandemic and the inequalities that lie at the root of so many global health challenges. “

“…Together with our partners in the tripartite and UN Environment, we have now agreed to establish a One Health High-Level Expert Council, supported by a joint secretariat. … “ “..in recognition of 2021 as the International Year of Health and Care Workers, we have also decided to make 2021 the Year of the Workforce, to focus on making WHO an organization that attracts the best people, gives them the best environment – inclusive and diverse – and enables and empowers them to do and be their best.

• Via UN News - Change the rules of the game “He pressed for action in three areas to “change the rules of the game”, starting with an appeal for transparency in any bilateral contracts between countries and COVAX, including on volumes, pricing and delivery dates. “We call on these countries to give much greater priority to COVAX’s place in the queue, and to share their own doses with COVAX, especially once they have vaccinated their own health workers and older populations, so that other countries can do the same”, he said. Tedros also called for vaccine producers to provide WHO with full data for regulatory review in real time, to accelerate approvals, and he urged countries to only use vaccines that have met international safety standards, and to accelerate readiness for their deployment….”

HPW - Bilateral Deals are Complicating COVID-19 Vaccine Delivery, Independent Panel Slams Pandemic Response and US Insists on China Expert Team Getting Full Access to Research https://healthpolicy-watch.news/bilateral-deals-covid-vaccine-delivery/

Coverage of the opening day of the EB meeting. “Escalating bilateral deals” between pharmaceutical companies and World Health Organization (WHO) member states have complicated the global body’s vaccine delivery platform, the COVAX Facility, a number of top WHO officials told the WHO’s Executive Board yesterday in the opening day of the EB’s 148th session, which focused largely on the pandemic….

In this coverage, also info on the Independent panel’s interim report (see below) & “China Appeals for Origin Research Not to Be Politicized.” (duh)

On the interim report of the Independent Panel, see also The Guardian

Excerpts: “A brand new report released this week by the Independent Panel for Pandemic Preparedness and Response, however, has made a number of scathing observations about the

global handling of the pandemic, including that the response has “deepened inequalities”, the global pandemic alert system “is not fit for purpose”, and that WHO has been “underpowered to do the job expected of it”. …. An independent panel has said Chinese officials could have applied public health measures more forcefully a year ago to curb Covid-19, and criticised the World Health Organization (WHO) for delays in declaring an international emergency, as the Trump and Biden camps clashed over future travel restrictions. … … …Specifically, it questioned why the WHO’s emergency committee did not meet until the third week of January and did not declare an international emergency until its second meeting, on 30 January. … “Although the term pandemic is neither used nor defined in the international health regulations (2005), its use does serve to focus attention on the gravity of a health event. It was not until 11 March that WHO used the term,” the report said. …. … The panel called for a “global reset” and said it would make recommendations in a final report to health ministers from the WHO’s 194 member states in May….”

HPW - …A Look At What Else Is In Store https://healthpolicy-watch.news/who-director-general-rebukes-countries-for-vaccine-hoarding-at- opening-of-who-executive-board/

Must-read (!!!) in-depth overview of the main agenda of this EB meeting.

See: “Executive Board Packed Agenda Addresses COVID Directly and Indirectly”:

“Much of the ten-day governing board meeting will focus on debates and a flurry of initiatives that are a product of the COVID-19 pandemic’s shockwaves. Beyond the optics and the politics, the quality of debate may be a test case for whether the 34-member EB, in its current alignment representing all six WHO member state regions equally, can regain its past lustre as a technically- focused board – or also requires more serious reform in the wake of shortcomings highlighted by the pandemic – as some critics have suggested. Items on the table will include, an exhaustive review of WHO’s emergency response operations in general, and its COVID-19 response more specifically. There is also an initiative by some 46 member states for more far-reaching reforms in WHO’s emergency powers and response capacity – looking toward a formal resolution to be submitted for approval at the May World Health Assembly. … … The EB will also consider a WHO request for a nearly 20% increase in its operating budget to fill out the many performance gaps that have been uncovered in the course of the pandemic; a new framework to examine how to put WHO’s shaky finances on a more sustainable footing; and foster a more efficient Organization through a series of WHO administrative reforms. … Along with that there are a host of other core WHO activities, initiatives and issues, now being re-examined through a COVID “lens”. These range from topics like patient safety and medicines access – to non-communicable diseases and mental health. …”

And a few more excerpts from this HPW analysis:

• IFPMA – Concerns Over Speed of Access “Potentially Misleading” (hahaha)

“Meanwhile, concerns over the lack of speedy access to coronavirus vaccines to low- and middle- income countries (LMICs) “are potentially misleading and might hinder rather than help this unprecedented effort of global collaboration and solidarity,” said the head of the International

Federation of Pharmaceutical Manufacturers and Associations (IFPMA), Thomas Cueni, in a lengthy response to the WHO DG’s remarks… … “While there is no room for complacency, it is important to note that this is the first global-health emergency in which new vaccines are being rolled out to LMICs at about the same time as in richer ones,” said Cueni – drawing a sharp contrast with other pandemics, where it took years for vital health products to reach poor countries.”

• “In another COVID-inspired move, some EB member states also are reportedly preparing a WHA resolution that aims to strengthen local production of medicines, vaccines and other health products, according to a Zero draft of the proposed resolution, obtained by Health Policy Watch. This has surfaced as an issue in light of the severe supply chain interruptions seen over the past year as a result of the pandemic – which left countries rich and poor facing dire shortages of basic medicines – from antimalarials in some parts of Africa to certain common antibiotics in Europe. …”

• “… A proposal to sharply increase the WHO budget for 2022-23 by nearly 20% or US$447 million is also on the table, raising the two-year budget level to US$ 4.478 billion. A big chunk of the added funds would go to strengthening WHO capacity at country level. WHO also promises to use the funds to integrate of “lessons learned” from COVID into other WHO initiatives; and “mainstream” WHO polio eradication teams – which have often serviced as the “backbone” of WHO vaccine support overall for developing countries – into other functions…”

Devex - Where is the political will to tackle the next health crisis? https://www.devex.com/news/where-is-the-political-will-to-tackle-the-next-health-crisis-98941

“As countries debate over what needs to change post-pandemic, Germany says the challenge is whether member states of the World Health Organization are ready to make the needed changes to avoid another global health crisis like COVID-19. “Colleagues, we do not have a lack of recommendations to make the world less vulnerable to global health crises. We do have a lack of common political will among 194 member states to learn from past mistakes and to implement these recommendations,” said Björn Kümmel, deputy head of the global health division in Germany’s health ministry on Tuesday’s session of the WHO executive board….”

See also M Pai ’s analysis, in this Forbes op-ed : “many reports, no takers… “

Quote: “…Many reports and commissions have looked at global health security and pandemic response. “There have been 12 panels and 14 recommendations on pandemic preparedness. We are not short on recommendations. We are short on political will to act upon recommendations,” said Joanne Liu….”

Reuters - WHO chief welcomes EU proposal for pandemic preparedness treaty https://www.reuters.com/article/uk-health-coronavirus-who-treaty/who-chief-welcomes-eu- council-proposal-for-pandemic-preparedness-treaty-idUSKBN29P1CI

“The head of the World Health Organization (WHO) on Wednesday welcomed an EU proposal to negotiate a global treaty on pandemic preparedness as a way to guarantee countries’ political commitment to fighting future disease outbreaks. The endorsement by Tedros Adhanom

Ghebreyesus came at the end of a three-day debate at the WHO’s executive board, at which the agency’s initial response to the coronavirus outbreak came under criticism….”

See also HPW - WHO Proposes New “Pandemic Treaty” To Tighten Global Monitoring and Enforcement of Disease Outbreak Response

“… if member states quickly set up a working group to push the treaty forward, they could present a draft resolution at the next World Health Assembly this May and thus prop up the Organization at an urgent time, said Dr Tedros. He warned, however, that without the “full cooperation” of member states, “good ideas can’t happen”….”

HPW - WHO’s Funding Must be Diversified To Prevent Repeat Of US Withdrawal, Say Member States https://healthpolicy-watch.news/whos-funding-diversified-repeat-us-withdrawal/

“Reform and diversification of the World Health Organization’s (WHO) funding model is vital if the global health body is to avoid repeating the consequences of the US’s withdrawal in April 2020, member states have said during WHO’s Executive Board meetings. …. … The US’ decision to rejoin the body, and pay up on its contributions, as Biden’s newly appointed Chief Medical Advisor Anthony Fauci promised to do on Thursday is clearly a positive step towards restabilizing WHO’s finances, EB members said. But that doesn’t solve the long-term problems of the Organization, which include an overreliance on a few key member states, as well as on voluntary contributions, which may vary year to year, instead of fixed member state assessments. Other budget challenges include the need to improve staffing and resources at country level – which are at the core of WHO’s work with governments and Ministries of Health.”

And some Links:

• HPW - Lacking Resources & Authority, WHO Was Too Slow To Act Against COVID-19 – Says Independent Review Panel

• HPW - Swiss-Based Biohub To Share Samples of Infectious Pathogens

WHO EB meeting: Reports, papers & analysis

PHM (Paper) - Covid19 Vaccine Governance: Sidelining Multilateralism P Patnaik; https://phmovement.org/wp-content/uploads/2021/01/Final_PHM_COVID-AND- GOVERNANCE-compressed.pdf

Hard-hitting analysis (to be read together with the next paper by J Richter). “‘Covid19 Vaccine Governance: Sidelining Multilateralism’ highlights the shortcomings of the multi-stakeholder approach to global governance of covid19 medical products, and vaccines in particular, in ensuring equitable access across countries.”

Paper released as part of PHM’s Democratising Global Health Governance initiative. Reflecting on the efforts in the past year and the need to strengthen multilateralism

Paper - Defending and Reclaiming WHO’s Capacity to Fulfil its Mandate : Suggestions from a Perspective of Language and Power Judith Richter; http://www.peah.it/2021/01/9249/

Another one of our favourite reads of the week. “… In this short text, I raise a number of possibilities, relating to language, propaganda even, and power, which could contribute to reclaiming WHO’s capacity to unequivocally work for peoples’ health….

Excerpt: “…. But governments have often hindered efforts undertaken in the interests of their people due to the rise of neoliberal ideology. Harmful changes resulting from the neoliberal restructuring of WHO and the international health arena include: 1) a gradual narrowing and re-definition of the role of WHO in the international public health arena – more or less reducing WHO’s role to that of a broker of public-private partnerships and part of a global ‘multi-stakeholder governance’ system. 2) the weaving of opaque webs of influence between mega-philanthropies, transnational corporations, WHO (and other UN agencies), government institutions, academics, and a number of public-interest-Non-State actors (PINGOs and civil society organizations and networks) which influence our health policies more than we think; 3)the framing of a neoliberal multistakeholder/partnership narrative, including the redefinition of key-political and legal terms, in a way that prevents open and informed discussions and decisions and undermines WHO’s mandate to safeguard international public interests. 4) the rise of a culture of secrecy and censorship which has gradually seeped into all spheres. …”

WHO EB paper on sustainable financing https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_26-en.pdf

Report by the DG well worth scanning. For the coverage of on the ‘sustainable financing’ debate, see elsewhere.

