IHP News 613 : Preparing for the Next Pandemic

IHP news 613 : Preparing for the next pandemic

( 19 March 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,

Last time I checked, the pandemic wasn’t exactly over yet, but nevertheless, the special issues, analyses and reflections on “preparing for the next pandemic” (any takers?) are already popping up like a thousand flowers blossoming in Spring. I do agree with their assessment, though: “The COVID- 19 pandemic has opened a window of opportunity for rethinking the way countries prepare for public-health crises. This window must not be wasted.” Let’s hope we define ‘public health crises’ not just as global health security, but broad enough. I can think of a few more wicked Anthropocene challenges coming in our direction.

Last weekend, the world learnt for the first time about “The Quad”, which sounds like a somewhat dumb superhero team from a Marvel movie. This time, apparently, with Mr Modi in the role of Ironman, while, sadly, Wonder Woman was nowhere to be seen (Unlike in the new WHO Council on the Economics of Health for All, from what we hear).

Anyway, this sort of geopolitical “vaccine diplomacy” - this week even edging a bit closer to a “vaccine war” - should not distract us from the real challenge. On Monday, Tony Blair, of all people, displayed some yogi wisdom when he called for relaxing IP rules for vaccines - pointing out, lest you might have missed it, that we’re in the midst of a pandemic. On social media, Tony hadn’t been this popular for a while. But Tony is right, with his version of ‘If not now, when?’ Even if Rachel Silverman made some valid points in a Washington Post op-ed, this week, some others call this debate a ‘red herring’, and we agree scaling up vaccine production is complicated, in essence there are no good arguments left against the Trips waiver proposal. Paraphrasing a former US president: “It’s a pandemic, stupid”, so if pharmaceutical companies don’t want to share their technology “voluntarily”, governments should make them do so (In China, CEOs go to jail for less ). And if they really do need some “compensation” for that, let’s go for a billionaire tax. Citizens are increasingly going berserk in countries, waiting for vaccines slowly ‘trickling down’, while seeing the US largely “lead from behind” so far on global vaccine equity, behaving like a chicken sitting on her nest. Let’s hope for some breakthrough in the weeks and months ahead. Also, a Trips waiver would be hugely important, symbolically, to show that we’re really all in this together. If not, expect more ugly populism in the years ahead, in addition to many more lives needlessly spilled. At his weekly media briefing last week, John Nkengasong announced that a campaign (Vaccinate Africa 2022) will be launched in the coming weeks, to vaccinate at least 60 % of African citizens by the end of 2022. It would be good if by then, WTO, the US and many others get their act together. #PeoplesVaccine

Enjoy your reading.

Kristof Decoster

Featured Article

Towards post-pandemic protest preparedness

Okikiolu Badejo (PhD Student at the University of Antwerp and ITM Antwerp & Emerging Voice 2018 Fellow)

Large-scale anti-government protests and collective aggression against leadership and government systems have increased in almost every region of the world since the start of the COVID-19 pandemic. With more than 30 significant demonstrations in 26 countries targeting COVID-19 restrictions, the year 2020 was aptly described as “the year of protests”.

A protest is a familiar manifestation of social behaviour that reflects (degrees of) a gap between the government and the governed. Carothers and Press (2020) distinguished four main groups of anti- government COVID-19 related protests: anti-authority lockdown protests, economic hardship lockdown protests, protests against the use of force in COVID-19 responses, and health-worker protests.

The anti-authority lockdown protests, which were the most common, occurred in response to perceived tension between individual freedom ideas vs restrictive public health measures. This type of protest is often, though not solely, driven by misinformation and conspiracy theories and may reflect political polarisation trends and scepticism of science and authority. See for example the thousands who protested in London in September 2020 against the second wave of lockdown restrictions.

Economic hardship lockdown protests made up the second type of protests. They were more common in low and middle income countries (LMICs), and reflected concerns about the impact of lockdown on livelihoods. The third category of protests concerned the use of force in COVID-19 responses, focusing on how restrictions were implemented (in terms of harshness, arbitrariness, and misuse of rules for repressive ends). Finally, health-care workers protested against government responses that left them vulnerable to COVID-19 risks in various countries. In Africa, between March and August 2020 there were 288 COVID-19-related protests by health-care workers calling for better provision of personal protective equipment and better remuneration for extra work done.

While the pandemic is anything but over yet, and various forms of COVID-19 related protests are continuing, there is every reason to believe that mass protests may even increase post-COVID-19 due to economic scarcity and resource competition. Even in settings with low cases or where government responses may have been adequate. Studies on the 2014-16 Ebola epidemic in West Africa and five cholera waves in the 19th century found more rebellions post-epidemic than before and argue that epidemics are incubators of more social disorder (to come). During an active epidemic, epidemic- related protests are very likely to crowd out other concerns. But unresolved pre-epidemic grievances can give rise to stronger post-epidemic protests, especially when there are additional grievances related to the epidemic itself.

The current global fixation on the COVID-19 vaccine assumes that the vaccine will allow a “return to normal” while underestimating the underlying social grievances that may pose a risk to post-pandemic social stability. We have already seen early signs of how wrong this assumption can be from massive

protests like the EndSARS protest in Nigeria and Senegal's recent protests. This highlights the need to look beyond vaccines and engage in more proactive policy action to forestall the worst impact of coming protests.

In short, we better soon get our act together on post-pandemic protest preparedness (PPPP). That obviously requires tackling some of the root causes, even if macro-economic circumstances are anything but easy now.

Highlights of the week

Global report on Ageism

WHO - Global report on ageism https://www.who.int/publications/i/item/9789240016866

“The Global report on ageism outlines a framework for action to reduce ageism including specific recommendations for different actors (e.g. government, UN agencies, civil society organizations, private sector). It brings together the best available evidence on the nature and magnitude of ageism, its determinants and its impact. It outlines what strategies work to prevent and counter ageism, identifies gaps and proposes future lines of research to improve our understanding of ageism.”

WHO (press release) - Ageism is a global challenge: UN https://www.who.int/news/item/18-03-2021-ageism-is-a-global-challenge-un

“Ageism leads to poorer health, social isolation, earlier deaths and cost economies billions: report calls for swift action to implement effective anti-ageism strategies…”

“Every second person in the world is believed to hold ageist attitudes – leading to poorer physical and mental health and reduced quality of life for older persons, costing societies billions of dollars each year, according to a new United Nations report on ageism…..”

Lancet Comment - Ageism: a social determinant of health that has come of age

C Mikton, E Krug et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00524- 9/fulltext

“… Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021– 2030). … Consensus on the meaning of ageism has remained elusive and there is insufficient evidence on the topic. The Global Report on Ageism, to which we all contributed, offers a clear and widely supported definition of ageism as the stereotypes, prejudice, and discrimination directed towards people on the basis of their age. The report highlights that ageism can be institutional,

interpersonal, or self-directed and summarises the best evidence on the scale, impacts, and determinants of ageism against both older and younger people and the most effective strategies to address ageism. Ageism is an important social determinant of health that has been largely neglected until now. …”

“… The evidence reviewed in the report shows that three strategies are effective to reduce ageism: policy and law, education, and intergenerational contact interventions. Policy and law can address discrimination and inequality on the basis of age and protect human rights. Educational interventions across all levels of education can correct misconceptions, provide accurate information, and counter stereotypes. Intergenerational contact interventions are among the interventions that work best to reduce ageism against older people and could also have a role in combating ageism against younger people. …. The Global Report on Ageism makes three recommendations for concrete actions that all stakeholders can take to combat ageism. First, invest in effective strategies to prevent and respond to ageism. Second, fund and improve data and research to better understand ageism and how to address it. Third, build a movement to change the narrative around age and ageing …”

Global Governance & Financing

Devex - Health commission debates WHO-FAO merger after COVID-19 https://www.devex.com/news/health-commission-debates-who-fao-merger-after-covid-19-99414

“Merging the United Nations’ health and food security agencies is one idea being discussed by an expert group convened by the World Health Organization to provide policy recommendations in light of the COVID-19 pandemic. The Pan-European Commission on Health and Sustainable Development, chaired by former Italian Prime Minister Mario Monti, launched in August 2020 and will present its final report this September. A statement released Tuesday shows the direction of the group’s work, as it calls for a “fundamental rethinking of policy priorities well beyond health policies.” Tuesday’s “call to action” floats a range of ideas including: establishing an Intergovernmental Panel on Health Threats, “pan-European measures to ensure the interoperability of health data,” promoting an International Pandemic Treaty, and “[creating] at the G20 level a Global Health Board, modelled on the Financial Stability Board established after the global financial crisis, which can evolve into a Global Public Goods Board that will identify failures in the provision of global public goods and marshal support from the international community to remedy them.”

AP - US, Indo-Pacific allies to expand India’s vaccine production

AP;

After last weekend, we all know “the Quad”. Let’s see whether it also turns into a global health entity of sorts, beyond the current vaccine diplomacy/geopolitics at work.

“President Joe Biden and fellow leaders of the Indo-Pacific alliance known as the Quad announce[d] a plan to expand coronavirus vaccine manufacturing capacity in India. The effort was being announced Friday at a virtual meeting of the leaders of Australia, India, Japan and the United States. It comes as the Biden administration is putting greater emphasis on the Indo-Pacific region in the face of growing economic competition from China. … … The effort by the Quad is projected to

allow India to increase manufacturing capacity by 1 billion doses by 2022, according to two senior administration officials who briefed reporters ahead of the meeting. …”

• See also the Guardian - Scott Morrison joins Joe Biden, Yoshihide Suga and Narendra Modi in plan to send 1bn coronavirus vaccines to Asian and Pacific island countries

“In a joint statement released after the first meeting, the four leaders called for a “transparent and results-oriented reform” of the World Health Organization and said they would work to strengthen climate actions of all nations. … The Quad countries say they will co-ordinate with COVAX – the international buying facility for vaccines – and raise manufacturing capabilities in India through that country’s Bio E vaccine manufacturing company….”

• And the NYT - Biden Takes First Tentative Steps to Address Global Vaccine Shortage

“Under pressure to play catch-up on “vaccine diplomacy,” President Biden says he will help finance vaccine manufacturing capacity but is still resisting exports of doses.”

Devex - In Brief: Health groups urge Biden to name PEPFAR leader https://www.devex.com/news/in-brief-health-groups-urge-biden-to-name-pepfar-leader-99434

“Fourteen organizations working to fight HIV have called on U.S. President Joe Biden to nominate a new U.S. global AIDS coordinator and U.S. special representative for global health diplomacy — the position previously held by Dr. Deborah Birx. In a March 16 letter, which Devex obtained, the groups urge Biden “to safeguard the integrity” of the U.S. President’s Emergency Plan for AIDS Relief — or PEPFAR — at a time when the COVID-19 pandemic has caused “grave disruptions to HIV service delivery and threats to the human rights of communities that are highly marginalized and vulnerable.”

“… The concern: The lack of a nominee to lead the U.S. government’s flagship HIV/AIDS program has caused some in the global health community to worry about the Biden administration’s commitment to PEPFAR. With all eyes on the COVID-19 pandemic, there are questions about whether the White House might try to restructure U.S. international health programs with a view toward strengthening health systems, instead of fighting specific diseases.”

HPW - ‘WHO As Fragile As It Is Indispensable’ – Report Probes Geneva Global Health Hub’s Response To COVID Crisis https://healthpolicy-watch.news/who-as-fragile-as-it-is-indispensable-report-probes-international- geneva-response-to-covid-crisis/

“One year after the World Health Organization (WHO) declared the coronavirus outbreak a pandemic on 11 March 2020, a new report by the Foundation for Geneva has traced the success and the failures of the WHO and other international Geneva organisations in their response – as well as the implications for the future of multilateralism….”

HPW - WHO Solidarity Fund Raises over $242 million From Global Community https://healthpolicy-watch.news/who-solidarity-fund-raises-over-242-million/

“Over 662,000 people, hundreds of corporations and organisations from 190 countries have donated $242 million to the COVID-19 Solidarity Response Fund in the past year, according to Elizabeth Cousens, CEO of the UN Foundation. Addressing the World Health Organization (WHO) biweekly media briefing on Monday, the first anniversary of the fund, Cousens said the fund had been a demonstration of global solidarity. “In just six weeks, we raised more than $200 million, and to date the fund has dispersed more than $226 million, making it one of the top donors to WHO’s COVID-19 response,” said Cousens….” The Fund covered Millions of Items of PPE, COVID Tests and ICU Beds.

See also WHO - COVID-19 Solidarity Response Fund marks first anniversary and appeals for continued support

“… The fund helps WHO to deploy lifesaving supplies, information and research to countries across the globe. An additional US$ 1.96 billion is needed for WHO in 2021 to continue coordinating global pandemic response, more than 60% will go towards requirements for the Access to COVID-19 tools, including diagnostics, treatments and vaccines…. … The recently launched WHO Foundation will lead the next phase of the Solidarity Response Fund to support the continuing fight against the COVID-19 pandemic, working in collaboration with the United Nations Foundation and a global network of fiduciary partners….”

WHO - ACT-A prioritized strategy and budget for 2021 https://www.who.int/publications/m/item/act-a-prioritized-strategy-and-budget-for-2021

Update as of 12 March. “Topics covered include: key achievements, priorities in 2021, maximizing impact, the funding gap…”

Speaking of the funding gap: “…Despite generous donor contributions amounting to US$ 11.0 billion to date, ACT-Accelerator continues to require an additional US$ 22.1 billion in 2021 to deliver on its full promise…”

And have a good look at especially the Health Systems Connector pillar. In terms of its relatively limited ambition, as well as huge remaining funding gap.

PS: (cfr an LSE webinar on Wednesday), dr. Tedros sees a long term future for ACT-A, beyond this pandemic. As part of global pandemic preparedness, and a Global Public Good.

Devex – Advocates: UK Integrated Review spells end of 'development superpower status' https://www.devex.com/news/advocates-uk-integrated-review-spells-end-of-development- superpower-status-99419

“A major U.K. government foreign policy review has heralded the end of the country’s status as a “development superpower” and is “laden with contradictions,” according to aid advocates. The Integrated Review of Security, Defence, Development and Foreign Policy pays relatively little attention to development. Security — including the expansion of the United Kingdom’s nuclear arsenal — resilience, and international contests are the dominant themes of the paper, dubbed “Global Britain in a Competitive Age.” …”

Guardian - WHO scientist who spoke out about Italy's handling of Covid crisis resigns https://www.theguardian.com/world/2021/mar/14/who-scientist-who-spoke-out-about-italy- handling-of-covid-crisis-resigns?CMP=share_btn_tw

Not exactly great PR for WHO in the current times.

