IHP news 633 : Spooky times
( 27 August 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,
Many in the global health community still enjoyed a relatively quiet (holiday) week, in spite of a world in turmoil. Things will no doubt pick up again in September, among others with pandemic treaty related discussions in Geneva. More in general, as Tedros argued on Wednesday (pointing to three major meetings in the coming months), it looks like autumn will be critical for future pandemic preparedness & response. We’ll see.
Also in September, Trips waiver related negotiations (WTO) “restart” again, there’s a G20 Health Ministers’ meeting in Rome scheduled (5-6 Sept), and let’s not forget the (UN) Global Goals week later this month. Wonder what the prevailing mood will be there. As Patrick Stewart pointed out, referring among others to the latest IPCC report, “ As damaging as COVID-19 has been to the SDGs, the global climate emergency presents a much graver long-term threat. “ That is exactly right. Already, the current Anthropocene/Capitalocene is called by some the ‘Pyrocene’. Add to this the danger - in an age of more and more crises hitting countries at the same time - that our empathy runs out and mankind basically becomes ethically numb (or more accurately: even more ethically numb ☹) (as Jacob Stern worried in The Atlantic ) and you know we will very much need a radicalized young generation throughout the 21st century. At the very least. Together, among others, with a global revival of the idea of “Common prosperity”, now advocated by Xi Jinping and, according to The Economist, “spooking” the prosperous there. (Here’s to spooky times for the (very) prosperous !) But let’s also not forget to spook Xi on some of the less enticing Chinese characteristics of his “model”.
On the global vaccine (in)equity front, although there has been some improvement lately, Madhukar Pai still pretty much nailed it on Twitter: “By now, the world over, every plant capable of making vaccines must be making Covid shots for 7.7 billion people Leaders in rich nations have instead chosen to allow a few companies to supply, procured a giant share for themselves & offer boosters for their citizens.” Obviously, ‘global solidarity’ hasn't worked much as an argument for the powers that be, in spite of their rhetoric, so perhaps Friedman & Gostin’s case in Foreign Policy , “The Whole World Needs Vaccines Before a Worse Variant Than Delta Arrives”, might spook Western leaders and citizens sufficiently to finally make progress on vaccine equity. Still, I wouldn’t count on it. The ugly truth is our leaders feel way more pressure from public opinion (including on social media) on migration, for example, than on global vaccine equity. But who knows, perhaps a good ‘outcome’ of the German federal election end of September could bring some new momentum in Trips waiver negotiations?
In Tokyo, the Paralympics have started, the sort of sports event where athletes routinely display the resilience and perseverance I can only dream of. Guess we should all be inspired by these brave
1
people, to try make progress in a world with so much injustice and so many challenges. They never give up. Neither should we.
Enjoy your reading.
Kristof Decoster
Featured Article
How the Afghan crisis could impact Pakistan
Mehr Manzoor (IHP correspondent & EV 2018)
As U.S. and other NATO troops are leaving Afghanistan, and the macro-economic situation deteriorating rapidly, the country finds itself once again on the brink of collapse. Echoes of desperation, fear, helplessness, and chaos fill the air as the Taliban take back control and are cracking down on individuals they believe to have helped or worked with the Americans, threatening to kill them. Even some of those who surrender are being executed. Many Afghanis see no hope under the Taliban, in spite of some of their more reassuring official messages, and want to flee the country. Although it’s far from clear which (political) scenario will prevail in the coming months and years, sustained Afghan instability forms a threat to the entire region for a number of reasons. In this article we will focus on the potential impact on Pakistan, one of the key players in the region.
Indeed, while most of the efforts to end the war in Afghanistan have focused on the Afghan government, the Taliban, and the United States, Pakistan’s (potential) role in facilitating meetings with the Taliban to negotiate a more inclusive government has largely been ignored by the U.S., mainly due to mistrust. Pakistan has previously been accused of its dual policy, of both aiding the Taliban behind the scenes, while also working with the United States in combating terrorism. Those who believe Pakistan gains from the current crisis, argue that the Taliban victory removes the threat of Afghan alignment with India, which was previously a concern for the Pakistani government. India on the other hand strongly opposes the role of the Taliban in Kashmir, thus limiting any possibility of an alliance with the Taliban. This view (of Pakistan being one of the geopolitical ‘winners’ in the current crisis) however largely ignores that Pakistan has been a victim of civil unrest in Afghanistan since the 1980s and continues to face the major brunt of the consequences. Including now.
Major threats facing Pakistan in the aftermath of a Taliban victory include border insecurity, the growing threat of terrorism especially from “Taliban elements” within Pakistan that have been responsible for killing thousands of civilians and attacking the military, a potential huge new influx of refugees (which it can’t afford to take in anymore, considering that the country already hosted millions of Afghan refugees in the past 3 decades), and a threat to women rights. Below I cover all four of them.