Independent Panel for Pandemic Preparedness and Response for the WHO Executive Board- 2nd progress report https://live-the-independent-panel.pantheonsite.io/wp-content/uploads/2021/01/Independent- Panel_Second-Report-on-Progress_Final-15-Jan-2021.pdf

This report got global coverage for obvious reasons. So do check out the key messages for yourself.

And some Links:

• On the IHR - Interim Progress Report Of The Review Committee On The Functioning Of The International Health Regulations (2005) During The COVID-19 Response

Coverage via Cidrap News: “A WHO committee, which routinely reviews how the International Health Regulations (IHRs) work during public health emergencies, presented its findings yesterday to the group's executive board. The panel said some areas need improvement, but major changes aren't needed.”

Biden Administration kicks off

As mentioned in the intro, hopes are high - at least among the more or less sane part of the world population : )

Back in WHO, joining Covax, re-joining the Paris agreement, revoking the Global Gag Rule, reviving multilateralism (hopefully on a more socially progressive/taxation footing)… you name it.

Some reads & links:

HPW - Just As President Joe Biden Is Inaugurated – United States Reconciliation With WHO Begins https://healthpolicy-watch.news/just-as-president-joe-biden-is-inaugurated-united-states- reconciliation-with-who-begins/

“Right after the pomp and ceremony of the heavily guarded inauguration of new US President Joe Biden and Vice-President Kamala Harris is over, a deadly serious new war on COVID-19 is due to get underway – including rejoining the World Health Organization as part of the new Administration’s seven point COVID pandemic plan. That agenda will also include buying into the WHO co- sponsored COVAX facility for fair global vaccine distribution – a move that is sure to be a welcome shot in the arm of the initiative … … Thursday’s WHO Executive Board [will] be the stage for the first scene of the US-WHO reconciliation, featuring an appearance by White House Covid Task Force head, Anthony Fauci, as head of the US delegation to WHO….”

See this seven point plan:

Including: “…Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, originally established by the Obama-Biden administration. Immediately restore our relationship with the World Health Organization, which — while not perfect — is essential to coordinating a global response during a pandemic. Re-launch and strengthen U.S. Agency for International Development’s pathogen-tracking program called PREDICT. Expand the number of CDC’s deployed disease detectives so we have eyes and ears on the ground, including rebuilding the office in Beijing….”

And via the Guardian – “US President Joe Biden has signed a letter retracting Donald Trump’s decision to leave the World Health Organization, which would have been effective in July this year.”

WP - Biden to re-engage with World Health Organization, will join global vaccine effort https://www.washingtonpost.com/world/biden-administration-who-covax/2021/01/20/3ddc25ce- 5a8c-11eb-aaad-93988621dd28_story.html

The Washington Post has the overview on the US re-engaging with WHO and joining Covax (as well as broader support for ACT-A).

Excerpts:

“… By moving quickly on both issues, the incoming administration signaled a return to a more cooperative approach to global health amid a crisis that has already claimed more than 2 million lives worldwide. … … There is no question that the WHO will continue to work with the United States, its largest donor, experts said. But it remains to be seen whether the appetite for U.S. leadership remains the same….” “… Because the United States had not technically left the organization, it will not “rejoin” this week but instead recommit. A key question going forward is whether re-engagement will come with additional financial backing, or other shows of support. … “

PS: Biden will release all funds owed to WHO.

Dr Fauci came with a more less similar message at the EB meeting, see Reuters - U.S. intends to join COVAX and remain WHO member - Fauci

For in-depth analysis of Fauci’s speech at the EB, see HPW - New US Chief Medical Advisor Anthony Fauci: Restores Relations With WHO & Reverses Global Health Course

Politico - Biden plans executive action blitz for Day One https://www.politico.com/news/2021/01/21/joe-biden-executive-action-blitz-day-one-460587

Excerpt on the revoking of the global gag rule:

“… Though several actions that Biden had previously promised to take are missing from the Day One blitz — including a reversal of Trump administration restrictions on funding for abortion providers and a 100-day moratorium on deportations — top officials in the incoming administration stressed to reporters on the Tuesday night call that additional announcements would soon follow. “There’s much more to come. This is just the beginning,” said incoming Press Secretary Jen Psaki, adding that Biden would take more actions “over the next 10 days.” Specifically, Psaki confirmed that Biden would move in the early days of the administration to reverse the Mexico City policy — a decades-old rule barring U.S. foreign aid from going to any organization that provides abortions, along with other health services that the Trump administration dramatically expanded — and revoke Trump’s ban on transgender people serving in the U.S. military….”

Biden will rescind the global gag rule on 28 January.

ODI - Beyond American exceptionalism: a global agenda for the Biden-Harris administration https://www.odi.org/blogs/17827-beyond-american-exceptionalism-global-agenda-biden- administration

Analysis by a number of ODI experts.

“All eyes are on the new Biden administration to reinvigorate international cooperation as part of the ‘global reset’. …. “ Based on a two-pronged strategy, “… we identify some immediate priorities for multilateral cooperation, geopolitics, peace and security to reset the US role on the world stage, while making note to the longer-term challenges….”

Link: IDS - Biden and Harris herald a welcome new dawn for global governance

Washington Post - Janet Yellen faces critical choice for global economy, poor nations rocked by coronavirus https://www.washingtonpost.com/us-policy/2021/01/19/yellen-global-economy/

Analysis of the IMF SDR (Special Drawing Rights) debate (and how Janet Yellen can play a decisive role in this).

Devex - Trump pushes foreign aid cuts as Biden pledges $11B https://www.devex.com/news/trump-pushes-foreign-aid-cuts-as-biden-pledges-11b-98926

As you can imagine, the orange dickhead tried to mess up things further right till inauguration day.

“With less than a week left in office, U.S. President Donald Trump’s administration took one final shot at the country’s foreign assistance programs by issuing a multibillion-dollar rescission package, which the administration’s own officials admit is unlikely to have much material effect. This is the third — and largest — attempt by the White House to pull back funding that Congress already appropriated. It arrived just as President-elect Joe Biden unveiled a COVID-19 spending plan that includes an additional $11 billion for international response efforts, highlighting the stark contrast between the outgoing and incoming administrations’ priorities. The funding will go toward international health and humanitarian response, mitigating the pandemic’s impacts on global health, food security, and gender-based violence, medical countermeasures for COVID-19, and building capacity to fight “COVID-19, its variants, and emerging biological threats,” the plan reads….”

See also Foreign Policy – Trump Mounts Last-Minute Attempt to Starve Funding for Foreign Aid, Global Vaccine Efforts

“... It is highly unlikely that the proposed cuts, amounting to $27.4 billion, including nearly $17 billion in funding for foreign aid and diplomatic programs, would be approved by Congress, according to multiple congressional sources. But the effort represents a parting shot by administration officials at diplomatic and foreign aid programs that run against the president’s “America first” agenda….”

And Devex – USAID draws criticism with last-minute policy rush

“President Donald Trump’s administration released three global development policies within two weeks of leaving office, raising questions about whether these efforts were politically motivated and if they were based on sufficient consultation inside and outside the United States Agency for International Development. In early January, USAID launched a gender policy, which faced criticism for failing to address LGBTQ rights, among other things. One week later, the agency launched a new economic growth policy, and the following day a revised policy on “counter-trafficking in persons.”…”

Friends of the Global Fight against AIDS, TB & malaria - Averting Disaster: New Urgency for U.S. Support of Global Fund in Next COVID-19 Supplemental https://www.theglobalfight.org/averting-disaster-urgency-us-support-global-fund-covid- supplemental/

Advocacy vs the incoming US administration.

“4 BILLION IS NEEDED AS SOON AS POSSIBLE FOR THE GLOBAL FUND’S COVID-19 RESPONSE as part of a broader investment to address COVID-19 in LMICs. …. The GF has run out of funds to assist countries in tackling Covid-19. In 2020, the Global Fund awarded nearly $1 billion to 106 countries to support their responses to COVID-19. … The Global Fund has exhausted its funding to support country responses to COVID-19 and protect AIDS, TB and malaria programming. … The Global Fund has estimated at least $28.5 billion is needed across international partners in the next 12 months to mitigate the impacts of COVID-19 (excluding vaccines)….”

Think Global Health – After the Inauguration: Global Health and the Biden Administration D Fidler; https://www.thinkglobalhealth.org/article/after-inauguration-global-health-and-biden- administration

David Fidler’s take on the global health challenges ahead for the US administration. Well worth a read, even if he’s still in the ‘ US leadership’ business …

“…In sum, U.S. foreign policy now confronts much worse global health problems, badly damaged mechanisms for international cooperation on such problems, and a geopolitical environment that will cause friction for efforts to improve global health governance. This daunting context does not counsel against the administration being bold; it does mean that the administration needs to be more strategic than the U.S. government was in the heyday of its leadership in global health during the Bush and Obama administrations….”

PS: Finally, a tweet by Roopa Dhatt (re Biden administration Covid plan (section 7: global part of the plan): “Interesting proposal on building a sustainable health security architecture, including a NEW @UN position in the #UNSG office.”

Other Global Health Governance news

Geneva Health Files – The Politics of Pathogens-Sharing

P Patnaik; Geneva Health Files

Analysis from last week, ahead of the EB. “… discussions on how pathogens should be shared continue to evolve at World Health Organization. This is fundamental for the access to vaccines, diagnostics and therapeutics during a disease outbreak, and for preparedness. Like its ubiquitous impact on almost every aspect of health policy, COVID-19 will inevitably change the discourse on the sharing of pathogens. Stakeholders hope that the change will be for the better, including by addressing the crucial matter on benefits for those sharing pathogens and biological materials. … … This initial story looks at the state of play in these discussions, including a document that [will] be considered at the Executive Board meeting at WHO next week….”

Guardian - UK plans early G7 virtual meeting and presses ahead with switch to D10 https://www.theguardian.com/world/2021/jan/15/uk-plans-early-g7-virtual-meeting-and-presses- ahead-with-switch-to-d10

“Boris Johnson is planning to host a virtual G7 summit of world leaders within weeks of Joe Biden becoming US president in an attempt to set an ambitious agenda covering climate change, a worldwide vaccination programme, future pandemic preparedness and relations with China.

He is also pressing ahead with plans to convert the face-to-face annual summit of the G7 in June into a D10 of leading democracies. It is due to be the first in-person meeting of world leaders for nearly two years, after the US-hosted G7 was cancelled and the Saudi-hosted G20 meeting moved online last year….”

See also UK Gov: “The United Kingdom will host the G7 summit in Cornwall on June 11-13, 2021, with the leaders of Australia, India, Korea, who will discuss how to #buildbackbetter, promote prosperity, protect biodiversity and tackle climate change, among other issues. “

Coming up – (virtual) WEF forum

Guardian - Fighting climate crisis made harder by Covid-19 inequality, says WEF https://www.theguardian.com/business/2021/jan/19/climate-crisis-covid-19-inequality-wef

“Tackling the existential risk posed by the climate crisis will be made harder by the growing gap between rich and poor triggered by the Covid-19 pandemic, the World Economic Forum has said.