GAVI - Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID announce innovative collaboration to support health supply chain leaders in low- and middle-income countries https://www.gavi.org/news/media-room/gavi-vaccine-alliance-global-fund-fight-aids-tuberculosis- and-malaria-and-usaid

“A new partnership between three donor agencies jointly offers an updated version of the Strategic Training Executive Programme, known as STEP 2.0; The transformative programme will increase supply chain efficiency to improve health outcomes for many countries struggling to access medicines or other health commodities; Managed by People that Deliver (PtD), the programme will pair public health supply chain leaders with private sector supply experts to enhance the management capacity of immunisation supply chains…”

Nature Medicine (special collection): Preparing for the next pandemic https://www.nature.com/collections/ibajaahdgh

“Nature Medicine launches a special Focus dedicated to understanding the long-term impact of the COVID-19 pandemic, and to begin to explore the lessons that can be drawn from the mistakes in handling the current health crisis in order to prepare for future ones.”

Lots of great articles. But start with the Editorial: “The COVID-19 pandemic has opened a window of opportunity for rethinking the way countries prepare for public-health crises. This window must not be wasted.”

The Editorial provides an overview of the papers in this Collection. Check them out.

Among others, Promoting diagnostics as a global good (by M Pai) “The COVID-19 pandemic has reasserted the central role of effective diagnostics in the response to outbreaks. But a lack of coordination still hampers widespread access to these critical tools. A diagnostics agenda for global

health is urgently needed for the promotion of diagnostics as a global good and to ensure their delivery.”

And a take by John Nkengasong :”… preparing for the next pandemic will require that we review how our current health-security-governance architecture is structured and has evolved over the years….”

PS: BMJ Global Health also has some articles to ‘prepare for the next pandemic’.

See for example Tom Frieden et al - The world must prepare now for the next pandemic

“…the world needs four inter-related and substantial changes: substantial new funding; improved country and global governance, robust technical support, and rigorous accountability. Success will require at least US$5-10 billion a year of new funding for at least a decade, with efficient financial mechanisms, stronger commitment to collaboration and new ways of working together that recognise the reality—so vividly illustrated by the COVID-19 pandemic—of our mutual dependency and mutual accountability….”

Telegraph – Countries should prioritise spending on health like defence, economist says https://www.telegraph.co.uk/global-health/science-and-disease/countries-should-prioritise- spending-health-like-defence-economist/

Coverage of LSE webinar this week, with Tedros, Mazzucato & Clare Wenham. “Failure to see health as a global public good is what got the world in this mess, the academics said”

“The world needs to prepare for future pandemics with the same urgency as it approaches fighting wars, according to a leading economist. … Covid-19 has shown that there is money available for public health in emergencies if needed, but improving preparedness would be a much better spend, Professor Mariana Mazzucato told a special lecture hosted by LSE’s Department of Health Policy and the Global Health Initiative on Tuesday…”

BMJ GH Commentary – Preparing international cooperation on pandemic prevention for the Anthropocene C Carlson, A Phelan et al; https://gh.bmj.com/content/6/3/e004254

“Anthropogenic stressors like climate change, land degradation, and wildlife trade are all risk factors for the future emergence of infectious diseases. Multilateral cooperation to reduce human footprints on natural systems will help reduce the spillover of emerging infections, but cannot necessarily prevent pandemics. Particularly given the fragility of international environmental cooperation, global health needs a strategy for pandemic prevention tailored to the Anthropocene. Future pandemic preparedness must include law and policy reform, health system strengthening, universal healthcare, and open and participatory science.”

Covid-19 key news

The usual key WHO messages & trends in this section. The AstraZeneca vaccine was “in the news” as well, as you no doubt noticed.

Cidrap News - Global COVID-19 cases rise for third week in a row https://www.cidrap.umn.edu/news-perspective/2021/03/global-covid-19-cases-rise-third-week-row

“In its latest snapshot of pandemic activity, cases rose 10% last week with upticks across several regions, the World Health Organization (WHO) said, marking a continuing reversal of a decline in the first months of the year. … All of the WHO regions saw increases last week except for Africa, though 80% of the new cases and deaths were from the Americas and Europe, the group said in its weekly situation report. Though deaths continue to decline overall, they increased last week in two WHO regions: the Eastern Mediterranean and the Western Pacific….”

Reuters - Benefits outweigh the risks of AstraZeneca COVID shot as review continues: WHO Reuters;

“A World Health Organization (WHO) vaccine safety panel said on Wednesday that it considers that the benefits of the AstraZeneca COVID-19 vaccine outweigh its risks and recommends that vaccinations continue….”

“ The WHO said its Global Advisory Committee on Vaccine Safety is carefully assessing the latest available safety data for the AstraZeneca vaccine. “Once that review is completed, WHO will immediately communicate the findings to the public,” WHO said in its statement a day after its experts held a closed-door meeting. “At this time, WHO considers that the benefits of the AstraZeneca vaccine outweigh its risks and recommends that vaccinations continue,” it added….”

See also UN News - Health experts give green light to Janssen COVID jab, allay clotting concerns

“The Janssen COVID-19 vaccine was publicly approved for international use on Wednesday by UN health agency expert advisory board, SAGE, which allayed concerns over clotting events being associated by some countries, without definitive evidence, with coronavirus jabs. … The expert panel also noted that clotting episodes - also known as hypercoagulable events - were a symptom of COVID-19, amid the suspension of the AstraZeneca/Oxford vaccine by several European countries, pending scientific review….”

PS: via Reuters - WHO vaccine safety panel to issue findings on AstraZeneca on Friday: spokesman

Reuters – African Union says benefits outweigh risks of AstraZeneca COVID shot

“The African Union said on Thursday that it considers that the benefits of AstraZeneca’s COVID-19 vaccine outweigh the risks and recommended that vaccinations continue across the continent…. “

Telegraph - WHO urges African countries to continue using AstraZeneca jab amid blood clot fears

“The World Health Organization has sought to calm fears amongst African officials about the safety of the Oxford-AstraZeneca vaccine after several European nations halted their roll outs over concerns the jab might cause blood clots in a few patients. Dr Richard Mihigo, the WHO’s head of immunisation in Africa, said that he was worried that African countries would start losing faith in the product and emphasised that the vaccine is safe to use based on current evidence….”

FT – EU drugs regulator backs ‘safe and effective’ AstraZeneca vaccine

The view from EMA on Thursday. “The AstraZeneca coronavirus vaccine is “safe and effective” and its benefits outweigh the risks, Europe’s medicines regulator has said, but it would continue to study possible links between the shot and a very rare blood clotting disorder….”

But see this tweet from Peter Hotez: “Yes but it doesn’t quite work that way. When major and serious countries like Germany and France voice serious concerns, with the former issuing an ominous document 2 days ago, and Fr with ties to Francophone Africa, who will do the damage control? A mess.”

See also FT - European pause in AstraZeneca jab risks rollout in developing states

“The pause in the Oxford/AstraZeneca vaccine rollout across Europe this week threatens to undermine immunisation campaigns in developing countries that rely almost exclusively on the jab, say health experts and policymakers. Calling the decision by a number of European governments to halt its use “irresponsible”, Dr Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, said many poorer countries did not have the luxury of choice but were relying on the relatively cheap and easy-to-store AstraZeneca jab….”

“Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, said it was hard to reverse negative public sentiment towards a vaccine once its safety had been questioned…. Larson said that the unhelpful messaging coming from Europe needed to be countered by trusted community leaders rather than distant politicians or regulators. …”

Science - ‘It’s a very special picture.’ Why vaccine safety experts put the brakes on AstraZeneca’s vaccine https://www.sciencemag.org/news/2021/03/it-s-very-special-picture-why-vaccine-safety-experts- put-brakes-astrazeneca-s-vaccine

“European doctors see an unusual combination of blood clots, low platelet counts, and internal bleeding in more than 13 vaccinated people.”

“The decision this week by more than 20 European countries to temporarily stop using AstraZeneca’s COVID-19 vaccine has opened a rift between vaccine safety experts, who say the cases of serious clotting and bleeding that triggered the pause are alarming and unusual, and public health officials concerned that the immunization pause on a continent in the grip of the pandemic’s third wave could take a heavy toll….”

See also Economist (Leader) - Another shot in the foot

“How Europe’s vaccine caution can cost lives; Avoid a small risk; incur a bigger one.”

And from earlier this week (Tuesday), via Geneva Health Files:

“The implications of how this vaccine, and the others, will be perceived are likely to be critical to fight vaccine hesitancy the world over. Inevitably it will also set off discussions on liability arising from such events. … As has been pointed out, the AZ vaccine has been the backbone of The COVAX Facility that aims to service large parts of the developing world. So, while rich countries may decide against the use of the vaccine, other countries may not have that choice. In fact, poorer countries may even come to gain from this discretionary policy of rich countries. This will also depend how excess doses be routed through the COVAX Facility, for example…. “

HPW - Tedros Challenges Brazilian Govt to Take Pandemic Seriously – WHO Approves J&J Vaccine https://healthpolicy-watch.news/tedros-urges-brazilian-govt/

Doesn’t happen very often, that WHO singles out a country. On last week Friday’s media briefing: “The Brazilian government needs to enforce “serious social measures” to contain the virus before it overwhelms its health facilities, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the body’s weekly COVID-19 briefing….”

UN News - WHO green lights Johnson & Johnson shots https://news.un.org/en/story/2021/03/1087222

News from last week, on Friday. “… WHO also announced it had given clearance to the vaccine developed by Janssen (Johnson & Johnson), for emergency use in all countries and for the international UN-partnered effort to roll-out vaccines equitably across the world, COVAX. The decision comes on the back of the European Medicines Agency (EMA) authorization, which was announced on Thursday….”

The Johnson & Johnson vaccine is the fourth COVID-19 vaccine to be listed for emergency use by the WHO, a key step that paves the way for it to be used in developing countries (and Covax).

And via HPW: “COVAX…. has already pre-ordered 500 million J&J doses in anticipation of its approval…. Meanwhile, a shortage of supplies such as glass vials is limiting the production of COVID-19 vaccines and could also “put the supply of routine childhood vaccines at risk’, said Tedros…”

“… WHO special advisor Bruce Aylward and the body’s COVAX representative said that COVAX “is trying to work with the company” to get the vaccine by July…. WHO Chief Scientist Soumya Swaminathan said that the WHO was ready to help J&J and any other vaccine manufacturers to expand their capacity, adding that COVAX partner the Coalition for Epidemic Preparedness

Innovation (CEPI), had identified “fill and finish capacity that is immediately available to any company to expand supplies”. …”

HPW -Kenya Confirms Third Wave of COVID-19 https://healthpolicy-watch.news/kenya-confirms-covid-19-third-wave/

“Kenya has officially announced a third wave of the COVID-19 outbreak this week, while the World Health Organization’s (WHO) Africa region reported a “slight uptick in cases and an upward trend in 12 countries, including in Cote d’Ivoire, Ethiopia and Cameroon.”…” “…Dr Matshidiso Moeti, WHO Regional Director for Africa, during the weekly press conference said there was an upward trend in some countries. …”

“… Africa Centres for Disease Control (CDC) director John Nkengasong told last week’s WHO Africa briefing that “we are beginning to see the beginning of a third wave in East Africa.” “

UN News - COVID-19 has exposed endemic gender inequality, Guterres tells UN Women’s commission https://news.un.org/en/story/2021/03/1087392

“The COVID-19 pandemic is having a devastating impact on women and girls, and the fallout has shown how deeply gender inequality remains embedded in the world’s political, social and economic systems, UN chief António Guterres said in his address to the Commission on the Status of Women, on Monday. This year’s Commission will focus on charting a global roadmap towards achieving full equality in public life but, as Mr. Guterres recalled in his speech, gender equality in all walks of life is a long way off and has been further undermined by the pandemic….”

See also Devex - The care economy costs women. It’s time to pay up, advocates say at CSW

“ COVID-19 has shown the economy depends on women’s unpaid work. Short-term responses should be rolled into systemic change, according to experts at the 65th session of the Commission on the Status of Women.”

“… UNDP’s short-term social protection scheme, unveiled March 4, proposes that low-income countries redirect 0.07% of their gross domestic product each month to a temporary basic income for women experiencing severe socioeconomic stress due to the pandemic. … As pandemic recovery begins, short-term, gender-sensitive responses can be rolled into long-term plans for systemic change, according to Lagunas and other gender experts taking part in the virtual 65th session of the United Nations Commission on the Status of Women, or CSW, this week…”

WHO Points To Wildlife Farms In Southern China As Likely Source Of Pandemic https://www.wbur.org/npr/977527808/who-points-to-wildlife-farms-in-southwest-china-as-likely- source-of-pandemic

“A member of the World Health Organization investigative team says wildlife farms in southern China are the most likely source of the COVID-19 pandemic. China shut down those wildlife farms in February 2020, says Peter Daszak, a disease ecologist with EcoHealth Alliance and a member of the WHO delegation that traveled to China this year. During that trip, Daszak says, the WHO team found new evidence that these wildlife farms were supplying vendors at the Huanan Seafood Wholesale Market in Wuhan with animals. Daszak told NPR that the government response was a strong signal that the Chinese government thought those farms were the most probable pathway for a coronavirus in bats in southern China to reach humans in Wuhan. …”

Guardian - Poorest countries will suffer most from Covid downturn, says UN https://www.theguardian.com/business/2021/mar/18/poorest-countries-will-suffer-most-from- covid-downturn-says-un

“Unctad agency says international cooperation has fallen well short of what is needed given scale of crisis.”

“… “The brunt of the hit to the global economy is being felt in developing countries with limited fiscal space, tightening balance of payments constraints and inadequate international support, Unctad said….”

See also UN News - No winners but fewer losers in global economy from COVID than expected

“The COVID-19 pandemic seriously impacted all economies around the world last year, with trillions of dollars of lost earnings, UN trade and development experts UNCTAD said on Thursday, before highlighting how several countries also showed unexpected resilience, too….”

Reuters – Still no deal on IMF reserve boost for pandemic relief: sources https://www.reuters.com/article/us-imf-g7-sdr/still-no-deal-on-imf-reserve-boost-for-pandemic- relief-sources-idUSKBN2B91GA

“G7 advanced economies are still discussing a proposal to boost International Monetary Fund reserves for pandemic relief, several sources close to the discussion said on Wednesday, dismissing a report that a deal had been reached….”

Covid-19 Science

WSJ - South Africa’s Drop in Covid-19 Cases Adds to Questions About Waves of Infections https://www.wsj.com/articles/south-africas-drop-in-covid-19-cases-adds-to-questions-about-waves- of-infections-11615734003

“Surprising decline after surge shows scientists still have much to learn about how the coronavirus moves through society.”

“…Since mid-January, confirmed Covid-19 infections in South Africa have fallen from a record of nearly 22,000 a day to around 1,000, without a large-scale vaccination campaign or stringent lockdown. Fewer than 5% of Covid-19 tests are finding traces of the virus, a sign that health agencies are missing fewer cases. The government has lifted most of its remaining virus restrictions for the country of 60 million people. The cause of this steep decline in cases remains somewhat of a mystery. As in other countries that have at some point experienced surprising drops in Covid-19 cases—such as India, Pakistan and some parts of Brazil— epidemiologists and virologists are piecing together different explanations for why the outbreak in South Africa isn’t following patterns set elsewhere… Those range from important population groups reaching sufficient levels of immunity to slow down transmission, to people sticking more closely to social-distancing rules, such as wearing masks and voluntarily reducing contacts, when deaths were mounting before the decline….”

WP - ‘An accelerated cauldron of evolution’: Covid-19 patients with cancer, HIV, may play a role in emergence of variants https://www.washingtonpost.com/health/2021/03/11/immunocompromised-patients-covid- variants/

“Some hospitalized patients with weakened immune systems were shown to have mutating viruses months before the variants were discovered in the outside world.” So basically, Covid-19 patients with weakened immune systems could be ‘incubators’ for the mutating virus.

Reuters -Exclusive: Regular booster vaccines are the future in battle with COVID- 19 virus, expert says Reuters;

“Regular booster vaccines against the novel coronavirus will be needed because of mutations that make it more transmissible and better able to evade human immunity, the head of Britain’s effort to sequence the virus’s genomes told Reuters….”

Reuters - COVID-19 reinfection rare, but more common in older people, study finds Reuters

Coverage of new Lancet study. “The majority of people who have had COVID-19 are protected from getting it again for at least six months, a study published on Wednesday showed, but older people are more prone to reinfection than younger people….”

Nature (News) – Has COVID peaked? Maybe, but it’s too soon to be sure https://www.nature.com/articles/d41586-021-00705- 9?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“Global COVID-19 cases have fallen significantly since they peaked in early January. Scientists are asking whether this is the beginning of the end of the pandemic.”

“…Ramanan Laxminarayan, an epidemiologist at Princeton University but based in New Delhi, India, is optimistic that the pandemic peaked in January. More waves are possible, and they might even reach new regional highs. But in terms of new cases and deaths globally, “the worst is behind us”, he argues….”

“…But some researchers urge caution when interpreting global trends. They point to blind spots in our understanding of the pandemic’s toll and the length of protection against reinfection, as well as the unpredictability of viral biology and people’s behaviour….”

Nature (News) – Five reasons why COVID herd immunity is probably impossible https://www.nature.com/articles/d41586-021-00728-2

“Even with vaccination efforts in full force, the theoretical threshold for vanquishing COVID-19 looks to be out of reach.”

UN News - Do not use weather as a basis to relax COVID-19 control measures, UN agency urges https://news.un.org/en/story/2021/03/1087652

“The UN weather agency on Thursday cautioned that the current onset of warmer temperatures in the northern hemisphere should not be used as a trigger to relax measures to halt the spread of coronavirus. “

“In a new report, the UN World Meteorological Organization (WMO) highlighted that contrary to popular assumptions about warm weather dampening viral spread, infections rose in late spring – and that “there is no evidence” that this year would be any different. “At this stage, evidence does not support the use of meteorological and air quality factors as a basis for governments to relax their interventions aimed at reducing transmission,” Ben Zaitchik, co-chair of an interdisciplinary and international WMO Task Team that produced the report, said. …”

And links:

HPW - Novavax Vaccine Shows High Efficacy Against Original COVID Virus – Less So For Variants; Sputnik V Vaccine To Be Produced In Italy

Covid-19 Vaccine access (and other bottlenecks)

Washington Post - Waiving vaccine patents won’t help inoculate poorer nations

R Silverman (CGD) https://www.washingtonpost.com/outlook/2021/03/15/vaccine-coronavirus- patents-waive-global-equity/

This stance caused a stir this week. Must-read.

Cfr a tweet by her colleague Charles Kenny: “@rsilv_dc argues that compulsory licensing and IP wavers are a useful stick to keep in reserve, but cooperation and voluntary licensing likely to lead to more global Covid vaccine production faster. (To which I'd add: contract transparency!) “

Rachel Silverman apologized for the title and clarified: “… And I specifically argue that activist pressure on IP, plus the threat of compulsory licensing (with support/non-retaliation from rich governments) is important as a condition for pharma to do the right thing...or else….”

HPW - EU Ambassador Says Europe Supports COVAX, Not TRIPS Waiver https://healthpolicy-watch.news/eu-ambassador-says-europe-supports-covax/

Yeah, we got that by now, unfortunately. “Although the European Union (EU) is opposed to the proposal by South Africa and India urging the World Trade Organisation (WTO) to waive intellectual property (IP) rights on COVID-19 products for the duration of the pandemic, the EU will support the expansion of vaccine access in Africa. This is according to the EU Ambassador to the African Union, Birgitte Markussen, who told a recent AU media briefing that the EU is putting its full weight behind the COVAX Facility to ensure that African countries are able to vaccines, rather than supporting the waiver proposal….”

“Meanwhile, Africa CDC Director John Nkengasong, Director of the Africa CDC, said the center is keen on ensuring that African institutions including the Institut Pasteur de Dakar in Senegal are capable of producing COVID-19 vaccines to ensure that African countries are able to have quick access to the vaccines especially when additional doses are needed.”…”

FT - Indian vaccine makers decry US use of wartime powers to protect supplies https://www.ft.com/content/7225cbad-8523-425f-b82c-d49b80c39417

“Pharmaceutical chiefs say world production is threatened by US Defense Production Act.”

“Two of India’s top vaccine manufacturers making AstraZeneca and Johnson & Johnson shots have warned that the world’s vaccine production is being threatened by America’s pandemic export controls. Mahima Datla, chief executive of pharmaceutical company Biological E, said US suppliers claim they may not be able to fulfil orders to global clients because of Washington’s use of the Defense Production Act. Calling for urgent international intervention, Datla told the Financial Times: “It’s not only going to make the scale up for Covid vaccines difficult, but because of this it’s going to make manufacturing of routine vaccines extremely difficult.” … … On Friday, Tedros Adhanom

Ghebreyesus, World Health Organization director-general, also warned of global shortages of vital components, which were limiting the production of Covid-19 shots but also jabs used for routine childhood immunisations. He said some countries had imposed legal restrictions, which was “putting lives at risk” and called on nations not to stockpile supplies. “We’re all interdependent,” he said. “No country can simply vaccinate its way out of this.”…”

TWN - WHO DG criticizes countries “putting lives at risk” in Covid-19 fight https://www.twn.my/title2/health.info/2021/hi210307.htm See also this in-depth analysis: “Without naming the United States, the European Union, and the United Kingdom, the WHO Director-General Dr Tedros Adhanom Ghebreyesus has criticized “some countries” that are “putting lives at risk around the world” in the fight against the COVID-19 pandemic which has so far claimed more than 2.6 million lives globally. The three countries along with Norway, Japan, and Switzerland as well as Big Pharma have continued to block an early outcome on the TRIPS waiver proposal co-sponsored by South Africa and India along with 55 other countries at the World Trade Organization, according to people familiar with the development. In addition to blocking by these six countries of the TRIPS waiver proposal, which has been endorsed by the WHO DG as one of the main approaches to combat COVID-19, they have now escalated their export restrictions on the vital supplies of raw materials even to those vaccine manufacturers that they had contracted with, according to media reports….”

“… Two major vaccine manufacturing companies from India – Biological E Ltd which has contracted with Johnson & Johnson to produce its one-shot vaccine, and the Serum Institute of India to produce the AstraZeneca vaccine – said they may not be able to fulfill global orders because of Washington’s use of the Defense Production Act (DPA), according to a report in the Financial Times on 15 March. Under the Defense Production Act used as wartime powers to solve major production-related problems, the Biden Administration has identified critical supply shortages of 12 items (coronavirus tests, N95 masks, isolation gowns, nitrile gloves and vaccine syringes among others) needed to help combat the coronavirus pandemic….”

PS: … In a report issued by the Institute for New Economic Thinking on 11 March on “The Pandemic and the Economic Crisis: A Global Agenda for Urgent Action”, Prof. Stiglitz said “insufficient production is an important reason for the poor and unequal distribution, since it has created scarcity.” …

Bloomberg – Vaccine nationalism threatens WHO’s 2021 goal of 2 billion doses Vaccine Nationalism Threatens WHO’s 2021 Goal of 2 Billion Doses

“Vaccine nationalism in countries including the U.S. and India is likely to derail efforts by the World Health Organization to deliver 2 billion doses to poorer and middle-income nations by the end of the year, according to the head of the world’s biggest vaccine maker. Countries are holding tight to their supplies and restricting access to materials needed to make more, said Adar Poonawalla, chief executive officer of the Serum Institute of India Ltd. The company is responsible for providing more than half of the shots used so far in the WHO-backed Covax program that aims to provide equitable vaccine access across the world. …”

“Many manufacturers, including Serum, already have missed timelines and commitments, Poonawalla said in an interview with Bloomberg Live that aired on Wednesday for the Bloomberg

Equality Summit. It will take two to three months for shipments to Covax to really pick up, and reaching the 2021 target of 2 billion doses will be challenging, he said, predicting it will “spill over by a few months.” …”

“… As a manufacturing giant, India has sought to portray itself as a generous benefactor through targeted vaccine diplomacy, while seeking to outdo regional rival China. At the same time, New Delhi has tightly controlled the deployment of the doses it has, mostly supplied by Serum, which is making the shot developed by AstraZeneca Plc and Oxford University. Indian officials have also requested more vaccines than initially expected from the company, said Poonawalla.” “… Poonawalla reiterated his concerns over impending bottlenecks caused by “raw materials nationalism” after the U.S. invoked the Defense Production Act this month to safeguard supplies of items, such as bags and filters, for its own manufacturers….”

HPW - Delayed Delivery Of Vaccines Procured By Africa CDC Threatens Timeline For Achieving ‘Herd Immunity’ https://healthpolicy-watch.news/delayed-vaccine-delivery-threatens-africas-herd-immunity-target/

“Africa’s goal of achieving herd immunity against COVID-19 hangs in the balance as 270 million doses of vaccines are yet to arrive in the continent despite being secured three months ago by the African Union (AU) and African Centres for Diseae Control (ACDC). Mid-January 2021, Health Policy Watch reported that the Africa CDC had pre-ordered millions of much-needed vaccines from various suppliers. But to date not even the centre’s leadership knows when the first set of shipment is due to arrive – or which country will be the first to receive the doses….”

Geneva Health Files Could Vaccine Nationalism Spur Disputes At The WTO; TRIPS Waiver Talks Update P Patnaik; https://genevahealthfiles.substack.com/p/could-vaccine-nationalism-spur-disputes

“… In our story this week, we explore the possibility of whether vaccine nationalism can result in disputes at the WTO. The opinion on this divided. … We also bring you a brief update on the TRIPS waiver discussions at the TRIPS Council meeting at WTO from earlier this week….”

“…Experts believe that the solution to vaccine nationalism is not filing disputes, but negotiations. But lawyers anticipate disputes even if filed simply for political leverage….”

On the TRIPS Waiver talks: “… The way these consultations on the waiver proposal will proceed over the coming weeks will be subject to factors including on how the DG brings together opposing groups, her emphasis on voluntary approaches to address the pandemic and a call by some members to engage with the industry. Forces outside of the WTO discussions will also play an active role in the future of the waiver proposal. (The Geneva Observer reported that the recent vaccine summit was an attempt “to cut the legs from the WTO [waiver] proposal”.)…”

Quote: “…We spoke to a Geneva-based trade lawyer to understand how the TRIPS waiver discussions were being viewed: “I mean to be perfectly honest, the law is what we want it to be, you know, so if if there is political will , sure we could have a waiver”….”

TWN - Strong support for TRIPS waiver amidst opposition by Big Pharma https://www.twn.my/title2/intellectual_property/info.service/2021/ip210306.htm

More coverage and analysis of last week’s TRIPS Council meeting.

“More than 100 countries have upped the stakes for text-based negotiations on the TRIPS waiver proposal that seeks to temporarily suspend certain provisions of the WTO’s TRIPS Agreement in combating the COVID-19 pandemic, amidst attempts by Big Pharma to kill the waiver proposal, said people familiar with the development. Ahead of the WTO’s TRIPS Council meeting on 10 March, the representatives of Big Pharma wrote to President Joseph Biden that the “US government has stood alongside other governments, including the European Union, United Kingdom, Japan, Canada, Switzerland, Brazil, and Norway to oppose this waiver.” “We urge your administration to maintain this longstanding support for innovation and American jobs by continuing to oppose the TRIPS waiver,” said the CEOs of Pfizer, AstraZeneca, PhRMA (Pharmaceutical Research and Manufacturers of America), Eli Lilly, Bristol Myers Squibb, Gilead Sciences, Merck, Sanofi, Takeda Pharmaceuticals, Novartis, Abbvie, Bayer AG, Amgen Inc, and Biogen among others….”