… Despite the loss of almost 2 million lives to Covid-19, the WEF’s global risks report found that environmental issues were considered to pose the biggest danger in the coming years, both in terms of impact and likelihood. …. The top five risks in terms of impact were infectious diseases, climate action failure, weapons of mass destruction, biodiversity loss and natural resource crises. … “

“The global risks survey is normally released a week before the annual meeting of the WEF but the pandemic has meant only a virtual event has been possible. A physical gathering is planned for Singapore in May.”

Reuters -Epidemics lead world's biggest short-term risks: World Economic Forum Reuters;

“Infectious diseases and livelihood crises led the rankings of risks expected to pose a critical threat to the world in the next two years, according to a survey of more than 650 World Economic Forum (WEF) members from business, government and academia….”

Coming up: (virtual) WEF Davos (25-29 January) Sessions: https://www.weforum.org/events/the-davos-agenda-2021

Including ‘Healthy Futures’ https://www.weforum.org/events/the-davos-agenda- 2021/themes/healthy-futures

Covid key news

With focus on other WHO messages (in addition to the ones already abovementioned in the EB section ), global trends, …

Global update via Cidrap News (20 Jan): “The global COVID-19 total over the past day topped 96 million cases and is at 96,640,644 with 2,068,921 deaths, according to the Johns Hopkins online dashboard.”

UN News - As COVID deaths pass two million worldwide, Guterres warns against self-defeating ‘vaccinationalism' https://news.un.org/en/story/2021/01/1082272

Sad milestone, reached last week on Friday.

Cidrap News - Global COVID-19 deaths climb; hot spot locations shift https://www.cidrap.umn.edu/news-perspective/2021/01/global-covid-19-deaths-climb-hot-spot- locations-shift

Global update as of 20 Jan. “Global COVID-19 cases declined a bit last week, but the number of deaths rose to record levels, as hot spots within world regions shift and more countries report the detection of variant SARS-CoV-2 strains, the World Health Organization (WHO) said yesterday in its regular weekly update. Cases were down 6%, partly led by declines in parts of Europe and the Americas. Deaths, however, increased by 9%, with the world reporting a record weekly high of

93,000, the WHO said, noting that hospitalizations and deaths are a lagging indicator. … Illness levels rose in the Eastern Mediterranean, African, and Western Pacific regions. In the Middle East, countries reporting recent large spikes include Lebanon and the United Arab Emirates. In Africa, cases fell in South Africa, the continent's main hot spot, but were up sharply in Nigeria and Zambia. And in the WHO's Western Pacific region, Japan reported the most cases, but Malaysia and the Philippines reported steep rises. … … In another example of shifts among regions, cases in the Americas were down slightly, by 2%, mainly due to a decline in the United States, but Brazil and Colombia both registered double-digit rises….”

Cidrap News - Hospitals in Americas, Europe under growing strain of COVID-19 https://www.cidrap.umn.edu/news-perspective/2021/01/hospitals-americas-europe-under- growing-strain-covid-19

(19 Jan) “…The world added more than 2 million new COVID-19 cases in the past 3 days, with health systems coming under pressure in the Americas and in more European countries …”

“Worsening situation in Americas region: Over the past week, the World Health Organization (WHO) Americas region reported 2.5 million cases, making up more than half of the global total, Carissa Etienne, MBBS, MSc, who directs the Pan American Health Organization (PAHO), said today at a briefing. …”

FT – Coronavirus second wave threatens to swamp Africa https://www.ft.com/content/3d000093-87a3-48f3-8bb5-4ad9a8316aa1

“Mildly hit the first time round, the continent’s death rate has now overtaken the global average.”

“…Authorities in Nigeria, Senegal, Sudan, South Africa and the Democratic Republic of Congo, as well as international organisations, say hospital capacity and oxygen supplies are running out as the continent-wide death rate this month surpassed the global average for the first time. … … Death rates in 20 African countries are now higher than the global average of 2.2 per cent, with fatalities rising by more than 30 per cent in the past month in Nigeria, Egypt and South Africa….”

See also Devex on the rising concerns in Africa

And Reuters (21 Jan) – Africa's COVID-19 case fatality rate surpasses global level

With the views from J Nkengasong & M Moeti yesterday (Thursday). They seem to differ a bit in terms of their worry & assessment of the current trend in Africa.

Reuters - WHO says expects global COVID deaths to top 100,000 a week Reuters;

“Global deaths from COVID-19 are expected to top 100,000 per week “very soon”, from more than 93,000 reported last week, the World Health Organization’s top emergency expert Mike Ryan said on Monday. In an epidemiological update provided to the WHO’s executive board meeting, he added

that the Americas region accounted for about 47 percent of current deaths. In Europe, cases and deaths are stabilising but at a high level, he said….”

See also the Telegraph - World’s deadliest day as more than 17,000 people die from Covid

(IHME) “Model predicts that death rate will not start levelling off until the beginning of February.”

COVID-19 committee stresses need for equitable vaccine access, more data sharing https://news.un.org/en/story/2021/01/1082182

On the meeting of the Emergency Committee on Covid-19, last week on Friday: “As COVID-19 cases spike in parts of Europe, Africa and the Americas, and new variants of the virus emerge in some countries, the head of the World Health Organization (WHO) on Friday called for greater global collaboration in ending the pandemic. “

“WHO chief Tedros Adhanom Ghebreyesus reported on the outcomes of the latest meeting of the Emergency Committee on COVID-19, held online the previous day. Experts issued a statement calling for upgrading national capacity for genome sequencing, and greater data sharing, in efforts to monitor and respond to changes in the virus. Tedros told journalists he was pleased they also emphasized that vaccines must be rolled out equitably. …” See also WHO - Statement on the sixth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

“The COVID-19 pandemic continues to constitute a Public Health Emergency of International Concern (PHEIC), according to the WHO Emergency Committee (EC) on COVID-19. The EC met virtually yesterday (14 January) at the request of WHO Director-General Dr Tedros Adhanom Ghebreyesus to review the emerging variants of SARS-CoV-2, the virus that causes COVID-19, and to consider the potential use of vaccination and testing certificates for international travel. … On variants, the EC called for a global expansion of genomic sequencing and sharing of data, along with greater scientific collaboration to address critical unknowns. … The committee urged WHO to develop a standardized system for naming new variants that avoids geographical markers, an area WHO has already begun work on. … On vaccines, the committee underlined the need for equitable access through the COVAX Facility as well as technology transfer to increase global production capacities. … The committee strongly encouraged vaccine manufacturers to rapidly provide safety and efficacy data to WHO for emergency use listing. The lack of such data is a barrier to ensuring the timely and equitable supply of vaccines at the global level.”

WHO - Scientists tackle vaccine safety, efficacy and access at global R&D forum

COVID-19 Cases Spike In Brazil As New Variant Spreads, While WHO Says No Need For ‘Vaccine Passport’ Yet https://healthpolicy-watch.news/brazil-variant-spike-who-vaccine-passport/

Coverage of WHO’s press conference last week on Friday.

Excerpt: “Several WHO officials at the press conference attempted to lower concerns about the variants, highlighting the greater role played by the increase in social mixing, break down in compliance with public health measures, and health systems that have already been weakened by previous waves….”

“ … Meanwhile, WHO is continuing with its efforts to set up a monitoring framework to evaluate the mutations of interest and the variants of concern to better understand what the mutations and variants mean and how they impact the behavior of the virus. …”

Link: Reuters - WHO stops short of advising proof of COVID-19 shots for travel

Guardian - India begins world's biggest Covid vaccination programme https://www.theguardian.com/world/2021/jan/16/india-begins-worlds-biggest-covid-vaccination- programme

“India has begun one of the world’s biggest Covid-19 vaccination programmes, the first major developing country to roll out the vaccine, marking the beginning of an effort to immunise more than 1.3 billion people. … The Indian health ministry has drawn up plans for 300 million people, almost the equivalent to the population of the US, to be vaccinated by August. Frontline healthcare workers, police and the army have been given priority, with those over 50 and with co-morbidity conditions to follow, all free of cost. … … Two vaccines have been given emergency approval for India’s immunisation programme; the Oxford/AstraZeneca vaccine, known in India as Covishield, and a domestic product, Covaxin, developed by the pharmaceutical company Bharat Biotech. The approval of Bharat Biotech’s vaccine, which was co-sponsored by an Indian government body, has proved controversial. Covaxin is still in phase 3 human trials and a full dataset on its efficacy has not been released or peer-reviewed, unlike the Oxford/AstraZeneca vaccine or the Pfizer and Moderna vaccines which have been authorised in the UK and the US….”

Link: UN News - UN agencies supporting mammoth India COVID-19 vaccine rollout WHO & UNICEF, among others.

Forbes - Vaccine Vacations - Getting A Private Covid-19 Shot Abroad https://www.forbes.com/sites/michelerobson/2021/01/17/vaccine-vaccationsgetting-a-private- covid-shot-abroad/?sh=3c7c4d4e76be

Shocking, but not unexpected. Coverage in this piece of one (UK) company's move to start offering "vaccination vacations" to an elite group of the super-rich in the U.K. In Dubai (UAE), among others.

See also Vice.

Covid vaccines

Mostly focusing on state of affairs re Covax first, but then also on a number of other vaccine policy & diplomacy related initiatives.

WHO presentation to EB (18 Jan) - Update on COVAX state of affairs Accelerating access to vaccines through the ACT Accelerator and COVAX

Bruce Aylward presented this to the WHO EB meeting. Ppt of 9 slides (and must-read!!!)

HPW - COVAX Is Ready To Deliver Vaccines, WHO Officials Tell WHO Executive Board – But Regulatory Approvals Still Lagging For Key COVAX Products https://healthpolicy-watch.news/covax-deliver-vaccines-who-approvals-lagging/

(19 Jan) Recommended read on current state of affairs re Covax, with plenty of detail.

“The World Health Organization’s (WHO) COVID-19 vaccine access platform, COVAX, is geared up to deliver vaccines to “far more” than 20% of member states’ populations beyond 2021, Dr Kate O’Brien, the body’s director of vaccines, told its Executive Board meeting on Tuesday. She was responding to concerns and criticisms expressed by member states at the EB’s opening session on Monday about the ability of COVAX to deliver vaccines to member states that have not been able to purchase them on their own….”

“WHO Now Examining Indian, Russian & Chinese Vaccines – While Moderna & Pfizer Hold Back” – “One key holdup with COVAX, in fact, appears to lie in the mismatch between the vaccines for which COVAX has arranged pre-order deals – and those that have received approval so far by WHO or another strict regulatory authority as safe to use….”