Devex - Exclusive: Tony Blair calls for relaxing IP rules for vaccines https://www.devex.com/news/exclusive-tony-blair-calls-for-relaxing-ip-rules-for-vaccines-99407

“World leaders should be doing more to push for the relaxation of intellectual property rules around vaccines and health technologies, according to former U.K. Prime Minister Tony Blair. In an interview with Devex, the U.K. politico — now founder and head of the Institute for Global Change — said the world “can't end up with constraints that had to do with normal times prevailing in what are completely abnormal times.”…”

The India Forum - The Political Economy of Covid-19 Vaccines J Ghosh; https://www.theindiaforum.in/article/political-economy-covid-19-vaccines

Jayati Ghosh analyzes the political economy of Covid-19 vaccines.

Reuters - As vaccine nationalism deepens, governments pay to bring production home https://www.reuters.com/article/health-coronavirus-vaccine-supply-insigh-idUSKBN2B40IX

Includes this quote: “… But large manufacturing sites are the most efficient and at some point, extra capacity spread across many countries may not be economical. Prashant Yadav, a senior fellow at the U.S.-based Center for Global Development, said the advantages of scale kick in once you can produce at least 100 million doses per year. He believes four or five countries could likely scale up without raising costs, but if many build small operations, “I think we get to a point where everybody will end up paying a higher price.”…”

Canadian company requests for licence to manufacture J&J’s COVID-19 vaccine, may stir up patent war https://www.moneycontrol.com/news/business/companies/canadian-company-requests-for- licence-to-manufacture-jjs-covid-19-vaccine-may-stir-up-patent-war-6639131.html/amp

Could be an interesting development: “Biolyse has warned that if J&J denies licence, it can invoke a compulsory licensing provision in Canada to manufacture and export the vaccine. The Biolyse move may make other pharma companies in India and elsewhere to take notice. Though India has granted such a licence to Natco Pharma for Nexavar in 2012….”

Lancet Letter- Free licensing of vaccines to end the COVID-19 crisis K Bozorgmehr, D Stuckler, M McKee et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00467-0/fulltext

“… It is not, however, too late to take bold measures to increase production. Ideally, an agreement could be reached with the patent holders to make the relevant intellectual property available. However, if this agreement is not possible, compulsory licensing is possible (ie, when a government grants permission to someone else to produce a patented product)…. … The EU should also use all instruments that are available, including compulsory licensing, to overcome the delays in vaccine production and to protect public health in this unprecedented crisis….”

Devex - ADB approves first loan under its COVID-19 vaccine access facility to the Philippines https://www.devex.com/news/adb-approves-first-loan-under-its-covid-19-vaccine-access-facility-to- the-philippines-99389

“The Asian Development Bank is providing the Philippines a $400 million loan for the procurement of COVID-19 vaccines. This is the first loan the bank is providing under its $9 billion Asia Pacific Vaccine Access Facility announced in December 2020…. “

Devex – Interactive: What does the data show about COVID-19 vaccine diplomacy? https://www.devex.com/news/interactive-what-does-the-data-show-about-covid-19-vaccinediplomacy-99416

Excellent overview of the vaccine diplomacy so far (by India, China, Russia, …).

“More than 20 million doses of COVID-19 vaccines have been donated directly to 81 low- and middle-income countries, as part of rapidly growing vaccine diplomacy. … Leading the charge is China and India, now in neck and neck battle to be seen as the most generous vaccine donor. As of March 18. India, which prefers to “grant” vaccines, has announced 8.1 million doses supporting 37 countries. China has donated 7.9 million doses of COVID-19 vaccines to 33 countries….”

Politico - Vaccine diplomacy: Asia flooded, Africa deserted https://www.politico.com/newsletters/global-translations/2021/03/12/vaccine-bombshell-day- 492092

Analysis after the news on the Quad meeting. “… Global Translations spoke to Strive Masiyiwa, the Zimbabwean telecoms billionaire who heads the African Vaccine Acquisition Task Team (AVATT) set up by the African Union. … Speed, not price, the biggest issue: Masiyiwa doesn’t mince words. He wants 60 percent of Africans vaccinated in 2021: “We expect COVAX to do 30 percent. And we do 30.” While 22 African countries have received vaccines through the COVAX program, Masiyiwa has a clear message to Western governments: “your factories haven't released a single vaccine to us.”…”

Do scan also The Hill - Inside Africa's world-leading coronavirus supply chain

“… Less than a year after its inception, the African Medical Supplies Platform hosts more than 600 suppliers selling products that can help combat the coronavirus through an interface that is no more complicated than Amazon.com. Access is limited to countries, health systems, nongovernmental organizations and donor organizations like UNICEF. Middlemen are not welcome. Those involved in the product’s development and those who have watched its early operations say it could become a model for the world, even after the pandemic subsides. It connects customers with suppliers across the globe, and African manufacturers with customers in search of their wares….”

LA Times - Op-Ed: Most of the world has no COVID-19 vaccine. That’s a huge global threat P Hotez; https://www.latimes.com/opinion/story/2021-03-13/vaccine-shortage-development-africa- asia

Hotez argues for, among others, building/expanding vaccine development capacity all over the globe: “… the lack of durable, easy-to-scale and effective COVID-19 vaccines reminds us of the urgency to shape a new or parallel framework. A long-term solution is to build or expand vaccine development capacity in Africa, the Middle East, Latin America and other regions with low- and middle-income countries. … … Consider Africa: State-of-the-art vaccine research and production facilities on the African continent would be game changing for multiple reasons. First, it would provide urgently needed vaccines that are specific for the region, including potential variants of concern for specific viral pathogens. This includes capacity for producing mRNA vaccines, a technology that in time will be refined to become easier to scale and stabilize at normal refrigerator temperatures or even room temperatures. Vaccines could be developed for Africa’s diseases of regional importance, including neglected tropical diseases such as Buruli ulcer, sleeping sickness or schistosomiasis, which are unlikely to attract the interest of pharmaceutical companies in North America and Europe. … A vaccine facility for Africa could also become a stimulus to train African scientists. The largest hurdle for establishing a center for excellence is not so much the investment in the physical facilities, but rather the human capital — trained vaccine scientists and staff versed in scaling up production, quality control and quality assurance….”

Reuters - World's top vaccine maker India criticised at home for exports as infections rise

Reuters;

“India’s main opposition Congress party on Tuesday hit out at Prime Minister Narendra Modi’s government for exporting nearly twice the number of coronavirus vaccine doses than immunisations conducted at home, despite a surge in infections….”

PS: cfr a tweet from last weekend: “ So far, 68 countries have received #COVID19 vaccines manufactured in India: - 35 as grant aid (8 million doses) - 15 on a purely commercial basis (34 million sold total) - 18 through COVAX only (16 million total provided) - see https://www.mea.gov.in/vaccine-supply.htm

Guardian - China to only allow foreign visitors who have had Chinese-made vaccine https://www.theguardian.com/world/2021/mar/17/china-to-allow-foreign-visitors-who-have-had- chinese-made-vaccine

“China is resuming visa processing for foreigners from dozens of countries, but only if they have been inoculated against Covid-19 with a Chinese-made vaccine. The move has raised questions about the motivations behind the demand, given China’s vaccines are not approved in many of the countries to which it has opened travel and that it will not accept foreign vaccines made elsewhere, including those approved by the World Health Organization….”

BMJ GH - COVID-19 vaccines pricing policy options for low-income and middle- income countries

J Guzman et al ; https://gh.bmj.com/content/6/3/e005347

“Commonly used policies such as fostering competition, generic substitution, and external and internal reference pricing will not work for novel vaccines. The rapid pace of vaccine development and the lack of historic safety, efficacy and pricing data make it difficult for governments to make informed procurement decisions to ensure equitable and affordable access. Transparent priority setting mechanisms for reviewing the evidence, measuring costs and benefits will be critical for evidence-based comparisons between vaccines, and between vaccines and other COVID-19 interventions. Low-income and middle-income countries and the donor community can leverage joint procurement mechanisms [ like Covax, PAHO & Africa CDC mechanisms ] and voluntary or compulsory licensing agreements as policy options for equitable and affordable access. One potential target for advocacy is the deduction of government research and development subsidies for COVID- 19 vaccine development. Low-income and middle-income countries lack adequate feasible pricing policies to ensure affordable and equitable access to the urgently needed vaccines being developed.”

Bloomberg - Covid Hit These Countries Hard. Now They Face Big Vaccine Bills https://www.bloomberg.com/news/articles/2021-03-16/covid-hit-these-countries-hard-now-they- face-big-vaccine-bills

“Colombia and other middle-income nations pay stiff prices; ‘They have no choice but to submit,’ health advocate says.”

FT - Von der Leyen warns of possible emergency Covid vaccine controls https://www.ft.com/content/3f2380d1-d4e1-45f2-9c3d-eea486697dd6

“EU says stricter export curbs on table to accelerate jabs drive in warning to US and UK.”

See also Reuters - Facing 'crisis of century', EU threatens ban on COVID vaccine exports to UK

“…Ursula von der Leyen raised the prospect of triggering the emergency Article 122, which would allow the EU to seize factories, waive intellectual property rights and patents and impose export bans on jabs….”

See FT - EU threat to vaccine exports exposes mutual risks to global supply chain

“The EU’s threat to restrict the export of Covid-19 jabs has exposed the mutual harm that countries could inflict on one another due to the interdependent nature of the global vaccine supply chain….”

Nature Biotechnology – Innovators target vaccines for variants and shortages in global South https://www.nature.com/articles/d41587-021-00001-x

“The next wave of vaccine developers are striking deals with producers and institutes in low- and middle-income countries. They are working on vaccines that combat fast-spreading variants, that are stable outside the fridge and that can be self-administered or more easily given. Nature Biotechnology enumerates these up-and-coming contenders and explores how they work.”

KFF – Global COVID-19 Vaccine Access: A Snapshot of Inequality https://www.kff.org/policy-watch/global-covid-19-vaccine-access-snapshot-of-inequality/

Update as of 17 March.

“… significant disparities remain. The latest data from the Duke Global Health Innovation Center Launch and Scale Speedometer, which monitors COVID-19 vaccine purchases, finds that high-income countries already own more than half of all global doses purchased, and it is estimated that there will not be enough vaccine doses to cover the world’s population until at least 2023….”

“…ultimately, we find that without redistribution of doses already purchased by high-income countries (through donations or other means) and/or increased support for manufacturing or production of additional doses, more than four in ten (41%) adults in the world will not be able to be vaccinated, even after allocating all COVAX doses to LMICs. …”

“…We find that although high-income countries only account for 19% of the global adult population, collectively, they have purchased more than half (54%, or 4.6 billion) of global vaccine doses purchased to date. Of the remaining doses, 33% have been purchased by LMICs, who account for 81% of the global adult population; an additional 13% have been purchased by COVAX. … … The disparity is even more pronounced when looking at the share who could be vaccinated. While enough vaccine doses have been purchased to cover 80% of the adult population, high-income countries own enough doses to vaccinate more than twice their populations while LMICs can only cover one-third….”

BMJ - Covid-19: A call for global vaccine equity

C Del Rio, G Gonsalves et al ; https://blogs.bmj.com/bmj/2021/03/17/covid-19-a-call-for-global- vaccine-equity/?utm_campaign=shareaholic&utm_medium=twitter&utm_source=socialnetwork

“The following call to global leaders for vaccine equity co-authored by a working group has been joined by over 850 scientists, public health and legal experts, and community leaders. The signatories list can be viewed and joined here. This call was started by those assembled from around the world for the Conference on Retroviruses and Opportunistic Infections (CROI)…”

BMJ - Scaling up covid-19 vaccine production: What are the problems and implications? https://blogs.bmj.com/bmj/2021/03/17/scaling-up-covid-19-vaccine-production-what-are-the- problems-and-implications/

“Increasing production of vaccines for covid-19 presents huge potential problems because of its unprecedented scale. The complex supply chain for vaccines is vulnerable to shortages of key components as well as trade restrictions. The scale-up also threatens the supply of other vaccines and therapies. What does it mean for the future, asks Charles Clift.”

“Last week Chatham House hosted a Global C-19 Vaccine Supply Chain & Manufacturing Summit which addressed emerging supply and manufacturing challenges in the massive scale up of

vaccines for covid-19 which is currently underway. … It is not widely known that current annual production of all vaccines in the world is about 5 billion doses. Yet this year the aim is to produce as much covid-19 vaccine as possible to meet projected demand—the organizers estimated about 9.5 billion doses which has never been done before. To date, production is less than 500 million doses so there is a very long way to go. … … There are a number of important concerns. Some of these related to the supply chain threats, others to the effect of the massive scale-up on other health interventions….”

Politico Global Pulse - What’s missing from the global vax rollout https://www.politico.com/newsletters/global-pulse/2021/03/18/whats-missing-from-the-global- vax-rollout-492150

This week with a focus on vaccinators in developing countries.

“… Groups working on the ground say that as the supply improves, keeping up will be challenging. There may not be enough vaccinators to meet the goal of inoculating one-fifth of the population through COVAX, the global equity effort. And it’s not just the poorest countries who will need to recruit and train vaccinators. Middle-income countries are also lagging as the largest vaccination campaign in history gets underway. The World Bank in a report today found only about one-third of the nearly 130 low- and middle-income countries it reviewed have plans so far to train the large number of vaccinators needed. … An internal February document of the World Health Organization seen by POLITICO estimates that the countries getting vaccines through COVAX would need anywhere between 347,000 and 1 million workers – roughly split between vaccinators and support staff – to hit the 20 percent vaccination target…”

Also with some info on possible back-up options, what it might cost, unintended consequences, …

For more on this huge vaccinators’ bottleneck, see also Devex - Billions of COVID-19 vaccines, one problem: Who will deliver them?.

WB – Assessing Country Readiness for COVID-19 Vaccines - First Insights from the Assessment Rollout https://www.worldbank.org/en/topic/health/publication/assessing-country-readiness-for-covid19- vaccines-first-insights-from-the-assessment-rollout?cid=hnp_tt_health_en_ext

“In November 2020, anticipating the availability of safe and effective vaccines for COVID-19, the World Bank together with WHO, UNICEF, the Global Fund, and Gavi rolled out readiness assessments in more than 100 low and middle-income countries….” Check out the findings.

WHO Afro – Africa’s COVID-19 vaccination gains pace, nearly 7 million doses given https://www.afro.who.int/news/africas-covid-19-vaccination-gains-pace-nearly-7-million-doses- given

Update as of 17 March. “Nearly 7 million COVID-19 vaccine doses have been administered in Africa, where after months of waiting on the side-lines for vaccines, many of the first wave of countries to start campaigns are rapidly vaccinating high-risk groups. Countries have accessed vaccines through the COVAX Facility, bilateral deals and donations. Altogether 38 African countries have received more than 25 million COVID-19 vaccines and 30 have started vaccination campaigns. Through the COVAX initiative – which is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance and the World Health Organization (WHO) in partnership with UNICEF – more than 16 million vaccine doses have so far been shipped to 27 countries….”

Devex – COVID-19 vaccine developer in Vietnam willing to share data https://www.devex.com/news/covid-19-vaccine-developer-in-vietnam-willing-to-share-data-99413

“Nanogen Pharmaceutical Biotechnology, based in Vietnam’s Ho Chi Minh City, is willing to share know-how and technology for developing its COVID-19 vaccine candidate. But the challenge for the company is finding manufacturers with the capacity to produce it in low-income countries….”

Just like many Western vaccine developers, “…countries such as China and Russia have not shared their vaccine technologies — and, in some instances, are selling their vaccines at potentially unaffordable prices for lower-income countries, said Max Lawson, head of inequality policy at Oxfam, who is among those advocating for a “people’s vaccine.”…”

Links:

Reuters - India's Gland Pharma to make up to 252 million Sputnik V vaccine doses

BMJ News - Covid-19: Chile joins top five countries in world vaccination league

Bloomberg - Mexico and Canada top Biden's list for eventual vaccine exports.

Covid-19 Analysis

The Geneva Observer - COVID-19 Vaccine Summit reveals fault lines in International Geneva https://www.thegenevaobserver.com/amp/covid-19-vaccine-summit-reveals-fault-lines-in- international-geneva?__twitter_impression=true

This was the read of the weekend. By John Zaracostas. Analysis of the faultlines in Geneva, as displayed at last week’s Vaccine summit.

“…. Although the WHO was a co-sponsor, it did not take a lead role in the event which was attended by more than 100 of the biggest players in the field. Instead, CEPI (the Coalition for Epidemic Preparedness Innovations) and industry players were the driving force behind the event. WHO Chief Tedros Adhanom Ghebreyesus was invited but did not attend, informed sources said. Instead, the WHO was led by its chief scientist Dr Soumya Swaminathan. Informed sources say that behind the scenes, tensions between the WHO, rich countries, and major pharmaceutical manufacturers has been brewing for some time… The absence of the WHO chief—who since January has become increasingly outspoken over issues surrounding equitable access to COVID-19 vaccines—was also noted by health experts and diplomats. WHO officials said he had a busy schedule and not to read too much into that. But informed sources say that behind the scenes, tensions between the WHO, rich countries, and major pharmaceutical manufacturers has been brewing for some time and began to heat up after Dr Tedros' hard-hitting remarks during a session of the agency's ruling Executive Board on January 18, when he declared: “As the first vaccines begin to be deployed, the promise of equitable access is at serious risk. 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.”…”

BMJ GH - Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: a rapid systematic review

K Grepin et al ; https://gh.bmj.com/content/6/3/e004537

This article reviews the effectiveness of travel measures implemented during the early stages of the COVID-19 pandemic to inform changes on how evidence is incorporated in the International Health Regulations (2005) (IHR).

Some of the findings and implications:

“The study finds that the domestic travel measures implemented in Wuhan were effective at reducing the importation of cases internationally and within China and that additional travel restrictions were also likely important. The study also finds that travel measures are more effective when implemented earlier in the outbreak. The findings generated implications for how evidence is integrated into the International Health Regulations and highlights important research gaps that remain. What do the new findings imply? Findings highlight the need to evaluate the potential effectiveness of travel measures using a risk and context-based assessment of each specific outbreak and the types of measures used. The findings of this study also suggest the need to strengthen the PHEIC process in such a way to increase the likelihood that travel measures, when warranted, can be implemented rapidly enough to maximise their effectiveness.”

Stat - For the first time in decades, vaccines are having a moment. Will it last? https://www.statnews.com/2021/03/15/for-the-first-time-in-decades-vaccines-are-having-a- moment-will-it-last/

Analysis, focusing on the US – but perhaps this rings true also broader. ‘Vaccines are having a moment’.

Sandro Galea - Public health and the temptations of power The healthiest goldfish;

Sandro Galea’s weekly essay is more than worth reading, usually. The same goes for this one.

“… Public health now finds itself at a similar crossroads with respect to power. We have amassed substantial power through our efforts to address the COVID crisis. This has been something of a change for us. In the past, it was not uncommon to hear complaints that public health is sometimes neglected, that its recommendations to policymakers and the public can fall on deaf ears. The pandemic reversed this. Notwithstanding the polarization that has kept a vocal faction of the population at odds with the recommendations of health authorities, we are in a moment when public health is more influential than it has ever been. And with the arrival of vaccines and signs that the pandemic has started to wane, this moment may well be ending. COVID itself is likely to remain with us in some form, as an endemic threat. But the emergency of COVID, the crisis of the pandemic year—its days are numbered. With the end of the emergency comes the question of what public health will do with its newfound power….”

BMJ Editorial - Domestic violence during the pandemic https://www.bmj.com/content/372/bmj.n722

“Healthcare systems have failed to respond adequately despite increased need globally.”

“…Domestic violence has been magnified by the covid-19 pandemic in two senses: incidence has increased globally, and the presence of domestic violence within all societies has also been revealed more clearly, alongside other adversities and inequalities. The societal response must be multisectoral. Here, we focus on challenges to the healthcare response….”

CGD - Tax Reforms in Developing Countries in an Era of COVID-19

S Gupta et al ; https://www.cgdev.org/blog/tax-reforms-developing-countries-era-covid-19

“The COVID-19 pandemic has cost lives and disrupted economic activity worldwide. It has impacted government budgets globally by reducing tax receipts and increasing spending on programs to save lives and transfer income to those adversely affected by the pandemic.”

BMJ - Preventing the next pandemic: the power of a global viral surveillance network https://www.bmj.com/content/372/bmj.n485

“Dennis Carroll and colleagues call for a global early warning system to detect viruses with pandemic potential.”

“An early warning system that detects new viral spillover well before it becomes a local outbreak is needed; A global, risk based, multisectoral viral surveillance network would focus on detecting new “high consequence” viruses in humans and animals in hotspots for emerging risks; For sustainability of an early warning system, strong political commitment, a sound governance structure, and long term financing will have to be assured.”

Devex - AfDB calls for 'one last debt relief for Africa' https://www.devex.com/news/afdb-calls-for-one-last-debt-relief-for-africa-99394

“African countries facing a new debt crisis need more long-term solutions, including debt restructuring accompanied by government reforms, to spur economic recovery, the continent’s biggest lender said Friday. “The time for one last debt relief for Africa is now,” Akinwumi Adesina, president at the African Development Bank, was quoted as saying in the lender’s latest “African Economic Outlook” report….”

NPR - COVID-19 Data Miss A Lot Of People — Raising Questions

NPR;

“What is the real failure in data collection over the past year? In humanitarian settings, data has not been collected in a systematic manner. In some of these countries, we don't know what the transmission has actually been. We should have been able to put in place much stronger contact- tracing systems, and it should be easier to do it in these settings than in the U.S. because community health workers and systems already exist. But that seemed to fail in many settings….

BMJ Collection - Artificial intelligence & Covid-19 https://www.bmj.com/AIcovid19

Collection with 4 articles. “Soon after the covid-19 pandemic was declared, the World Health Organization signalled that artificial intelligence (AI) could be an important technology to manage the crisis caused by the virus. AI, a core technology of the fourth industrial revolution, is an important non-medical intervention to overcome the current global health crisis, to build next-generation epidemic preparedness, and to move towards a resilient recovery. While AI holds much promise it also raises serious questions concerning fairness, reliability, accountability, privacy, transparency, and safety. Based on best practices and lessons learnt from using artificial intelligence during the covid-19 pandemic, this collection attempts to answer these questions and looks forward to an intelligent healthcare future.”

“…This collection of articles was proposed by the WHO Department of Digital Health and Innovation and commissioned by The BMJ.”

FT - Pharma is riding a vaccine high, but reputational risks loom https://www.ft.com/content/7ad9d74e-f4e7-4b30-9391-0b934662b6ac

“Suspensions of AstraZeneca’s jab over blood clot concerns are a harbinger of challenges to come… … Nor can the industry wave off complaints about pricing and access. If anything they could become worse if vaccine makers appear to profit from the pandemic after receiving government support….”

Lancet (Comment) - Triple jeopardy: disabled people and the COVID-19 pandemic Tom Shakespeare et al; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(21)00625-5/fulltext

“People with disabilities have been differentially affected by COVID-19 because of three factors: the increased risk of poor outcomes from the disease itself, reduced access to routine health care and rehabilitation, and the adverse social impacts of efforts to mitigate the pandemic. …”

Chatham House (Expert Comment)- Brussels Silent on Vaccinating Undocumented Migrants https://www.chathamhouse.org/2021/03/brussels-silent-vaccinating-undocumented-migrants

“Often working in frontline jobs, and therefore among those most exposed to and likely to transmit COVID-19, undocumented migrants are also the least protected.”

“During the last few weeks, the European Union (EU) has been widely criticized for its 'failed' vaccination strategy. But with all the focus on the general slowness of the EU in vaccinating the populations of its member states, another aspect of the EU's public health crisis has been ignored. Undocumented persons are being left out of COVID-19 national vaccination programmes and Brussels remains alarmingly silent about it. This should come as no surprise as migration is a toxic issue and governments in EU countries are now under immense pressure to vaccinate their own citizens as soon as possible….”

See also a Lancet Public Health Letter - Migrant health is public health: a call for equitable access to COVID-19 vaccines (by A Al-Oraibi et al)

“…WHO and the IOM have promoted equitable distribution of SARS-CoV-2 vaccines, supported by the Access to COVID-19 Tools Accelerator and the COVID-19 Vaccine Global Access Facility (COVAX Facility), with calls to explicitly include migrant populations. However, UNHCR estimates that only half of countries have integrated refugees in their national SARS-CoV-2 vaccination plans….”

TGH - Just How Do Deaths Due to COVID-19 Stack Up?

C Troeger; https://www.thinkglobalhealth.org/article/just-how-do-deaths-due-covid-19-stack

Think Global Health launches a tracker of COVID as a cause of death globally and the factors driving those trends.

Very informative blog, with some great IHME data visualisations and world maps.

“COVID-19 is the leading cause of death in France, England, Mexico, and Brazil, and the second leading cause in the U.S. … In contrast, COVID-19 was not a leading cause of death in much of the African, South-East Asian, or Western Pacific Regions. … In the WHO Africa Region, COVID-19 ranks as the twenty-fourth leading cause of death…”

BMJ GH (Editorial) - Vaccinating the world against COVID-19: getting the delivery right is the greatest challenge R Shretta et al ; https://gh.bmj.com/content/6/3/e005273

“… Recognition is growing that vaccinating the global population against COVID-19, particularly those in low and middle-income countries (LMIC), will be the largest global peacetime logistical effort ever undertaken, requiring unprecedented government/industry collaboration across distinct administrative, business, medical and information infrastructures. …”

IDS (paper) - COVID-19, Governance, and Conflict: Emerging Impacts and Future Evidence Needs H Sian & H Marquette; https://opendocs.ids.ac.uk/opendocs/handle/20.500.12413/16477

“This paper reviews emerging evidence of the impact of COVID-19 on governance and conflict, using a “governance and conflict first” approach in contrast to other research and synthesis on COVID-19 in the social sciences that tends to be structured through a public health lens. It largely focuses on evidence on low- and middle-income countries but also includes a number of examples from high-income countries, reflecting the global nature of the crisis. It is organised around four cross-cutting themes that have enabled the identification of emerging bodies of evidence and/or analysis: Power and legitimacy; Effectiveness, capacity, and corruption; Violence, unrest, and conflict; and Resilience, vulnerability, and risk. The paper concludes with three over-arching insights that have emerged from the research: (1) the importance of leadership; (2) resilience and what “fixing the cracks” really means; and (3) why better ways are needed to add up all the “noise” when it comes to COVID-19 and evidence.”

Coverage via F2P blog What is COVID-19 telling us about leadership?

LSE (blog) - Why didn’t pandemic planning anticipate the need for lockdowns? https://blogs.lse.ac.uk/covid19/2021/03/17/why-didnt-pandemic-planning-anticipate-the-need-for- lockdowns/

“The world is often said to have prepared for the wrong kind of pandemic, anticipating a new strain of influenza. In fact, says Celia Blanco-Jimenez (LSE), a number of plans were in place for the

rapid spread of a respiratory disease. But none anticipated that lockdowns or travel restrictions would be put in place. “

Global Public Health - Beyond command and control: A rapid review of meaningful community-engaged responses to COVID-19 R Loewenson et al ; https://www.tandfonline.com/eprint/H6KDVDGXMHYFAS8Y3CTD/full?target=10.1080/17441692.20 21.1900316

“Responses to COVID-19 have included top-down, command-and-control measures, laissez-faire approaches, and bottom-up, community-driven solidarity and support, reflecting long-standing contradictions around how people and populations are imagined in public health—as a ‘problem’ to be managed, as ‘free agents’ who make their own choices, or as a potential ‘solution’ to be engaged and empowered for comprehensive public health. In this rapid review, we examine community- engaged responses that move beyond risk communication and instead meaningfully integrate communities into decision-making and multi-sectoral action on various dimensions of the response to COVID-19. Based on a rapid, global review of 42 case studies of diverse forms of substantive community engagement in response to COVID-19, this paper identifies promising models of effective community-engaged responses and highlights the factors enabling or disabling these responses. The paper reflects on the ways in which these community-engaged responses contribute to comprehensive approaches and address social determinants and rights, within dynamics of relational power and inequality, and how they are sometimes able to take advantage of the ruptures and uncertainties of a new pandemic to refashion some of these dynamics.”

Links:

Global Social Policy - Global Social Policy Digest 21.1: An equitable and sustainable recovery from COVID-19? Covering June 2020 till August 2020.