PS: via Devex (18 Jan): on some criticism of Covax at the EB meeting:

“Amid WHO’s call for support for COVAX, however, came questions from a member of the executive board. Dr. Clemens Martin Auer, special envoy for health of Austria’s Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, said the basic principles behind COVAX — ensuring equal vaccine access — are “fantastic” but that it has “substantial shortcomings” when it comes to delivering on its goals. He said the initiative is “slow” and has not closed enough contracts to ensure the delivery of a substantial number of vaccine doses to those who have signed up to the initiative. … Referring to Gavi, the Vaccine Alliance, which manages COVAX, he said the European Union was “skeptical that Gavi COVAX had the means and the capabilities to fulfill its tasks to negotiate the necessary contract[s] and to secure the needs of our citizens.” He also asked why Gavi did not include mRNA-based vaccines in the COVAX portfolio. “This was a major mistake,” he said, adding that mRNA-based COVID-19 vaccines were the earliest ones out in the market. He asked for detailed plans on when and what number of vaccines member states can expect to be delivered via COVAX, adding that these details aren’t clear at the moment. …”

Reuters - WHO plans slew of COVID-19 vaccine approvals for global rollout - document Reuters;

“The World Health Organization (WHO) plans to approve several COVID-19 vaccines from Western and Chinese manufacturers in the coming weeks and months, an internal document seen by Reuters shows, as it aims for rapid rollouts in poorer countries….”

“In the race to deploy shots, regulatory approvals are key to confirming the effectiveness and safety of vaccines, and to boosting output. But some poorer countries rely mostly on WHO authorisations as they have limited regulatory capacity. The WHO is therefore “expediting” emergency approvals, according to a COVAX internal document, which cites data updated to Jan. 7. The COVID-19 vaccine developed by AstraZeneca and manufactured by the Serum Institute of India (SII) could be authorised by the WHO in January or February, the document says….”

Also some info on others in the pipeline, including on two Chinese vaccines.

PS: “…The vaccine developed by Johnson & Johnson (J&J), which has a non-binding agreement to supply COVAX with 500 million doses over an unspecified timeframe, is expected to get WHO approval in May or June at the earliest, the COVAX document says….”

Reuters - WHO expects to have access to Pfizer vaccine 'very soon' Reuters;

“The World Health Organization is in advanced negotiations with Pfizer about including the company’s COVID-19 vaccine in the agency’s portfolio of shots to be shared with poorer countries, a senior WHO official said on Monday. “We are in very detailed discussions with Pfizer. We believe very soon we will have access to that product,” Bruce Aylward, a senior adviser, said at the WHO’s executive board meeting. The WHO’s vaccine-sharing scheme COVAX is set to start rolling out vaccines to poor and middle income countries in February.

And by now, this seems to have happened, see Reuters - Pfizer-BioNTech agree to supply WHO co- led COVID-19 vaccine scheme - sources

“Pfizer and BioNTech have agreed to supply their COVID-19 vaccine to the World Health Organization co-led COVAX vaccine access scheme, two sources familiar with the deal said, the latest in a series of shots to be included in the project aimed at lower-income countries. The deal is expected to be announced on Friday, according to the sources, who declined to be named due to the confidentiality of the agreement. Details on the size of the deal or the price per dose COVAX would pay were not immediately clear, but the sources said the allotment would likely be relatively small. One source said the reason for the limited volume was that the doses were primarily meant for healthcare workers in the countries that COVAX serves….”

Reuters - China's COVID-19 vaccine makers apply to join COVAX scheme Reuters;

“China said on Wednesday three drugmakers had submitted applications to supply their COVID-19 vaccines to global vaccine-sharing scheme COVAX in the country’s first formal move to provide locally developed shots to the initiative. Sinovac Biotech, China National Pharmaceutical Group (Sinopharm) and CanSino Biologics have filed applications to join the scheme, China’s foreign ministry spokeswoman Hua Chunying told a news conference on Wednesday….”

Reuters - EU eyes scheme to share surplus COVID-19 vaccines with poorer nations https://www.reuters.com/article/us-health-coronavirus-eu-kyriakides/eu-eyes-scheme-to-share- surplus-covid-19-vaccines-with-poorer-nations-idUSKBN29O0UN

“Interesting development” in the EU: “The European Union wants to set up a mechanism that would allow the sharing of surplus COVID-19 vaccines with poorer neighbouring states and Africa, the EU health chief said on Tuesday, in a move that may undercut a WHO-led global scheme. “We are working with member states to propose a European mechanism to share vaccines beyond our borders,” EU health commissioner Stella Kyriakides told EU lawmakers on Tuesday, confirming a Reuters report from December. She stressed the mechanism would get vaccines to poorer countries “before COVAX is fully operational”…

“COVAX is already operational but has so far struggled to secure vaccines. It announced in December deals for nearly 2 billion doses, but the largest part of these shots has been pledged by vaccine makers under non-binding accords because COVAX is currently short of money to book them in advance. “Firms will not give you doses if you don’t pay in advance,” a senior EU vaccine negotiator said on condition of anonymity, noting that the EU initiative was the result of COVAX having fallen short of expectations. … Kyriakides said the EU vaccine-sharing scheme should prioritise health workers and most vulnerable people in the Western Balkans, North Africa and poorer Sub-Saharan African countries. The EU official said the EU could give some vaccines to COVAX which would then distribute them to poor countries….”

PS: More info on the EU & Covid vaccines access policies & frameworks, and on an upcoming G20 summit: in this EC Communication: A united front to beat Covid-19.

“… Team Europe has also mobilised €853 million in support of COVAX, the global initiative to ensure equitable and fair access to safe and effective vaccines.The EU as a whole is COVAX's biggest donor. … EU will maintain its support to COVAX, including the establishment of a humanitarian buffer of about 100 million doses. COVAX remains the main route for supporting Low and Middle Income Countries to have fair access to vaccines, ensuring 20% coverage in the 92 poorest countries. However, this will take time. Most are therefore currently reliant on EU support to provide early access to vaccines for the most vulnerable, for medical staff, and for other priority groups. Building on the experience of the EU’s Vaccine Strategy, the Commission is ready to set up an EU vaccine sharing mechanism. This would ensure the sharing of access to some of the 2.3 billion doses secured by the EU, through the proven “Team Europe” approach. Special attention would be given to the Western Balkans, our Eastern and Southern neighbourhood and Africa. This could primarily benefit health workers, as well as humanitarian needs. This mechanism would act as a single point for requests and a pipeline through which initial doses can be provided, possibly through COVAX, without disrupting Member States’ vaccination plans. …. “

“… In parallel, efforts should be intensified to increase international cooperation and solidarity not only to contain the current pandemic but also to prepare for the next one. The recently proposed new EU–US Agenda for Global Change will form the basis for a strong commitment and

contribution to COVAX by both the EU and the United States. …. The Commission will explore all further available options to provide its partners with access to COVID-19 vaccines. The upcoming Global Health Summit, co-hosted by Italy and the Commission in May 2021 in the framework of the G20, will also provide an opportunity to rally international support to increase preparedness and resilience for future pandemics….”

Telegraph - Norway to share Covid-19 vaccine with poorer countries at same time as protecting its own citizens https://www.telegraph.co.uk/global-health/science-and-disease/norway-share-covid-19-vaccine- poorer-countries-time-protecting/

“Other countries have pledged to help poorer nations, but Norway is thought to be the first to do so 'in parallel' with its own programme.”

“Norway has become the first country in the world to explicitly commit to sharing Covid-19 vaccine doses with poorer countries at the same time as vaccinating its own citizens. Dag-Inge Ulstein, Minister of International Development, said Norway would begin donating doses of the Oxford University/AstraZeneca vaccine to lower-income nations as soon as the jab gets approval from the European Medicines Agency. … … Norway will donate doses through the World Health Organization co-led Covax scheme, a mechanism aimed at distributing vaccines equitably around the globe….”

Guardian - Global immunisation: low-income countries rush to access Covid vaccine supply

S Boseley; https://www.theguardian.com/world/2021/jan/15/global-immunisation-low-income- countries-rush-to-access-covid-vaccine-supply

“Despite efforts to procure Covid vaccine, some nations will only vaccinate 20% of population.”

Great overview of the current state of affairs (as of end of last week), with focus on the AstraZeneca vaccine, but also others in the running (to provide for LMICs).

FT - Lower-income countries fall behind in race for vaccines https://www.ft.com/content/331ca95c-63fa-40de-8866-e3adccea3647

Another helicopter view (from this Wednesday).

Excerpts: “Inadequate supplies of Covid-19 vaccines for lower-income countries mean it could take years to inoculate some parts of the world, undermining global efforts to end the pandemic. Desperate to vaccinate their populations against Covid-19, high-income nations, home to about 1bn people, have secured 4.2bn doses, approximately 74 per cent of total government orders, according to the latest weekly data compiled by the Global Health Innovation Center at Duke University of North Carolina. In contrast, lower-middle and low-income countries have secured orders for only 675m doses. … The shortfall means that while the UK aims to offer coronavirus vaccinations to all adults in Britain by September, in many parts of the world it could take as long as three years to inoculate the population during which time the virus will continue to circulate, experts have warned.

… … Covax has struggled to mobilise the support needed from wealthy nations to subsidise the initiative. It has only secured orders for 1.07bn doses so far, while rich nations have preferred to sign bilateral supply deals. … Aurélia Nguyen of Gavi told the Financial Times that Covax had “line of sight” on 1.97bn vaccination doses and was on track to meet its goal of fair and equitable access to vaccines for developing countries. However, she declined to say how many doses would be delivered this year. This would depend on production volumes and on regulatory approval in each country where vaccines will be used, she said. … Kate Elder, senior vaccines policy adviser at Médecins Sans Frontières, said that low-income countries faced “an artificially induced supply constraint”, explaining that a more collaborative approach to intellectual property could have made it easier for supplies of successful vaccines to be ramped up by other manufacturers….”

Reuters - Exclusive: COVID-19 shots to cost $3 to $10 under African Union vaccine plan Reuters;

Update on the AU efforts. “African countries will pay between $3 and $10 per vaccine dose to access 270 million COVID-19 shots secured this month by the African Union (AU), according to a draft briefing on the plan prepared by the African Export-Import Bank (Afreximbank) and provided to Reuters. … . Countries can pay back the loans in instalments over five to seven years, the document showed. … The document, which was shared with Reuters by two sources, provides the first public details on the prices manufacturers are offering African nations outside of the COVAX global vaccine sharing scheme ….. Although the prices are heavily discounted compared to what wealthier nations are paying, some experts worry about countries already struggling to manage the economic fallout of the pandemic having to borrow more money to protect their people.”

“…. John Nkengasong, who heads the Africa Centres for Disease Control and Prevention (CDC), said the prices were comparable to those available through COVAX. “My thinking is that the vaccines market will open up in the coming months, when for example Johnson & Johnson and others land on the market,” Nkengasong told Reuters. “For now, what is critical is access to the market, secure quantities and start vaccinating.” … … Afreximbank’s financing arrangement hopes to cover shots for about 15%, with 20% to be supplied through COVAX and the remaining 25% covered by the World Bank and other sources, the document showed. … “

Devex - Africa CDC outlines ultracold storage strategy for COVID-19 vaccines https://www.devex.com/news/africa-cdc-outlines-ultracold-storage-strategy-for-covid-19-vaccines- 98962

“During a press conference Thursday, Africa Centres for Disease Control and Prevention Director John Nkengasong outlined a strategy that will enable all African nations to roll out vaccines that require ultracold temperature storage. “All African countries, all 55 of them, can receive any vaccine now,” he said, adding that he wishes to dispel the idea that some African nations aren’t ready to start vaccination campaigns….”