Africa CDC - COVID 19 Vaccine Perceptions: A 15 country study

Coverage via Politico Global Pulse: “… Political leaders have criticized WHO's coronavirus response in the early days, but people in 15 African countries surveyed for Africa CDC still trust it most on whether a Covid-19 vaccine is safe and effective. Health care workers and the government come in second and third. Gavi, the international partnership that has provided vaccines for children in the poorest countries for over a decade, is on par with pharmaceutical companies.  Western governments score the lowest, which could mean a stamp of approval from their regulators doesn't matter much. …” The countries surveyed are: Burkina Faso, Ivory Coast, Democratic Republic of Congo, Ethiopia, Gabon, Kenya, Malawi, Morocco, Niger, Nigeria, Senegal, South Africa, Sudan, Tunisia and Uganda.

Covid impact on other global health programmes

UN News - South Asia: Sharp rise in child, maternal deaths due to COVID-19- induced disruptions https://news.un.org/en/story/2021/03/1087542

“Severe disruptions in health services due to the COVID-19 pandemic may have resulted in an additional 239,000 child and maternal deaths in South Asia last year, United Nations agencies said on Wednesday. In a new report, UN Children’s Fund (UNICEF), World Health Organization (WHO) and UN Population Fund (UNFPA) said that the impact also included sharp drops in the number of young children treated for severe acute malnutrition as well as in childhood immunizations. …”

Devex - 1 million people undiagnosed, untreated for tuberculosis in 2020 https://www.devex.com/news/1-million-people-undiagnosed-untreated-for-tuberculosis-in-2020- 99427

“Nine countries representing 60% of the global tuberculosis burden have suffered significant declines in TB diagnosis and treatment in 2020, ranging from 16% to 41%, according to new data published by the Stop TB Partnership. This poses a serious setback in efforts to end the disease in the selected countries, including Bangladesh, India, Indonesia, Myanmar, Pakistan, Philippines, South Africa, Tajikistan, and Ukraine. Data from 23 countries reveals a 1 million drop in the number of people diagnosed and treated for TB in 2020, with these nine countries contributing significantly to the decline. …”

See also HPW - COVID-19 Eliminates Twelve Years of Progress Against Tuberculosis, Global Investment Needed

Quote Peter Sands: “…COVID-19 claimed 1.8 million lives in 2020 and said Sands pointed out that the numbers of people who died from TB in 2020 may have been around 1.7 million, 90% of the number of COVID deaths.. But the investment in TB is not as substantial as the investment in COVID-19 – 2% of what is spent on COVID-19 is the amount invested in TB, which Sands called “drastically different in terms of resource commitment.”

CGD (blog) - Still Neglected and Still Not Gone: The Implications of COVID-19 for the WHO Policy of Elimination of Congenital Syphilis

D Walker et al ; https://www.cgdev.org/blog/still-neglected-and-still-not-gone-implications-covid- 19-who-policy-elimination-congenital

“In many low- and middle-income countries, the COVID-19 pandemic is limiting access to antenatal care and posing considerable challenges to global efforts to eliminate congenital syphilis. A review of the present WHO strategy to eliminate congenital syphilis is urgently needed.”

WHO - New research highlights risks of separating newborns from mothers during COVID-19 pandemic https://www.who.int/news/item/16-03-2021-new-research-highlights-risks-of-separating- newborns-from-mothers-during-covid-19-pandemic

“ New research from WHO and partners shows that the COVID-19 pandemic is severely affecting the quality of care given to small and sick newborns, resulting in unnecessary suffering and deaths. A study published in the Lancet EclinicalMedicine highlights the critical importance of ensuring newborn babies have close contact with parents after birth, especially for those born too small (at low birthweight) or too soon (preterm). However, in many countries, if COVID-19 infections are confirmed or suspected, newborn babies are being routinely separated from their mothers, putting them at higher risk of death and lifelong health complications. This is especially the case in the poorest countries where the greatest number of preterm births and infant deaths occur. According to the report, disruptions to kangaroo mother care – which involves close contact between a parent, usually a mother, and a newborn baby - will worsen these risks. Up to 125 000 babies’ lives could be saved with full coverage of kangaroo mother care….”

See also Devex (on another study in BMJ Global Health) - COVID-19 has created a risky practice on newborn care, study finds

“COVID-19 has disrupted health care services globally. A new survey of health workers across 62 countries finds it caused disruptions in newborn care as well, putting small and sick newborns at increased risk of death. Prior to COVID-19, the world lost an estimated 2.4 million newborns per year. Health experts point out increased intensive care, including interventions such as kangaroo mother care or KMC, which involves early, prolonged skin-to-skin contact between mothers and small, vulnerable newborns with a birth weight of less than 2,000 grams (70.5 ounces) soon after birth, as well as exclusive breastfeeding, can help reduce this mortality rate. However, the new survey, covering 1,120 health care professionals carried out between July and October 2020 published in BMJ Global Health, finds that implementation of these critical interventions was delayed, or not followed, for a number of reasons….”

And a link:

Lancet Public Health - COVID-19 hindering progress against female genital mutilation

“…According to the anti-FGM organisation Orchid, from March, 2020, early in the COVID-19 crisis, reports began to emerge from their local grassroots partners that they were witnessing elevated rates of FGM. It is a worrying signal. According to their report Impact of COVID-19 on Female Genital Cutting, built from surveys with grassroots activists, COVID-19 lockdowns present opportunities to carry out FGM “undetected”, and the lack of integration of services within the COVID-19 response is leaving girls at risk with no recourse to essential prevention, protection, and support services. The latest UN Population Fund (UNFPA) projections suggest that due to the disruption of programmes to prevent FGM in response to COVID-19, 2 million cases might occur over the next decade that could have been averted. “…

Covid resources

Duke University - interactive COVID-19 country vaccination cost tracker and prediction application developed at The Center for Policy Impact in Global Health https://centerforpolicyimpact.shinyapps.io/covid-vaccination-costs-analysis/

Check it out.

WB - COVID 19: Debt Service Suspension Initiative https://www.worldbank.org/en/topic/debt/brief/covid-19-debt-service-suspension- initiative?cid=SHR_SitesShareTT_EN_EXT

“In the interest of greater transparency, this webpage offers a country-by-country accounting of DSSI participants and the amounts they owe to creditors, based on information from the World Bank’s International Debt Statistics (IDS) database. …”

Ebola DRC

Stat News - Bombshell analysis traces new Ebola outbreak to survivor of West Africa crisis New Ebola outbreak likely sparked by a person infected 5 years ago

“A survivor of the massive 2014-2016 West African Ebola outbreak almost certainly triggered an outbreak currently underway in Guinea, according to a new genetic analysis, news that has landed like a bombshell in the community of researchers who study the dangerous virus. The analysis suggests that a survivor of the historic Ebola outbreak continued harboring the virus at least five years after being infected, eventually transmitting it to someone. Previously, the longest an Ebola survivor was believed to have shed the virus was about 500 days….”

See also Science News - https://www.sciencemag.org/news/2021/03/new-ebola-outbreak-likely- sparked-person-infected-5-years-ago

“Genome analyses suggesting virus persistence raise worries about stigmatization of survivors.”

Devex – In Brief: Community resistance plagues new Ebola outbreaks https://www.devex.com/news/in-brief-community-resistance-plagues-new-ebola-outbreaks-99443

“Community resistance, a problem that plagued previous Ebola crises, has reemerged as a top challenge in containing new outbreaks in Guinea and the Democratic Republic of Congo. Because of this, those who have come into contact with infected people have not all been traced and there is

a high risk of regional spread, said Dr. Merawi Aragaw, incident manager for Ebola in DRC and Guinea at the Africa Centres for Disease Control and Prevention, during a press briefing Thursday….”

“The two outbreaks are still small, with a total of 30 reported cases, 15 deaths, and 11 recoveries. While anyone who has come into contact with these people should be monitored, Aragaw said, health workers have only been able to do so for about 86% of contacts in DRC and about 96% in Guinea….”

NCDs

Lancet World Report – Aid agencies turn attention to diabetes https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00658-9/fulltext

“The rise in non-communicable diseases and their contribution to COVID-19 is prompting a shift in priorities. Sharmila Devi reports.”

“…Aid agencies and donors have traditionally focused on emergency assistance, but a massive rise in NCDs, which make people more vulnerable to severe COVID-19 and death, have made these diseases impossible to ignore….”

Overview of measures taken by or in the pipeline by MSF, WHO, … as well as recent reports.

Decolonize Global Health

Decolonise Global Health (ActDGH) https://decolonise.health/

“ActDGH is an activist, action-oriented collective of global health academics, practitioners, and students coming together to put forward ideas, arguments, and strategies to reconstruct our global health system. We will move to a system that has more a equitable concentration power, where extractive policies are replaced with greater autonomy of people and communities.”

See Tammam Aloudat - Do we need to decolonise global health?

And some satire: School of Decolonizing Global Health Accepting Applicants!!

Lancet Letter- Undoing supremacy in global health will require more than decolonisation https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00383-4/fulltext

By K Gedela.

One of a number of Lancet Letters responding to the earlier viewpoint by M Pai & S Abimbola.

See also Undoing supremacy in global health will require more than decolonisation (by P Allotey et al): “…Ultimately, a decolonised global health can only exist within a broader geopolitical and economic environment that supports rights, equity, and justice.”

And the reply by S Abimbola & M Pai - Reply:

“…As we emphasised, colonialism and power asymmetry between high-income countries (HICs) and low-income and middle-income countries (LMICs) is but one manifestation of supremacy. Therefore, undoing supremacy will require much more than decolonisation. Nevertheless, decolonisation is a good place to start given its role in the creation of global health, and how coloniality persists in the field. … …. To understand how geopolitics perpetuate inequities and how incorporating local knowledge can help to reduce inequities in global health, we must undo another important supremacy in the field—ie, the disciplinary supremacy that places the quantitative biomedical and epidemiological sciences (often led by HICs) above the qualitative political and anthropological sciences. One of the many great lessons of the COVID-19 pandemic is that achieving equity in (the circumstances that create) health is at least as much a domain of the political and anthropological sciences as it is one of the biomedical and epidemiological sciences. This lesson is relevant within HICs and LMICs, as it is in global and international affairs…. … Ultimately, as both Correspondences highlight, the locus of the change we seek in global health is within not only HICs but also LMICs. In research partnerships or funding decisions, it is not enough that HIC actors lean out. LMIC actors must also lean in—eg, by calling out parachute research, demanding reciprocity, setting up their own high-impact academic journals, or building high-quality schools of public health. However, doing so requires funding and political action, which national and international power relations might obstruct, but against which we must fight because combating all forms of supremacy should be synonymous with global health….”

Tweets

• Race & Health

““Global South” and “developing countries” are terms coined by the Global North to define countries as poor, though these countries are so rich in resources. Most Affected Peoples and Areas (MAPA) is an alternative with more nuance.”

• Chalapati Rao:

“One marker on this path would be the deconstruction of the Global Burden of Disease study, with each country producing its own estimates from local demographic and epidemiological data. Such locally derived health data will drive local policy and evaluation..(decolonisation?)”

This was a tweet in response to this question: “OK, i am going to ask. How will we know when global health has been decolonized? @paimadhu and others, have you seen anything that really helps us understand the goals?”

Planetary Health

Nature (Editorial) - Growing support for valuing ecosystems will help conserve the planet https://www.nature.com/articles/d41586-021-00616-9

“The idea that ecosystems have monetary value now has global support — and creates a route to protecting Earth’s endangered regions.”

“… Last week, however, countries took a giant step towards enabling public authorities to put a value on their environment. At its annual meeting, the United Nations Statistical Commission — whose members are responsible for setting and verifying standards for official statistics in their countries — laid out a set of principles for measuring ecosystem health and calculating a monetary value. These principles, known as the System of Environmental-Economic Accounting Ecosystem Accounting (SEEA EA), are set to be adopted by many countries on 11 March. The principles were agreed after a 3-year writing and review process that involved 100 experts and 500 reviewers from various disciplines and countries. Once adopted, they will give national statisticians an internationally agreed rule book. It will provide a template for payments for ecosystem services … and an official benchmark against which the condition of ecosystems can be judged by policymakers and researchers over time. …

Lancet Planetary Health (March issue) https://www.thelancet.com/journals/lanplh/issue/vol5no3/PIIS2542-5196(21)X0003-4

Well worth a proper read, this new March issue!

• Start with the Editorial - Valuing nature

On the Dasgupta Review. “We are collectively failing to value nature adequately. …. … Critiques of mainstream economics and its inability to properly value nature are not intellectually new, but in the context of the past 40 years of neoliberal orientated politics, they have been marginal voices. … … In this context the UK Government commissioned Prof Sir Partha Dasgupta to lead an independent review on the economics of biodiversity. The report was published in February 2021, at a key moment when governments are preparing for UN meetings on climate change and biodiversity and simultaneously considering COVID-19 economic recovery planning. The Dasgupta Review calls for fundamental and sweeping changes to economic thinking and practice. … … we will need to change measures of economic success, in particular focussing less on GDP, which is transaction orientated and fails to adequately consider natural asset depreciation. The review recommends incorporating natural capital into national accounting systems as a critical first step towards making more inclusive measures of wealth our measure of progress….” “… Perverse incentive structures in our economic system lay at the heart of many of the challenges we face in combating climate change, biodiversity loss, and social injustice. We hope this review will mark a watershed moment when mainstream economics begins to seriously engage with natural capital.”

• Comment - The determinants of planetary health (by N Redvers)

“… a new lens could be used to describe and frame the combined factors and conditions that affect the health of the planet; the determinants of planetary health. Factors such as Indigenous land rights, which were highlighted in the 2019 Intergovernmental Panel on Climate Change (IPCC) special report as being critical to safeguarding the world's lands and forests, is a determinant of planetary health. Specific economic structures, the positionality of community, regional and international politics, and colonial mentality are other determinants of planetary health. … …

“… A group of Indigenous scholars, Elders, practitioners, and land defenders are currently working to frame the determinants of planetary health from an Indigenous worldview, and we look forward to sharing this work as it progresses ….”

• Comment : The role of violence in planetary health (by C Correa-Salazar et al)

“…planetary health science is primarily driven by initiatives and organisations from high-income countries, which largely ignore the role of violence for communities striving to protect the environment and its resources in low-income and middle-income countries (LMICs)….”