“…Nkengasong called on countries to use an urban-centered approach, in which the government purchases ultracold storage freezers for a handful of hospitals around a capital city….” “Each freezer costs about $15,000, which is “very, very doable,” according to Nkengasong. These freezers are available to countries through the Africa Medical Supplies Platform. Both the COVAX Facility and the World Bank are working with countries to finance their vaccine rollouts….”

WHO Afro - Africa needs timely access to safe and effective COVID-19 vaccines https://www.afro.who.int/news/africa-needs-timely-access-safe-and-effective-covid-19-vaccines

Extensive update on the vaccine access (in SSA) situation (cfr WHO Afro press conference of 21 Jan).

On how Covax is preparing to roll out (with the help of WHO, UNICEF & GAVI).

Excerpts:

“According to the WHO vaccine introduction readiness assessment tool, African nations are on average 42% ready for their mass-vaccination campaigns, which is an improvement on the starting point of 33% two months ago. However, there is still a long way to go to reach the desired benchmark of 80%. As the largest vaccine buyer in the world, procuring more than 2 billion doses annually for routine immunization and outbreak response on behalf of nearly 100 countries, UNICEF is coordinating and supporting the procurement, international freight and delivery of COVID-19 vaccines for the COVAX Facility …. … All the 54 countries on the continent have expressed interest in the COVAX Facility. Eight higher and middle-income countries will self-finance their own participation, while lower-middle income and low-income countries will access the vaccines at no cost through the Facility. The vaccines distributed by COVAX will have received WHO Emergency Use Listing authorization and as such will have undergone stringent validation of their safety and effectiveness. However, vaccine nationalism is threatening the COVAX initiative. The COVAX initiative has raised US $6 billion in pledges but needs an additional US $2.8 billion in 2021 and WHO and partners are urging countries and donors to contribute and help end the pandemic globally.”

PS: via HPW – US Move to Rejoin WHO Will Help Expedite Global Vaccine Rollout – WHO’s Regional Director For Africa

“The fact that the United States has now committed to join the global vaccine facility, COVAX, which aims to roll out vaccine doses to countries worldwide, is “extremely significant”, Dr Matshidiso Moeti, WHO Regional Director for Africa told Health Policy Watch this afternoon….”

India, 'pharmacy of the world', starts COVID vaccine exports Reuters;

“India started exporting coronavirus shots on Wednesday with a shipment to the neighbouring Himalayan kingdom of Bhutan, the foreign ministry said, as the so-called pharmacy of the world looks to bolster its vaccine diplomacy. … India initially will only ship the AstraZeneca vaccine, made by the Serum Institute of India, the world’s biggest vaccine maker, which brands the shot as COVISHIELD….”

• See also Livemint - India pushes vaccine diplomacy in region

“India may donate 10 mn doses of vaccines to Afghanistan, Bhutan, Bangladesh, Nepal, Sri Lanka, the Maldives, and Mauritius.”

And the related Indian government statement: Supply of Indian manufactured vaccines to neighbouring and key partner countries.

• And Reuters - India to begin commercial vaccine exports with shipments to Brazil, Morocco

“India’s government has cleared commercial exports of COVID-19 vaccines, with the first consignments to be shipped to Brazil and Morocco on Friday, the Indian foreign secretary told Reuters. The shots developed by UK-based drugmaker AstraZeneca and Oxford University are being manufactured at the Serum Institute of India, the world’s biggest producer of vaccines, which has received orders from countries across the world. … … To be followed by South Africa and Saudi Arabia.

Reuters - Exclusive: International COVID-19 vaccine poll shows higher mistrust of Russia, China shots

Reuters;

“People across the world are generally likely to say yes to getting a COVID-19 vaccine, but would be more distrustful of shots made in China or Russia than those developed in Germany or the United States, an international poll showed on Friday….”

FT - Chinese and Russian vaccines in high demand as world scrambles for doses https://www.ft.com/content/f5fa265d-6616-4fcf-988a-deaefa532669

“Sales represent coup for Beijing and Moscow, even as concerns over pharma standards linger.”

“As the international scramble for Covid-19 vaccines intensifies Chinese and Russian manufacturers have found a growing list of foreign buyers despite lingering concerns over incomplete trial data and the rigour of domestic approval processes. Russia’s Gamaleya Research Institute of Epidemiology and Microbiology has agreed to sell its Sputnik V vaccine to countries including Algeria, Argentina, Saudi Arabia and Brazil, while the two leading Chinese manufacturers have signed deals with more than a dozen countries including Bahrain, United Arab Emirates, Egypt, Philippines, Indonesia and Hungary. For Moscow and Beijing, both keen to see their pharmaceutical sectors compete internationally, the sales represent a significant political and commercial coup. China in particular has made bold promises that its vaccines will deliver a diplomatic win by playing a leading role in the global immunisation drive….”

Nature (News) - China COVID vaccine reports mixed results — what does that mean for the pandemic?

Nature;

“Scientists say CoronaVac could reduce cases of severe disease, particularly in countries with raging outbreaks.”

TWN - Opponents of TRIPS waiver asked to respond to questions by proponents https://www.twn.my/title2/health.info/2021/hi210102.htm

In-depth analysis ahead of the informal TRIPS Council meeting which took place on 19 January.

“….The proponents of the temporary TRIPS waiver – South Africa, India, Kenya, Eswatini (formerly Swaziland), and Pakistan among others – had challenged the opponents led by the United States, the European Union, Switzerland, Japan, Canada, Brazil, Australia, and Mexico among others with a set of questions at the last TRIPS Council meeting on 10 December last year. At that meeting, the proponents answered many questions raised by the opponents about the perceived negative effects of the waiver on the WTO’s TRIPS Agreement and the global economy, insisting that the waiver only helps countries to overcome the global shortage of COVID-19 therapeutics and vaccines by ramping up their production in the immediate short-term. It is against this backdrop that the opponents of the waiver will have an opportunity to answer the questions raised by the proponents for the first time at an informal TRIPS Council meeting to be held on 19 January, said a source familiar with the development….”

PS: Check out the statement (15 Jan) by India, South Africa and co-sponsors of game changing #TRIPS waiver proposal giving responses to questions raised by opposing countries.

PS: tweets Geneva Health files related to the meeting on 19 January:

“Sources say 30 members engaged at the TRIPS Council informal meeting today. Countries reiterated their positions. Next formal meeting likely Feb 4th when positions will be stated on record, for consideration by the General Council in early March.”

“TRIPS Council meeting @wto today European Union, the United States, Switzerland, the United Kingdom and Japan continued to oppose the #TRIPSWaiver proposal. They reportedly said proposal doesn't address problems of capacity or raw materials that are impeding sufficient supply.”

So unfortunately, nothing seems to be moving for the time being. Next meeting: 4 Feb.

IISD – WTO Highlights Linkages Between Trade Policy and COVID-19 Vaccine Value Chain http://sdg.iisd.org/news/wto-highlights-linkages-between-trade-policy-and-covid-19-vaccine-value- chain/

“The World Trade Organization emphasizes that successful immunization programmes needed to rein in the pandemic are built on functional, end-to-end supply chain and logistics systems. A non- exhaustive seven-step overview of the vaccine development and delivery process visualizes the supply chain, and identifies intersections with governments’ trade policies and WTO rules….”

WB - World Bank Supports First COVID-19 Vaccine Rollout in Lebanon https://www.worldbank.org/en/news/press-release/2021/01/21/world-bank-supports-first-covid- 19-vaccine-rollout-in-lebanon

The World Bank is getting into the act. “The World Bank today approved a re-allocation of US$34 million under the existing Lebanon Health Resilience Project to support vaccines for Lebanon as it

faces an unprecedented surge in COVID-19, with record-breaking numbers of around 5,500 daily confirmed cases since the beginning of the year. This is the first World Bank-financed operation to fund the procurement of COVID-19 vaccines. …”

Apparently: “financing programs for other countries coming soon from our $12 BN COVID-19 vaccines fund.”

Development Today - Norway and South Africa call on OECD finance ministers to go beyond aid to fund global COVID19 gap https://www.development-today.com/archive/dt-2021/dt-1--2021/norway-and-south-africa-call-on- oecd-finance-ministers-to-close-usd-27b-pandemic-funding-gap

(gated) “The finance ministers of Norway and South Africa have invited colleagues from OECD countries to a meeting to discuss the establishment of a mechanism to fund the USD 27 billion shortfall in the Access to COVID19 Tools Accelerator. One option being tabled is to frontload payments via the bond market.”

Lancet World Report – CEPI criticised for lack of transparency https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00143-4/fulltext

“The publicly funded epidemic response agency CEPI has been criticised for the lack of transparency in its grant agreements with COVID-19 vaccine developers. Ann Danaiya Usher reports.”

“Donors have contributed US$1·4 billion in public money, mainly development assistance, to the Coalition for Epidemic Preparedness Innovations (CEPI) to accelerate COVID-19 vaccine research and ensure vaccines are available for low-income and middle-income countries (LMICs). Over the past year, CEPI has provided grants to ten different vaccine developers, some of which have started receiving regulatory approval for their vaccines (Moderna and AstraZeneca) or are in phase 3 trials (Novavax). CEPI says that the organisation's agreements contain strong provisions on equitable access and include sanctions that can be used if companies do not live up to their promises of making cheaper vaccines available to LMICs. But the agency has been criticised for being too secretive about the conditions in its contracts and for not pushing vaccine developers harder to achieve better terms….”

Links:

• Globe and Mail - Pfizer pushes for tax breaks in 2021 federal budget

Cfr tweet M-A Gagnon: “With a gun to the head (or needle to the arm), Pfizer demands that Canada increases tax credits, and stops fighting tax evasion and dubious transfer pricing practices.”

• Devex - COVAX will be a 'small part' of Russia's Sputnik V portfolio, fund CEO says

“… While the fund is engaging with African and Asian countries, Dmitriev said it prefers to work with countries directly rather than through COVAX, the global initiative set up to ensure equitable access to COVID-19 vaccines….” “…“COVAX will be a small part of our portfolio.”

• Business live - SA paying huge premium for Covid-19 shots from Serum Institute of India

“EU, US and AU will pay far less.”

“South Africa, which was left scrambling to source Covid-19 vaccines after failing to timeously place orders with manufacturers, is set to pay a massive premium on the shots it has secured directly from the Serum Institute of India (SII), the health department confirmed on Wednesday. After weeks of growing criticism over the slow pace of its vaccine acquisition plans, the government announced in early January that it had secured 1.5-million doses of the SII’s Covishield shot, which the institute is manufacturing under licence from AstraZeneca. It has now emerged that the government has agreed to pay the SII $5.25 (about R78) a dose, more than twice the price the EU negotiated directly with AstraZeneca in 2020.” See also the Guardian - South Africa paying more than double EU price for Oxford vaccine “Health ministry quotes says premium is because government did not pay into research and development effort.”

• Letter to Tedros - Letter from the People’s Vaccine Alliance and Health Action International to Dr. Tedros on C-TAP : recommended.

Covid science

Quite some worries on the ‘South African’ variant, among others.

FT - The new Covid variants are a peril to us all Adam Kucharski; https://www.ft.com/content/5691b1bb-0f9f-4410-9ade-84f4d55ea778

“Mutations crop up every now and then and dramatically change the threat we face.”

“In recent weeks, researchers have noticed three troubling new Sars-Cov-2 variants scattered among the various virus lineages circulating globally. Such variants could well change the pandemic’s shape in 2021. … …. The emergence of three new variants with shared characteristics raises the possibility of “convergent evolution”, with viruses independently adapting to human populations around the world in similar ways….”

See also the Atlantic - A Troubling New Pattern Among the Coronavirus Variants

“The most concerning versions of the virus are not simply mutating—they’re mutating in similar ways.”

Reuters - Previous coronavirus infection may offer less protection from new variant Reuters;

“Previous infection with the coronavirus may offer less protection against the new variant first identified in South Africa, scientists said on Monday, although they hope that vaccines will still work….”

See also the Guardian - Covid vaccines may need updating to protect against new variant, study suggests

Science (News) - New coronavirus variants could cause more reinfections, require updated vaccines https://www.sciencemag.org/news/2021/01/new-coronavirus-variants-could-cause-more- reinfections-require-updated-vaccines

“Scientists worry mutations found in Brazil and South Africa could help SARS-CoV-2 evade human antibodies.”

CNN - Variant might partially evade protection from vaccines or prior infection, early research suggests CNN;

“A new study suggests someone might be able to get infected with one of the new variants of the coronavirus even if they've had Covid-19 before or have been vaccinated. The variant was first spotted in South Africa in October and has now been found in more than a dozen countries. "I think we should be alarmed," said Penny Moore, associate professor at the National Institute for Communicable Diseases in South Africa and the senior author of the study….”

And HPW - New Vaccine Approach May Be Needed As ‘Natural’ Antibodies Fail to Recognise COVID- 19 Variant in South Africa

HPW -Israel’s Massive Immunization Campaign Pricked By Soaring COVID-19 Infections https://healthpolicy-watch.news/israels-immunization-trial-balloon-pricked-by-soaring-covid- infections/

Update on how Israel’s vaccine campaign is going, what the impact is so far. Also info on the Palestinians’ access.

“As the world watches Israel’s precedent-setting vaccine rollout to see if the first real-world test of new COVID-19 vaccines can really beat back the virus, once soaring hopes that vaccines on their own could offer an easy way out of the COVID crisis are now diving sharply. While the vaccine itself appears to be about as effective as reported in clinical trials – Israel’s new COVID-19 cases reached yet another record of 10,000 new infections daily this week – one of the highest rates per capita in the world. The infection surge led to a government decision on Tuesday to extend a lockdown in effect until 1 February. That is despite the fact that nearly one quarter of the Israeli population have now received at least one dose of the virus. While initial analyses of some 460,000 Israelis vaccinated have suggested that the first dose was providing roughly 50-60% protection after two weeks, health

officials yesterday suggested the protective quality of the first dose may be less than previously believed- although they didn’t offer concrete data. …”

Some links from this week:

• Reuters - Norway advises caution in use of Pfizer vaccine for the most frail

“ Norway has changed its policy on the use of Pfizer and BioNTech’s COVID-19 vaccine to consider excluding the terminally ill, following reports of deaths in highly frail recipients after the inoculation was given, BioNTech said on Monday….”

• Stat - What we now know — and don’t know — about the coronavirus variants

Covid analysis

Global Public health - The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems

Owain Williams, K Grepin et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1874470

“For decades, governments and development partners promoted neoliberal policies in the health sector in many LMICs, largely motivated by the belief that governments in these countries were too weak to provide all the health services necessary to meet population needs. Private health markets became the governance and policy solution to improve the delivery of health services which allowed embedded forms of market failure to persist in these countries and which were exposed during the COVID-19 pandemic. In this article, we analyse the manifestations of these market failures using data from an assembled database of COVID-19 related news items sourced from the Global Database of Events, Language, and Tone. Specifically, we identify how pre-existing market failure and failures of redistribution have led to the rise of three urgent crises in LMICs: a financial and liquidity crisis among private providers, a crisis of service provision and pricing, and an attendant crisis in state-provider relations. The COVID-19 pandemic has therefore exposed important failures of the public-private models of health systems and provides an opportunity to rethink the future orientation of national health systems and commitments towards Universal Health Coverage.”

Virtual launch of PMAC/BMJ Special Collection - COVID 19: Advancing towards an equitable and healthy world https://pmac2021.com/sideMeeting/detail/14

“Join the launch of a special collection from The BMJ of ten papers focused on this year’s PMAC theme of ‘COVID 19: Advancing towards an equitable and healthy world’. The collection analyses the major issues arising from the pandemic, including the political economy of the response, the role

of international institutions, overwhelmed health systems, the role of social determinants, the value of global indices of preparedness, and global megatrends and solidarity. …”

Probably online later today (on BMJ).

The Conversation - COVID-19 policy briefs must be realistic: a review by young southern African scientists P Segalo et al; https://theconversation.com/covid-19-policy-briefs-must-be-realistic-a-review-by- young-southern-african-scientists-152029

“… a group of young scientists who are part of the Young Academies of Sciences from southern Africa came together to discuss how policy briefs that focus on non-pharmaceutical interventions could be made more accessible for the general public and policy makers alike. The group comprised experts in the behavioural, social, natural, health and human sciences. … … The briefs are intended to inform public health and social measures in Africa. They are based on social, economic, epidemiological, population movement, and security data from 20 African Union member states. The briefs highlight the various strategies African governments have taken in responding to COVID-19 and whether these are effective or not. … We discussed the briefs in a closed webinar. It aimed to assess whether the briefs take into account the real experiences of people in our communities…”

Pfizer, BioNTech and Moderna to rake in $15bn from COVID-19 vaccines sales by 2023 https://finance.yahoo.com/news/pfizer-bio-n-tech-and-moderna-to-rake-in-15-bn-from-covid-19- vaccines-sales-by-2023-130039411.html

It’s “Vegas time” for some of these Big Pharma fellas.

“New data has shown that 2021 in particular “is set to become quite a year for the pharma companies leading the COVID-19 vaccine race, with significant revenues on the line,” said research company Finaria….”

Devex - EIB boss: Vaccine access could mean difference between 'war and peace' https://www.devex.com/news/eib-boss-vaccine-access-could-mean-difference-between-war-and- peace-98948

“A failure to vaccinate people everywhere, beyond the borders of wealthy countries, is not just an ethical issue, but “it is a question of stability around the world,” the president of the European Investment Bank said Wednesday. “This can become a question of enormous instabilities and a question of enormous social unrest,” Werner Hoyer said at a press conference. “It can develop into a question of war and peace.” Announcing the multilateral lender’s results for 2020, Hoyer told journalists that access to vaccines against COVID-19 is “not luxury; this is global responsibility.” The bank recently issued a €400 million loan to the COVAX Facility…”

Nature - ‘A bloody mess’: Confusion reigns over naming of new COVID variants https://www.nature.com/articles/d41586-021-00097-w

“As more lineages emerge, researchers are struggling with a patchwork of nomenclature.”

Telegraph - Fears of ‘vaccine apartheid’ as countries mull immunisation passports Telegraph;

“It may be a divisive move but proof of inoculation is likely to become the norm for anyone wanting to travel and enjoy life.”

BMJ GH - Priority setting during the COVID-19 pandemic: going beyond vaccines I Williams et al; https://gh.bmj.com/content/6/1/e004686

“…Much attention has been paid to how to prioritise between patient groups for vaccination and how to ensure equity, especially in low-income countries, but there are other important decisions that need to be made. These decisions include: (a) choosing between the various vaccines that will become available, (b) continuing to invest in other aspects of the COVID-19 response and (c) balancing the COVID-19 response with the need to invest in other healthcare that has suffered during the pandemic. Although these decisions are inherently difficult, principles of good priority setting can be helpful; these principles include: evidence-based and transparent decision-making, participation of stakeholders and a focus on the implementation of decisions….”

BMJ GH (Commentary) - Equitable recovery from COVID-19: bring global commitments to community level

R Loewenson et al; https://gh.bmj.com/content/6/1/e004757

“… The pandemic, lockdown and other responses, along with underfunded, poorly prepared and overstretched public sector social and health systems in many countries worsened many dimensions of family, women’s, child and adolescent health and well-being that were already facing deficits, generating a rising health and social debt in communities, the true scale and long-term consequences of which are as yet unknown, especially for the most marginalised in society. Rather than ‘getting back to normal’, recovery and ‘reset’ demands change to tackle the inequalities, conditions, services, socioeconomic and environmental policies that made people susceptible and vulnerable to COVID-19. … an equitable recovery should include significant investment in: (1) universal, public sector, primary health care-oriented health services; (2) redistributive, universal rights-based and life course based social protection; and (3) people, especially in early childhood and in youth, as drivers of change. Who designs the ‘reset’ influences the change, and within countries and internationally, opportunities must be provided for meaningful public engagement as a critical driver of an equitable recovery.”

BMJ GH Analysis - Navigating inequities: a roadmap out of the pandemic S Ismail et al ; https://gh.bmj.com/content/6/1/e004087

“…We present the first validated equity framework applied to COVID-19 that sheds light on the full spectrum of health inequities, navigates their sources and intersections, and directs ethically just interventions. The Equity Matrix also provides a comprehensive map to guide surveillance and research in order to unveil epidemiological uncertainties of novel diseases like COVID-19, recognising that inequities may exist where evidence is currently insufficient….”

Lancet Editorial - COVID-19: the intersection of education and health https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00142-2/fulltext

“What lessons does the COVID-19 syndemic offer when considering the convergence between health and education? The International Day of Education, on Jan 24, provides an opportunity to reflect on the weaknesses of the education system before COVID-19, and on the impact of school closures and education disruptions on children and adolescents. …” “….the Sustainable Development Goals (SDGs) for health (SGD3) and quality education (SDG4), … explicitly acknowledge the linkage between health and education. Yet, the two sectors remain distant; arguments over whether to close schools to prevent infection can even imply that they are in opposition. This disconnect needs to be remedied. Closer cooperation would revitalise not only education, but also child and adolescent health.”