• Research article: Climate change and child health: a scoping review and an expanded conceptual framework

Guardian – UK's Cop26 president calls for world to get on track to hit net zero by 2050 https://www.theguardian.com/environment/2021/mar/18/uk-cop26-alok-sharma-world-get-on- track-net-zero-by-2050

“Alok Sharma sets out UK’s aims as host of climate talks, including new emissions targets for 2030.”

“The world must be put on a path to reaching net zero by 2050 if the goal of holding global temperature rises below 1.5C is to be kept within reach, the UK host of this year’s climate talks has said. … The UK’s four goals for Cop26 are: For countries to set net zero emissions targets, which governments responsible for two-thirds of global emissions have already done, and set targets for emissions cuts by 2030. To formulate plans for countries to adapt to the impacts of the climate crisis. To encourage rich countries to provide finance to the poor world for emissions cuts and adaptation. For civil society to take a strong role in the talks….”

CGD - Whose Climate Finance is “New and Additional”? I Mitchell; https://www.cgdev.org/blog/whose-climate-finance-new-and-additional

“As we pass the 2020 deadline for $100 billion a year of climate finance we look at how much climate finance could be “new and additional” as the original commitment envisaged, and how much each country has contributed.”

“Our analysis shows the value of total development finance increased by $43.6bn from 2009 to 2018—so, this is the maximum amount that could be classed as “new and additional.” Set against the OECD’s estimate that climate finance has now reached $78.9bn, this shows that almost half (45 percent) of that amount was not additional, and largely came from the re- badging or re-focussing existing development efforts. Several countries—including Canada, Spain, and the US—actually reduced their finance levels over the period….”

Thomson Reuters - Over 10 million displaced by climate disasters in six months - report https://news.trust.org/item/20210317073035-6jw9c/

“Climate is now by far the leading cause of internal displacement, said humanitarian report, with Asia particularly hard hit.”

“About 10.3 million people were displaced by climate change-induced events such as flooding and droughts in the last six months, the majority of them in Asia, a humanitarian organisation said on Wednesday. The International Federation of Red Cross and Red Crescent Societies said about 2.3 million others were displaced by conflict in the same period, indicating the vast majority of internal displacements are now triggered by climate change. Though the figures cover only a six-month period from September 2020 to February 2021, they highlight an accelerating global trend of climate-related displacement, said Helen Brunt, Asia Pacific Migration and Displacement Coordinator for the IFRC. "Things are getting worse as climate change aggravates existing factors like poverty, conflict, and political instability," Brunt said. "The compounded impact makes recovery longer and more difficult: people barely have time to recover and they're slammed with another disaster." Some 60% of climate-IDPs (internally displaced persons) in the last six months were in Asia, according to IFRC's report….”

New Republic – Saving the Climate in a Triple Crisis M Mazzucato; https://newrepublic.com/article/161579/moonshot-mariana-mazzucato-climate- capitalism-crisis

“A moon shot model for the transformation of capitalism.” “…we need new frameworks of economic collaboration that can tackle the triple crisis before us in a holistic way that brings public purpose to the center of how we co-create value.” She argues for mission-based capitalism.

“Capitalism is facing three major crises. A pandemic-induced health crisis has rapidly ignited an economic crisis with yet unknown consequences for financial stability, and all of this is playing out against the backdrop of a climate crisis that cannot be addressed under the rubric of business as usual… “ “…Critically, the health crisis, the climate crisis, and the economic crisis must be viewed together….” “…Starting from the system we have already built, we need to rethink capitalism, combat negative public-private relationships, and direct finance toward the world’s overlapping crises—and particularly the longer-term challenge of climate change. …”

“The problem is clear enough—particularly as the Covid crisis continues destabilizing basic provisions for human needs: The financial sector has to a large extent been financing itself rather than the real economy. Most finance money goes back into finance, insurance, and real

estate rather than into productive uses. The acronym for this explosion of the paper economy is FIRE (finance, insurance, real estate)…”

Among others, she also argues for “a market shaping and co-creation view of public policy— rather than one wed to simply market-fixing.” Eat that, Bill .

“There’s mounting consensus across the global economic order that the sheer magnitude of the climate crisis mandates an FDR-scale commitment of investment and collective resources….”

Confronting Simultaneous Climate, Public Health, and Economic Shocks in Developing Countries L Martinez-Diaz; https://www.wri.org/news/confronting-simultaneous-climate-public-health-and- economic-shocks-developing-countries

On “compound shocks”. And with two proposals.

Other news of the week

Guardian - UK scientists attack 'reckless' Tory cuts to international research https://www.theguardian.com/science/2021/mar/14/uk-scientists-attack-reckless-tory-cuts-to- international-research?CMP=Share_iOSApp_Other

“Projects tackling some of world’s major problems – including the climate crisis – are set to be cancelled or cut back after budget cuts.”

“…. the cuts are the result of the government’s decision to reduce its international aid budget from 0.7% of gross national income to 0.5%. This cutback has meant that reductions had to be made in development assistance spending at the Department for Business, Energy and Industrial Strategy (BEIS) – which funds UKRI. … … Most of the development budget that is spent through the UKRI goes to a programme called the Global Challenges Research Fund, which was set up in 2016 to find creative solutions to some of the biggest issues facing low- and middle-income countries, in collaboration with local experts. These include projects to tackle dementia and neglected tropical diseases, and generate electricity in impoverished regions….”

Guardian - ‘We choose good guys and bad guys’: beneath the myth of ‘model’ Rwanda https://www.theguardian.com/global-development/2021/mar/19/we-choose-good-guys-and-bad- guys-beneath-the-myth-of-model-rwanda

“President Paul Kagame – long feted by leaders in the west – is accused of serial human rights abuses in expansive new book.”

“… A devastating new book will accuse Rwanda’s president Paul Kagame – long feted by his prominent international supporters as the model of visionary new African leadership – of being a serial human rights abuser, including for his role in a sustained campaign of assassinating his rivals in exile. Written by Michela Wrong, the author who covered the Rwandan genocide in 1994, when more than 800,000 people – largely ethnic Tutsis as well as moderate Hutus – were killed by Hutu militias over 100 days, Do Not Disturb represents one of the most far-reaching historical revisions of Kagame and his regime….”

Devex - In Brief: Fighters deliberately target health facilities in Tigray https://www.devex.com/news/in-brief-fighters-deliberately-target-health-facilities-in-tigray-99404

“Armed militants have deliberately targeted health facilities in the Tigray region of Ethiopia, according to Médecins Sans Frontières….”

Science (News) - California universities and Elsevier make up, ink big open-access deal https://www.sciencemag.org/news/2021/03/california-universities-and-elsevier-make-ink-big-open- access-deal

“Two years after a high-profile falling out, the University of California (UC) system and the academic publishing giant Elsevier have patched up differences and agreed on what will be the largest deal for open-access publishing in scholarly journals in North America. The deal is also the world’s first such contract that includes Elsevier’s highly selective flagship journals Cell and The Lancet….”

CGD (blog) - It's Time to Invest in Global Childcare M O’Donnell et al ; https://www.cgdev.org/blog/its-time-invest-global-childcare

“The topic of childcare is receiving some much needed attention. For decades, working families from Dhaka to Durbin have faced the challenge of finding quality affordable childcare. But the problem was hidden away, obscured behind old images that never fit the realities of women’s widespread labor force participation in low- and middle-income countries, nor the need to prioritize early childhood development and associated community and economic opportunities. A growing number of recent reports, along with the reality of women struggling to balance childcare with paid work laid bare during the pandemic, are finally bringing the world’s underinvestment in quality childcare out of the shadows. Now it is time for action….”

Links:

Lancet Editorial - Myanmar's democracy and health on life support

Some papers, collections and reports of the week

Eurodad – What can’t be counted doesn’t count: tracking financing for sustainable development https://views-voices.oxfam.org.uk/2021/03/what-cant-be-counted-doesnt-count-tracking-financing- for-sustainable-development/

“In this discussion paper, experts from ActionAid, AidWatch Canada and Oxfam International shed light on a new statistical metric, Total Official Support for Sustainable Development (TOSSD), that could significantly shape the future of development finance.”

“Our report sheds light on how TOSSD works in practice as well as on its ambitions and shortcomings. The report looks into the political perspectives on this new metric, examining its strengths and significant challenges. We conclude: whatever you may think about TOSSD, if you care about development, you’d better know about it….”

HSG - Evaluation of the Sixth Global Symposium on Health Systems Research https://healthsystemsglobal.org/news/out-now-evaluation-of-the-sixth-global-symposium-on- health-systems-research/

Check out the evaluation (report) of the Dubai HSG symposium (stage 1 & 2).

Lancet Global Health – April issue https://www.thelancet.com/journals/langlo/issue/current

Many articles have already been published online before. Of the ones that are ‘new’ check out especially:

• Editorial: Unlocking human potential with universal eye health

“…the Lancet Global Health Commission on Global Eye Health: the culmination of 2 years of intensive work from 73 multidisciplinary academics, practitioners, policy makers, and advocates from 25 countries. Launched this month across a series of webinars, the Commission makes a strong case for reframing eye health as a development issue as well as a health issue, and builds on the WHO World Report's recommendation to include eye health within universal health coverage….”

• Building resilience needs to be central to treating drug-resistant tuberculosis (Comment by H Cox et al)

“… together with increasing discourse around providing more patient-centred care in tuberculosis, there is a growing body of literature describing the experiences of individuals going through DRTB treatment. In The Lancet Global Health, Amrita Daftary and colleagues add to this

literature by describing distinct stages through DRTB diagnosis and treatment from the point of view of patients with DRTB and HIV in KwaZulu-Natal province, South Africa. The study emphasises that despite improvements in treatment, including shorter, all-oral regimens that include bedaquiline, DRTB treatment remains lengthy, difficult, and life-changing for individuals…. We believe that the study by Daftary and colleagues and other studies highlight three key areas where person-centredness for all patients with tuberculosis, particularly those with DRTB, can be improved. These areas are treatment literacy, psychosocial support, and most importantly, social protection provisions or economic support for patients, all of which need to extend beyond the end of treatment and include measures to reintegrate individuals into their communities, both socially and economically….”

BMJ Collection - Child health redesign https://www.bmj.com/child-health-redesign

“… The Sustainable Development Goal (SDG) framework adopted in 2015 includes a holistic approach to improving child and adolescent health, still relevant in the wake of covid-19. The framework is based on recognition of macro level trends, and attaining the SDG’s requires a substantial shift in thinking about child and adolescent health. This entails moving on from a focus on under-5 survival, to recognizing the interconnectedness of maternal, newborn, child and adolescent health, with understanding of how early life events ripple throughout a child’s life into adulthood. Demographic and disease burden changes have forced the issue of how countries should strengthen their health systems to be more responsive to the changing needs of children and adolescents. Consequently, the World Health Organization and UNICEF have initiated efforts to reorient their child health strategy, shifting attention towards a life course perspective and away from a previous exclusive focus on under-5 survival. This collection sets out the evidence from the redesign process.”

Policy & Politics - Drivers of health policy adoption: a political economy of HIV treatment policy

M Kavanagh et al ; https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=3380&context=facpub

“Why do some countries rapidly adopt policies suggested by scientific consensus while others are slow to do so? Through a mixed methods study, we show that the institutional political economy of countries is a stronger and more robust predictor of health policy adoption than either disease burden or national wealth. Our findings challenge expectations in scholarship and among many international actors that policy divergence is best addressed through greater evidence and dissemination channels. Our study of HIV treatment policies shows that factors such as the formal structures of government and the degree of racial and ethnic stratification in society predict the speed with which new medical science is translated into policy, while level of democracy does not. This provides important new insights about the drivers of policy transfer and diffusion and suggests new paths for practical efforts to secure adoption of ‘evidence-based’ policies.”

Global Health Science & Practice (Supplement) - Communities as the Cornerstone of Primary Health Care: Learning, Policy, and Practice https://www.ghspjournal.org/content/9/Supplement_1

Start with the Editorial - Strength in Diversity: Integrating Community in Primary Health Care to Advance Universal Health Coverage

“The supplement highlights a systems approach that recognizes the communities' roles and their interactions with other health system actors to accelerate outcomes and reflect the diversity of the community health ecosystem. Several cross-cutting priorities emerge from the articles, namely coverage, community health financing, policy change, institutionalization, resilience, accountability, community engagement, and whole-of-society efforts.”

BMJ GH (Analysis) - Adolescent health in the Sustainable Development Goal era: are we aligned for multisectoral action?

A George et al; https://gh.bmj.com/content/6/3/e004448

“Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multisectoral action for adolescent health, to understand the context of such change and to spark, sustain and steer it.”

IMF (report) - Rising Corporate Market Power : Emerging Policy Issues https://www.imf.org/en/Publications/Staff-Discussion-Notes/Issues/2021/03/10/Rising-Corporate- Market-Power-Emerging-Policy-Issues-48619

“Corporate market power has risen in recent decades, and new estimates in this note suggest that the likely wave of small and medium-sized enterprise bankruptcies from the ongoing pandemic will further strengthen market concentration. Whether and how policymakers should address this issue is hotly debated. This note provides new evidence on the policy relevance of rising market power and highlights possible implications for the design of competition policy frameworks and macroeconomic policies.”

With some specific attention for (the trends in/for) Big Pharma… : “While broad-based across countries and industries, this rise has been sharper in the technology and pharmaceutical industries… Market power has increased even more for pharmaceuticals than for the tech industry… … unlike in the tech industry, the rise of market power in pharmaceuticals reflects primarily increased markups charged by incumbent firms…” “…The magnitude and nature of the market power increase in the pharmaceutical industry warrant further analysis of intellectual property rights systems…”

Salient (report) – How can blended financing improve health product distribution? https://www.salientadvisory.com/blended-financing-report/

“…Supported by the Bill & Melinda Gates Foundation, and guided by a Learning Committee, we assessed the needs and potential uses of blended financing to accelerate the growth and impact of start-ups and mid-sized distributors of health products in Nigeria, Kenya, Ghana and Uganda. Findings suggest that start-ups and distributors have 5 key needs that blended financing approaches may be well-positioned to address:…”

WHO Euro - Rethinking Policy Priorities in the light of Pandemics: a call to action https://www.euro.who.int/__data/assets/pdf_file/0010/495856/Pan-European-Commission-Call-to- action-eng.pdf?utm_campaign=covid19&utm_medium=email&utm_source=email

By the Pan-European Commission on Health and Sustainable Development. New WHO report (led by Mario Monti), calling for a new concept of “One Health” and a fundamental revamp of policy priorities to tackle inequalities, changes in the global financial system, and investment in GPGs.