Lancet - Offline: The danger of unreliable narrators R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00148-3/fulltext

Final paragraph: “For now is the time to search for the truth. Now is the time to insist, to demand, that those who navigated our path through this pandemic are held fully accountable for their decisions and actions. First, China. What actually happened in Wuhan in 2019? …. … It suits some critics to deflect responsibility for 2 million COVID-19 deaths away from their own culpability. But that motivation doesn't absolve Chinese authorities from working with WHO to produce a credible chronology of the origin and spread of SARS-CoV-2. For the rest of the world, now is the moment to prepare for national public inquiries into their COVID-19 responses. …. But most western countries sought to mitigate the outbreak—to delay the epidemic surge and, to use UK Prime Minister Boris Johnson's words, to “take it on the chin”. Mitigation led to hundreds of thousands of avoidable deaths. Unreliable narrators can be eloquent and convincing. Beware their charming fictions.”

PS: I do think there was a gradation in mitigation strategies, though…

Covid resources

CGD launches “The COVID-19 Gender and Development Initiative” https://www.cgdev.org/project/covid-gender-initiative

“New global research hub explores the gendered dimensions of COVID-19 to promote equality through recovery.”

“This global research initiative will examine COVID-19 recovery policies in three areas to determine the best ways to address long-standing gender inequality: Health policy: The initiative will examine how COVID-19 and its response measures are indirectly impacting women’s and girls’ health, including access to sexual and reproductive health services and other essential medical care, in order to develop possible solutions to mitigate adverse effects in ongoing and future epidemics. Social protection policy: The initiative will examine the design of social protection policies already enacted during the pandemic and provide recommendations to ensure that future social protection programs reach and benefit women and girls. Economic development policy: The initiative will examine data on the impact of the COVID-19 global recession on women’s work in low- and middle- income countries, including entrepreneurship, wage and salaried work, work in subsistence agriculture, and unpaid care work, and make recommendations to design policies to promote women’s economic opportunities and empowerment.”

AMR

FT - Antibiotic resistance: how to tackle a public health crisis https://www.ft.com/content/21a00f82-9145-4863-b2fc-4bb1946e065e

From a FT special report on AMR. “Recommendations from an FT roundtable with pharma, government, and NGO experts.” Extensive overview of what needs to be done.

NCDs

Vital Strategies (report) - The Sobering Truth: Incentivizing Alcohol Death and Disability https://www.vitalstrategies.org/resources/the-sobering-truth-incentivizing-alcohol-death-and- disability/

“Harmful alcohol consumption leads to one death every 10 seconds globally, resulting in 3 million deaths per year. … But despite this global burden, billions of dollars are given to the alcohol industry every year through tax breaks, marketing subsidies and other incentives, particularly in low-and middle-income countries. A new report from Vital Strategies, The Sobering Truth: Incentivizing Alcohol Death and Disability, uncovers these “perverse incentives,” and also examines how the industry interferes in government policies that are aimed at reducing consumption of alcohol products. The report proposes key recommendations for countries to strengthen their health systems against the harmful use of alcohol.”

Lancet & Lancet Global Oncology on global demand for cancer surgery

Lancet - Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Lancet Oncology - Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study

Cfr press release: The Lancet and The Lancet Oncology: Global demand for cancer surgery set to grow by almost 5 million procedures within 20 years, with greatest burden in low-income countries.”

“A modelling study suggests that demand for cancer surgery will rise by 52% – equal to 4.7 million procedures – between 2018 and 2040, with the greatest relative increase in low-income countries, which already have substantially lower staffing levels than high-income countries. A separate observational study comparing global cancer surgery outcomes also suggests that patients in low- and middle-income countries (LMICs) are four times more likely to die from colorectal or gastric cancer (odds of 4.59 and 3.72, respectively) than those in high-income countries (HICs) currently, and that poor provision of care to manage post-operative complications (which includes staffing, ward space and access to facilities) explains a significant proportion of the disproportionate deaths in LMICs. “

“Demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next twenty years, requiring a huge increase in the workforce including nearly 200,000 additional surgeons and 87,000 anaesthetists globally. With access to post-operative care strongly linked to lower mortality, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications. The findings of the two studies, published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle income countries, while also scaling-up their workforces in order to cope with increasing demand. …

BMJ GH (Editorial) - Unseen and unheard: African children with cancer are consistently excluded from clinical trials

E Amuako et al ; https://gh.bmj.com/content/6/1/e004750

« The conspicuous absence of African children from cancer clinical trials highlights the global disparities that exist in cancer research and care. This disparity must be addressed if the WHO global initiative for childhood cancers is to achieve its goal of at least 60% survival for all children with cancer by 2030….”

FT (special report) - Future of AI and Digital Healthcare https://www.ft.com/reports/future-ai-digital-healthcare

While waiting for the joint commission from The Lancet and Financial Times on Governing Health Futures 2030 (expected for autumn 2021).

In this special report, “We explore how AI and other digital advancements are being harnessed to improve healthcare in the world’s poorest regions.”

Check out, among others:

FT - Harnessing the power of AI for global health https://www.ft.com/content/3e5d9e12-f631-11e9-9ef3-eca8fc8f2d65

On the purpose of the forthcoming Commission: “Lancet/FT Commission examines how to match new technology with suitable regulation.”

“… Yet concerns about the applications of technology are emerging, not least over privacy, accountability and equality of access in order not to leave the poor behind. A new joint Lancet and Financial Times Commission, chaired by Ilona Kickbusch of the Graduate Institute of International and Development Studies in Geneva and me, is exploring these challenges. … … Framing a clear set of recommendations on the implementation and governance of digital health, AI and universal health coverage is a considerable task. This will be the focus of the Lancet/FT Commission. A diverse set of independent commissioners will consider a wide range of voices and deliberate with a common concern over the next two years: how to exploit new technology while ensuring suitable regulation and governance are in place to improve the health and wellbeing of all, in particular those who are currently most excluded: women and children in low income and middle-income countries such as India…..”

FT - We need a new era of international data diplomacy https://www.ft.com/content/66f1ff42-fe49-4376-aafb-3943a9f04a1c

“Global standards on collection, storage and use would improve health while protecting privacy.”

“From contact-tracing apps to telemedicine, digital health innovations that can help tackle coronavirus have been adopted swiftly during the pandemic. Lagging far behind, however, are any investigations of their reliability and the implications for privacy and human rights. In the wake of this surge in “techno-solutionism”, the world needs a new era of data diplomacy to catch up. Big data holds great promise in improving health outcomes. But it requires norms and standards to govern collection, storage and use, for which there is no global consensus. The world broadly comprises four data zones — China, the US, the EU and the remainder … …. Global diplomacy is needed to bring some harmony in norms and practices between these four zones, but the task is not easy. ….”

Decolonialize Global Health

Lancet Global Health Editorial – Global health 2021: who tells the story?

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00004- 8/fulltext#.YAg9B6B8sQA.twitter Editorial of the new February issue.

“… It is time to disrupt the old order where local researchers and practitioners are thought to have everything to learn from their high-income country counterparts but nothing to teach them. The intended beneficiaries and targets of global health research programmes should have an active role in shaping the discourse. So, this year, this journal seeks to amplify the voices of the health workers and researchers in LMICs for whom the notion of ”global health” is but an everyday reality of their working lives. We therefore invite readers, particularly those who are not regular contributors to our pages, to share their expertise and experiences with us in the form of Correspondence, Viewpoints, and Comments on the theme: What is wrong with global health? Open the debate. Ask the hard questions. Offer solutions based on your own experiences. We will welcome frank, open discussion about the problems in academic global health throughout the year. ….”

Short answer: an awful lot .

BMJ GH - Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences

L Vein et al ; https://gh.bmj.com/content/6/1/e003455

« This study aims to describe the factors that impact LMIC representation at global health conferences. … Thematic analysis yielded two themes: ‘barriers to conference attendance’ and ‘facilitators to conference attendance’. In total, 112 conferences with 254 601 attendees were described, of which 4% of the conferences were hosted in low-income countries. Of the 98 302 conference attendees, for whom affiliation was disclosed, 38 167 (39%) were from LMICs. Conclusion : ‘Conference inequity’ is common in global health, with LMIC attendees under- represented at global health conferences. LMIC attendance is limited by systemic barriers including high travel costs, visa restrictions and lower acceptance rates for research presentations. This may be mitigated by relocating conferences to visa-friendly countries, providing travel scholarships and developing mentorship programmes to enable LMIC researchers to participate in global conferences. »

One stat: 4% of “global health” conferences hosted in low income countries.

UHC

WHO - Governments push for Universal Health Coverage as COVID-19 continues to devastate communities and economies https://www.who.int/news-room/feature-stories/detail/governments-push-for-universal-health- coverage-as-covid-19-continues-to-devastate-communities-and-economies

“The UHC Partnership, one of WHO’s largest initiatives for international cooperation for UHC, supports countries to strengthen the foundations of their health systems to boost their COVID-19 response, enhance preparedness for impending health emergencies, and ensure that everyone, especially the most vulnerable, can access the essential health services they need without experiencing financial hardship. Countries are demonstrating that effective primary health care and a strong health workforce are among the most powerful ways to bring health services closer to communities, protect everyone from all health threats and inch closer to UHC. Some of these country examples are documented in the UHC Partnership’s special series of stories from the field on the COVID-19 response….”

PS: “… The UHC Partnership expands WHO’s assistance and technical expertise to 115 countries, through funding from the European Union, the Grand Duchy of Luxembourg, Irish Aid, the French Ministry for Europe and Foreign Affairs, the Government of Japan, the United Kingdom - Foreign, Commonwealth & Development Office and Belgium. The Partnership supports governments in strengthening health systems to accelerate progress towards UHC. Its work includes a special focus on health security and noncommunicable disease…”

Health Financing in Africa (blog) - The Health Financing Progress Matrix

http://www.healthfinancingafrica.org/home/the-health-financing-progress-matrix

Interview by Joel Arthur Kiendrebeogo.

“Last December, the WHO released its Health Financing Progress Matrix (HFPM), a new tool to assess country health financing systems against a set of evidence-based benchmarks, framed as nineteen desirable attributes. Each attribute represents one critical element of a health financing system and signals the direction in which institutions, policies and their implementation need to develop in order to make progress towards universal health coverage (UHC). Health Financing in Africa has interviewed Matthew Jowett, who leads this program of work at WHO Geneva. “

Global Health Action - Strategies for financing social health insurance schemes for providing universal health care: a comparative analysis of five countries A Fenny, R Yates & R Thompson; https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1868054

“… Though social health insurance is considered a mechanism for providing financial protection, less well documented in the literature is evidence from countries in Africa who are at various stages of adopting this financing strategy as a way to improve health insurance coverage for their populations. The study investigates whether social health insurance schemes are effectively and efficiently covering all groups. The objective is to provide evidence of how these schemes have been implemented and whether the fundamental goals are met. The selected countries are Ghana, Rwanda, Tanzania, Kenya and Ethiopia. “

“The results show that each of the selected countries relies on a plurality of health insurance schemes with each targeting different groups. Additionally, many of the Social Health Insurance programs start by covering the formal sector first, with the hope of covering other groups in the informal sector at a later stage. Health insurance coverage for poor groups is very low, with targeting mechanisms to cover the poor in the form of exemptions and waivers achieving no desirable results.

Conclusions: The ability for Social Health Insurance programs to cover all groups has been limited in the selected countries. Hence, relying solely on social health insurance schemes to achieve Universal Health Coverage may not be plausible in Africa. Also, highly fragmented risk pools impede efforts to widen the insurance pools and promote cross-subsidies.”

Some other news of the week

UN News - Over 1.9 billion people in Asia-Pacific unable to afford a healthy diet: UN report https://news.un.org/en/story/2021/01/1082542

“The economic impact of the coronavirus pandemic and surging food prices are keeping almost two billion people in Asia and the Pacific from healthy diets, United Nations agencies said on Wednesday.”

“According to the 2020 Regional Overview of Food Security and Nutrition, the region’s poor have been worst affected, forced to choose cheaper and less nutritious foods. The report is jointly produced by the FAO, UNICEF, WFP and WHO …”

Some reports & papers of the week

IJHPM - Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-income Countries: A Qualitative Evidence Synthesis P Y Grimm, K Wyss et al ; http://www.ijhpm.com/article_3999.html

“… By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications. The review uses the best-fit framework synthesis approach. … Ten themes were generated from the analysis. Five confirmed the a priori conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms….”

Lancet Global Health - Global Fund contributions to health security in ten countries, 2014–20: mapping synergies between vertical disease programmes and capacities for preventing, detecting, and responding to public health emergencies M Boyce, R Katz et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30420- 4/fulltext#.YAg9YiMrXiM.twitter

“The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. …”

Interpretation of the results: “…Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening.”

International Journal of Environmental Research and Health - New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals F Baum et al ; https://www.mdpi.com/1660-4601/18/2/661/htm

“Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. … Methods: this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu’s concepts of capitals (economic, cultural, symbolic and social). Results: we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu’s capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways. Conclusion: we demonstrate the value of combing a SDH and Bourdieu’s capital lens to investigate GLED. We proposed a theoretical framework to guide future research. »

WB - Trickle Down Tax Morale : A Cross Country Survey Experiment

World Bank;

The one ‘trickle down’ theory we believe in . “Studies have encouraged pro-social behavior by experimentally manipulating people's views of what others like them tend to do (descriptive norms). These studies positively change behaviors, including charitable giving, littering, organ donation, and tax compliance. This paper argues that these results may be explained by a tendency to reciprocate positive actions and avoid being taken advantage of. The descriptive norm account predicts that positively describing the behavior of ordinary people will be most effective at increasing citizens’ willingness to pay taxes, and messages describing the behavior of other groups should be less effective. However, reciprocity theory suggests that highlighting pro-social behavior by groups

believed not to contribute their fair share, such as rich people, should be effective because it will reduce the subject's perception that they are being taken advantage of when they pay taxes. These theories are tested in an online experiment in Kenya, Australia, the United States, the Philippines, and South Africa. The findings show that the descriptive norms treatment is ineffective, while the rich people treatment significantly increases tax morale, supporting reciprocity theory. The findings suggest that tax agencies may increase tax compliance by visibly tackling tax avoidance among groups believed to avoid taxes, such as rich citizens.”

Gain & JH (report) - 42 policies and actions to orient food systems towards healthier diets for all

C Hawkes et al ; https://researchcentres.city.ac.uk/__data/assets/pdf_file/0011/583517/42-Food- Systems-for-Healthy-Diets-Actions-December-18-2020-FINAL.pdf

“In January 2020, the Centre for Food Policy at City, University of London, the Global Alliance for Improved Nutrition (GAIN) and Johns Hopkins University began compiling recommendations made by major international reports on how to orient food systems for nutrition. … As part of this process, a long-list of 42 policies and actions with the potential to orient the food system towards healthy diets was generated. Aligned with the High Level Panel of Experts on Food Security and Nutrition (HLPE) report Food Systems and Nutrition, the list is made up of actions with the potential to effect change through food supply chains, food environments and consumers. Actions to change principles, governance and political processes, although critically important to frame and enable the delivery of these actions, were not the focus of the project….”

CGD (paper) - ODA in Turmoil: Why Aid Definitions and Targets Will Come Under Pressure in the Pandemic Age, and What Might Be Done About It A Rogerson et al ; https://www.cgdev.org/sites/default/files/PP198-Ritchie-Rogerson-ODA- Turmoil.pdf

“In the wake of the COVID-19 pandemic, official development assistance (ODA) remains an essential, though often criticised, form of external financing for developing countries. At the same time, the pandemic risks aggravating existing pressures on ODA which may erode its credibility and the volume of public concessional, cross-border resources made available for development purposes. We revisit the evolution of ODA and discuss three such pressures: ODA/GNI ratio targets threaten ODA budgets when GNI is falling in many donor countries; flawed new rules on scoring debt relief as ODA will lead to large-scale doublecounting just as debt relief looks ever more likely; and the increasingly-blurred boundary between global public goods and traditional ODA may allow the former to displace the latter. We discuss ways in which the Development Assistance Committee has sought to mitigate these pressures in the past, and conclude that alternative strategies may be required. To this end, we recommend that the DAC rolls back its new debt relief rules, considers an additional target tier for “beyond ODA” spend on global public goods, and commits to greater transparency and developing country participation in its financial metric-setting processes.”

Health Research Policy & Systems - The state of health research governance in Africa: what do we know and how can we improve? J Nabyonga et al; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020- 00676-9

Employing a cross-sectional survey, the authors collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region.

Results: “…Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north–south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research.”

Blogs of the week

Devex - Calls for a 'new social contract' continue. But what does that mean? https://www.devex.com/news/calls-for-a-new-social-contract-continue-but-what-does-that-mean- 98929

“Since the start of the COVID-19 pandemic, leading development organizations, ranging from Save the Children to the World Economic Forum, have consistently called for a “new social contract” that extends well beyond the crisis. In July, United Nations chief António Guterres similarly urged an effort that will “create equal opportunities for all and respect the rights and freedoms of all,” when he delivered what experts have since called a stump speech for his reelection campaign. … But what, in reality, would a new social contract between governments and societies actually look like? And how far away is the achievement of anything that matches this grand ambition? A recent half-day forum on inequality and COVID-19, co-hosted by the Overseas Development Institute and Irish Aid, presented some tangible ideas for what sweeping social, economic, and political reform might mean. There isn’t one easy answer, according to Francesca Bastagli, director of ODI’s equity and social policy program. …”

Some tweets of the week

M Kavanagh “Time to say it: #COVAX without #CTAP isn’t working. That is: equitable access to vaccines is not going to happen while a few companies have global monopoly on supply. Same dynamic we saw on #HIV—full global production capacity needed. @WHO right to back both. So now #EB148...”

M Pai “Seeing the slow pace of #COVID19 vaccination in US, Canada & HICs, we need: A Lancet Commission on Mass Vaccination in High-Income Countries Authored by Commissioners from low & middle-income countries (who know a lot about this). In return, HICs will share vaccines with LMICs.”

Global health events

Coming up: PMAC (Main conference 29 Jan – 3 Feb (virtual conference) https://pmac2021.com/program#upcoming

Check out the programme.

Coming up (25 January): Launch of The Lancet Series on women’s & children’s health in conflict settings

New 4-part Series of papers to be published in The Lancet. Register for the launch: here.

Global governance of health

More links & analysis on the WHO’s EB meeting

NYT -Covid Response Was a Global Series of Failures, W.H.O.-Established Panel Says https://www.nytimes.com/2021/01/18/world/europe/virus-WHO-report-failures.html?smid=tw- nytimesworld&smtyp=cur

NYT coverage of the interim report by the Independent Panel: “An interim report is both a bleak recounting of deadly missteps and an early blueprint for repairs: “We have failed in our collective capacity.””

Reuters - Pandemic could be WHO's Chernobyl moment for reform -review panel https://www.reuters.com/article/us-health-coronavirus-who-panel/pandemic-could-be-whos- chernobyl-moment-for-reform-review-panel-idUSKBN29O1L3

Also coverage of the Independent panel’s interim progress report.

PS: “…The United States and European Union backed drawing up reform proposals for a ministerial meeting in May. … …. Germany’s Björn Kümmel called for “common responsibility and investment in global health preparedness. To defend the status quo or to only implement the so-called low- hanging fruit cannot be an option”….”

Reuters - U.S. and China clash at WHO over scientific mission in Wuhan Reuters;

Surprise, surprise.

Reuters - China defends early actions on COVID-19 after panel report. Also not much of a surprise.

Reuters - Chinese media criticise Pfizer COVID-19 vaccine, tout local shots

Reuters;

“Chinese state media outlets have run a series of articles criticising Western COVID-19 vaccines in the past week, including Pfizer’s, while touting China-made vaccines as safer and more accessible. The reports have come as China’s vaccines, which are being rolled out to countries including Brazil, Indonesia, and Turkey, have faced criticism in the West for insufficient data disclosure. The Global Times, a tabloid published by the People’s Daily, the official newspaper of China’s ruling Communist Party, has published more than ten reports in the past week critical of vaccines and inoculation schemes in the West. About half of them have referred to reported deaths of some highly frail patients in Norway after being inoculated with the COVID-19 vaccine developed Pfizer and its partner BioNTech….”

Foreign Affairs - Wealthy Countries Should Share Vaccine Doses Before It Is Too Late L Gostin, E Friedman & S Moon; https://www.foreignaffairs.com/articles/world/2021-01- 19/wealthy-countries-should-share-vaccine-doses-it-too-late

With quite an equity action agenda, I have to say.

“ …. Instead of hoarding supplies, these [wealthy] countries should reallocate doses to low- and middle-income countries and provide funding to ensure that the most vulnerable populations— including minorities and stateless people—and, ultimately, entire populations are immunized, regardless of income. … … An equitable and truly effective worldwide vaccination program requires wealthy nations to reallocate their vaccine supplies. Canada, the EU, and the United States have all signaled some willingness to share doses that exceed their national needs. But sharing on the margins is insufficient. The EU, the United States, and COVAX should instead devise a plan that commits all countries that have secured doses to reallocating them. High-income countries are already vaccinating their vulnerable populations. But the doses that will be procured later this year— which are expected to be used for the general, low-risk populations of these high-income countries— can still be reallocated to COVAX. …”

“… At the same time, all countries should increase their funding for the Access to COVID-19 Tools Accelerator (ACT-Accelerator), a global collaboration spearheaded by the World Health Organization (WHO) for the equitable distribution of COVID-19 testing and drugs. Doing so could raise the $24 billion that will be needed this year to secure global access not only to vaccines but also to testing, personal protective equipment, and therapies that can aid countries when vaccine access lags. These technologies would allow specialists to track and control the virus’s evolution and spread. “

“… Wealthy countries should commit at least two percent of their COVID-19 spending to response and recovery measures in low- and middle-income countries. … … The next novel outbreak may or may not compare to COVID-19 in magnitude and severity; but to anticipate its eventuality, the WHO, with full support from the world’s governments, should set up a standing fund to cover vaccine

research, development, and allocation. The G-7 or G-20, for example, could spearhead this fund. …”