Some blogs of the week

Is the Digital Divide the Newest Social Determinant of Health? S Heath; https://patientengagementhit.com/news/is-the-digital-divide-the-newest-social- determinant-of-health

“The digital divide fuels and is fueled by other leading social determinants of health, ultimately having an impact on patient wellness and health equity. … … Population health leaders are starting to look into the digital divide and where it is leading to health inequities and ultimately health disparities. In uncovering those issues, experts can craft better multimodal patient engagement strategies account for equity. Below, PatientEngagementHIT outlines where the digital divide has proven a challenge and how it has become a key social determinant of health. …”

Some tweets of the week

Gavin Yamey Re a chest-thumping tweet from Ron Klain on vaccination progress in US so far:

“Am I the only one who finds this tweet awful? There are many low & middle income nations where not a single dose has been administered. The US is the Hoarder In Chief. Why gleefully proclaim “USA! USA!” when health workers & high risk people in many nations aren’t yet vaccinated?”

Ilona Kickbusch “I guess someone is collecting all the words used for geopolitical #vaccinediplomacy - India uses „vaccine friendship." "Vaccine Maitri," from Sanskrit that means friendship, goodwill, or kindness. Modi wants the world to see India as a benevolent power.”

James Love “Thing is, in the middle of a pandemic with as much problem scaling production and as much inequality, hoarding know-how and IP is really appalling. And every effort to do voluntary open sourcing of vaccine manufacturing know-how, even with royalties, is being blocked.”

Céline Derveaux “ Love @MazzucatoM ‘s approach on an all-female @WHO Economic Council for Health for All: “When someone asks ‘why?’, the answer is ‘Why not!’”

Katri Bertram “Nice shout-out by @DrTedros to @IlonaKickbusch for pushing for WHO Chief Economist - interesting that still noted as to be established „in near future“. #LSECovid19”

Global governance of health

Devex - PEPFAR planning process changes raise transparency concerns https://www.devex.com/news/pepfar-planning-process-changes-raise-transparency-concerns- 99410

PEPFAR “will pursue a “much shortened and streamlined” approach to planning this year. Some worry the decision could limit participation and transparency in one of the world’s most important processes for setting goals and charting investments to tackle infectious disease….”

Telegraph - Cuba and Taiwan push for homegrown Covid vaccines amid frosty relations with the world’s superpowers https://www.telegraph.co.uk/global-health/science-and-disease/cuba-taiwan-push-homegrown- covid-vaccines-amid-frosty-relations/

“'A different form of vaccine diplomacy': US sanctions and concerns about Chinese influence prompted Cuba and Taiwan to develop jabs at home.”

CGD - Africa’s Crisis Recovery Requires Upgrading the Global Financial Safety Net

D Sembene; https://www.cgdev.org/blog/africas-crisis-recovery-requires-upgrading-global-financial- safety-net

Blog related to a new policy paper - Mobilizing External Financing for Africa’s Crisis Recovery.

“… Despite the significant support for COVID-19 response provided by their bilateral and multilateral partners, African countries continue to face significant financing needs to protect lives and livelihood and bolster prospects for a stronger and more resilient economic recovery. In this light, the time for the international community to go big on supporting Africa’s pandemic crisis recovery is now. To this end, I believe the following steps—which I detail in a new policy paper—will go a long way toward making the global financial system more effective, thereby helping countries on the continent mobilize more adequate levels of external financing for their crisis recovery….”

UHC

CGD blog - Comprehensive Primary Health Care for India: Looking at the Cost Implications of Improving Coverage for 1.4 Billion People (re-posted from HP&P Debated)

Planetary health

Guardian - UK, US and others face credit rating fall over CO2 emissions - study https://www.theguardian.com/business/2021/mar/18/uk-us-and-others-face-credit-rating-fall-over- co2-emissions-study?CMP=Share_iOSApp_Other

“Sovereign debt downgrades are in prospect for Britain, the US and scores of other countries around the world unless they urgently step up their efforts to reduce greenhouse gas emissions, according to a study. In the first attempt to adjust credit ratings to take account of the economic consequences of the climate emergency, a team of academics led by Cambridge University said failure to act would leave governments paying billions of dollars more to borrow….”

Nature (Comment) - Net-zero emissions targets are vague: three ways to fix https://www.nature.com/articles/d41586-021-00662-3

“To limit warming, action plans from countries and companies must be fair, rigorous and transparent.”

“…Here we call on nations, companies and the researchers advising them to clarify three aspects of their targets: their scope; how they are deemed adequate and fair; and concrete road maps towards and beyond net zero. A key date for this clarity will be the next UN climate summit, in Glasgow, UK, in November, where countries will present new climate pledges….”

Nature (News) - How microbes in permafrost could trigger a massive carbon bomb https://www.nature.com/articles/d41586-021-00659-y

“Genomics studies are helping to reveal how bacteria and archaea influence one of Earth’s largest carbon stores as it begins to thaw.”

CGD (blog) – If We’re Going to Fund Climate Mitigation from ODA, We Need to Double It. E Ritchie & C Kenny; https://www.cgdev.org/blog/if-were-going-fund-climate-mitigation-oda-we- need-double-it#.YFNa0kMfDZQ.twitter

“There is not enough ODA to cope adequately with existing development challenges, and yet it is now being charged with funding a large share of donor country commitments toward global climate finance. We think it should be doubled.”

“…In short, if rich countries insist on funding climate mitigation projects from ODA, then ODA needs a historically unprecedented increase. To meet existing commitments to mitigation alone, without further reducing existing funds for development, this would suggest Germany, the Netherlands, and the UK each spending well over 1 percent of GNI, France spending just under, and the US spending $60 billion on the basis of a proportional increase. If these numbers don’t seem plausible, donors need to look beyond ODA for climate finance.”

Links:

• Guardian - Feeding cows seaweed could cut their methane emissions by 82%, scientists say

Wonder whether it also works for human beings.

• Vox - The surprise catch of seafood trawling: Massive greenhouse gas emissions

“A new study shows that one industrial fishing method emits as much carbon dioxide annually as the aviation industry.”

• HPW - Africa’s Natural Disaster & Climate Funds Have Been Diverted To Address COVID-19 Pandemic – IFRC World Disaster Report

“COVID-19 has presented new risks to the African continent, with already limited financial resources needed to respond to climate hazards and natural disasters now being diverted to fight the pandemic…”

Infectious diseases & NTDs

Lancet Global Health (Comment) - Cost-effectiveness of universal HIV testing and treatment: where next? J Nachega et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00089- 9/fulltext

Comment linked to a new study in the Lancet GH - Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial

“The HPTN 071 (PopART) trial and others have shown that a combination HIV prevention package, including universal testing and treatment (UTT), can reduce the population-level incidence of HIV compared with standard care. However, evidence on the cost and cost-effectiveness of this strategy has been limited. In The Lancet Global Health, Ranjeeta Thomas and colleagues report on a cost- effectiveness analysis model, projecting that combination HIV prevention including UTT (ie, PopART) is cost-effective at thresholds greater than US$800 per disability-adjusted life year (DALY) averted in individuals older than 14 years. Their incremental cost-effectiveness ratios (ICERs) are lower than those in previous modelling studies, suggesting that population-level combination HIV prevention might be more cost-effective than initially suggested….”

WHO - WHO publishes new clinical and service delivery recommendations for HIV prevention, treatment and care https://www.who.int/news/item/17-03-2021-who-publishes-new-clinical-recommendations-on-hiv- prevention-infant-diagnosis-antiretroviral-therapy-initiation-and-monitoring#.YFIlo6o7pPg.twitter

“These guidelines provide new and updated recommendations on the use of point-of-care testing in children under 18 months of age and point-of-care tests to monitor treatment in people living with HIV; the treatment monitoring algorithm; and timing of antiretroviral therapy (ART) among people living with HIV who are being treated for tuberculosis….”

Sexual & Reproductive / maternal, neonatal & child health

HPW - WHO Calls For Comprehensive Tobacco Control Measures To Protect Young Children In Context of ‘Nurturing Care’ https://healthpolicy-watch.news/new-who-study-calls-for-comprehensive-tobacco-control- measures-to-protect-children/

“Tobacco use and second-hand smoking during pregnancy doubles the risk of sudden infant death and birth defects – issues highlighted in a new policy brief on the linkages between tobacco control and children’s health, published by the World Health Organisation (WHO). The brief, Tobacco

Control To Improve Child Health and Development, notes that exposure to second-hand smoke during pregnancy is linked to a 23% increased risk to stillbirths and 13% increased risk of congenital malformation. And of the 1.2 million deaths every year caused by second-hand tobacco smoke exhaled by smokers, the study found that up to 65,000 occurs among children under 15 years. Emerging evidence suggests that smoking during pregnancy can have an impact across generations, the brief notes: “For example, grandchildren of women who smoked during pregnancy are at a higher risk of asthma,” it states. The brief, released on Tuesday, is part of a new “Nurturing Care” initiative by WHO, which aims to highlight ways in which healthcare practices and policy choices and improve children’s prospects of health and development….”

Links:

• HP&P - Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

• Journal of Equity in Health - The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs

Human resources for health

Guardian – Lesotho sacks hundreds of striking nurses as doctors warn of dire shortages https://www.theguardian.com/global-development/2021/mar/16/lesotho-sacks-hundreds-of- striking-nurses-as-doctors-warn-of-dire-shortages

“Lesotho has sacked hundreds of its nurses over the past few days in a row over pay. The small southern African country’s main hospital in the capital, Maseru, fired 345 nurses and nursing assistants, who have been on strike for the past month, with immediate effect. The nurses went on strike to press the government-owned Queen Mamohato Memorial Hospital (QMMH) to give them the same salaries as their counterparts in other government and private institutions….”

Extra Covid section

We will gradually include more of the Covid reads & analysis in this (extra) section.

Science Editorial – COVID-19 vaccination passports https://science.sciencemag.org/content/371/6535/1184

“As countries grow eager to reignite their economies and people increasingly yearn for mobility and normalcy in life, pressure is mounting for some form of COVID-19 health status certificate that would support these desires. There has already been an explosion of COVID-19 passport initiatives for

domestic use and international travel. But scientific, legal, and ethical concerns abound with such documentation. Given the high stakes, what is the path forward? “

“… Among newly proposed COVID-19 passport schemes are the WHO's Smart Vaccination Certificate, Israel's “green passport,” the European Union's proposed Digital Green Pass, and the Africa Centres for Disease Control and Prevention's “My COVID Pass.” Given the momentum, what are the main principles that COVID-19 passports should follow to ensure their appropriate use?...”

Economist - John Magufuli, Tanzania’s covid-denying president, dies aged 61 https://www.economist.com/middle-east-and-africa/2021/03/18/john-magufuli-tanzanias-covid- denying-president-dies-aged-61

That didn’t end well.

Globalization & Health - Countries with delayed COVID-19 introduction – characteristics, drivers, gaps, and opportunities Zheng Li et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021- 00678-4

“Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs)….”

NYT - Why Older People Managed to Stay Happier Through the Pandemic https://www.nytimes.com/2021/03/12/health/covid-pandemic-happiness-age.html

“New surveys over the last year show that the ability to cope improves with age.”

Nature - COVID antibody treatments show promise for preventing severe disease https://www.nature.com/articles/d41586-021-00650- 7?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“But uptake by patients and physicians has been low in the United States, where some therapies have been authorized for months.”

BMJ GH - Ghana’s COVID-19 response: the Black Star can do even better

N K Quakyi et al ; https://gh.bmj.com/content/6/3/e005569

On Ghana’s response so far.

Guardian - Small number of Facebook users responsible for most Covid vaccine skepticism – report https://www.theguardian.com/technology/2021/mar/15/facebook-study-covid-vaccine-skepticism

“Washington Post reported on the study which confirmed what researchers have long argued about: the echo chamber effect.”

New York Intelligencer - How the West Lost COVID How did so many rich countries get it so wrong? How did others get it so right? D Wallace-Wells; https://nymag.com/intelligencer/2021/03/how-the-west-lost-covid-19.html

Longread. “How did so many rich countries get it so wrong? How did others get it so right?”

“…In Europe, North America, and South America: nearly universal failure. In sub-Saharan Africa and South Asia: high caseloads and low death rates, owing largely to the age structure of populations. In East Asia, South-East Asia and Oceania: inarguable success. You can compare countries within these clusters, and wonder why Canada has outperformed the U.S. or why Uruguay has outshone Argentina, why Iran suffered so much or how Japan, which never locked down and never tested all that widely, succeeded so brilliantly. But the differences in outcomes between the groups of nations are far greater than those within them, so much so that they appear almost as the burn scars of entirely different diseases…”

Vox - Covid-19’s big public health lesson: Ask people to be careful, not perfect https://www.vox.com/22315478/covid-19-coronavirus-harm-reduction-abstinence

“Harm reduction works. Covid-19 has proved it.”

HPW - Pakistan Threatens Health Workers: Get the Chinese-donated vaccine or get fired! https://healthpolicy-watch.news/pakistan-threatens-health-workers-get-the-chinese-donated- vaccine-or-get-fired/

“Pakistan authorities are threatening to fire healthcare workers who refuse to be vaccinated with the Chinese-donated SinoPharm COVID-19 vaccine….”

Guardian - Why home-produced Covid vaccine hasn't helped India, Russia and China rollouts https://www.theguardian.com/world/2021/mar/17/why-covid-vaccine-home-produced-india-russia- china-slow-start

“Challenge of reaching vast, far-flung populations is combined with a lack of public interest.”

Science - How do you treat coronavirus? Here are physicians’ best strategies https://www.sciencemag.org/news/2021/03/how-do-you-treat-coronavirus-here-are-physicians- best-strategies

For the MDs among you.

Links:

Telegraph - Pakistan imports Covid vaccines for private sale, starting with 50,000 doses of Russia’s Sputnik V

Guardian - US to send 4m AstraZeneca vaccine doses to Mexico and Canada

“Biden administration has come under pressure to share vaccine, which has been authorized in other countries but not yet in US.”