1) Security Risk Pakistan has had a long history of tense relations with Afghanistan, with whom it shares its western border, resulting in poor bilateral relations marked by lack of trust and anti-neighbour sentiments on
2
both sides. Upon the creation of Pakistan, as a sovereign state in 1947, Afghanistan was the only country who did not recognize the country and voted against its inclusion in the United Nations. Till now Afghanis don’t recognize the colonial-era Durand Line as an international border. Both countries blame each other for harboring terrorist elements that launch terrorist attacks on innocent civilians on both sides of the border, a porous border facilitating such threats. Recently, Pakistan has tightened its border security to reduce the frequency of such attacks. Afghanis also blame Pakistan of having friendly ties with the Taliban and question why Pakistan has not leveraged these ties to pressurize Taliban to reduce violence. Pakistan denies such leverage.
Moreover, in relation to its neighbours, Pakistan feels a bit “sandwiched” with India sharing its eastern border, China and Russia in the north, and Afghanistan and Iran on the west. The growing involvement of China, Russia, Iran (and to a lesser extent India) in Afghanistan means more competition for Pakistan to maintain its strategic position (even if relations with China aren’t bad given the Belt and Road connection). There is also the constant threat of border insecurity and militant attacks from all corners, which has resulted in a major portion of Pakistan’s annual budget being allocated for strengthening its military capability and tightening its border security rather than spending on education and health.
It’s a complex picture, though. As the Taliban seize control of Kabul, Pakistan’s political stance on the Taliban will at least partly be “inspired” by its fear of India. Indeed, Pakistan is believed to seek support of the Taliban in combating Indian militant attacks. Also, as is well known, several factions of its army (and intelligence community) admire the Taliban. Nevertheless, all in all, the security risks for Pakistan in the wake of Taliban’s victory remain a real threat for its own stability. Which brings me to the next point.
2) Threat from Terrorism Recently, Pakistan army’s top command declared the Afghan Taliban and their counterparts, the Tehrik-e-Taliban Pakistan (TTP) group, “two faces of the same coin”. TTP has been responsible for launching several violent attacks in Pakistan, killing thousands of civilians (among others, in an attack on a school in Peshawar in 2014 that killed 150 people, mostly children). They have also repeatedly attacked the army. While many Pakistanis condemn TTP, it is widely believed that they have a soft(er) spot for the Afghan Taliban. There are various reasons for this. Many Pakistanis have mixed feelings about the role the U.S. played in the region and its fight against Islamic extremism in recent decades; the former Afghan government led by Ashraf Ghani (who fled the country as the Taliban entered Kabul), backed by the US, was perceived as weak and corrupt; and last but not least, India has been showing growing interest in Afghanistan, threatening among others Pakistan’s border security. All of these mitigated Pakistani sentiments on the rise of the Taliban, even if the latter comes with its own risks. Indeed, the rise of the Taliban poses a serious security threat to Pakistan in terms of spillover and terrorist groups like TTP becoming more active again. Furthermore, Pakistan doesn’t want a Taliban-type government in power over its own people.
On a side note: the #SanctionPakistan campaign went viral as the Taliban seized control of Afghanistan. It was tweeted around 73,000 times with 37% of the tweets emerging out of Afghanistan. The campaign represents anti-Pakistan sentiment among Afghanis who believe Pakistan to be supportive of the Taliban. Pakistan on the other hand blames the weak and corrupt (now former) Afghan government and its lack of military capability in controlling the Taliban from taking over. Afghanistan, after all, received $ 2trillion dollars over the last two decades to build and strengthen its own national army. Where was all that money spent?
3
3) A new Refugee Crisis? Pakistan is the 5th most populous country in the world, with a population of over 208 million people. The current population growth rate of 2.4% is twice the average rate for South Asian countries (1.2%). At this rate, Pakistan’s population will double in 29 years. The province of Punjab remains the most populated province, among others due to inter-provincial and rural-urban migration taking place between Punjab and Sindh. Pakistan has already expressed concerns on its ability to absorb more refugees: the country has hosted millions of refugees from Afghanistan since the 1980s, and currently, at least a few million refugees are still living in the country (both registered and unregistered ones). It’s the third largest refugee-hosting country in the world for the moment. The near constant influx of refugees has posed a threat to the economic and health care system of the country as refugees face financial hardship and emotional trauma. The inflow of refugees has also been linked to over- exploitation of natural resources leading to deforestation, soil erosion, and depletion and pollution of water resources as people need to rely on water, food, shelter, and medicine for survival. A new Afghan refugee crisis and influx might further worsen the already difficult situation due to a deteriorating security situation, violence, drought, and threat of COVID-19. With international aid, as always, as a big ‘question mark’…
4) Women’s Empowerment and rights Women face an uncertain future under the Taliban regime (understatement). When the U.S. first invaded Afghanistan in 2001, they used women rights to help justify their action. While some progress towards gender equality and women’s empowerment was achieved with women entering political, economic, and legal spheres in the aftermath of the U.S. invasion in Afghanistan, it all seems to be under threat now under the new Taliban rule. Women in positions of power and authority, as well as female activists, also face the threat of kidnapping and violence. Taliban are already reported to have sent females home from schools and their workplaces.
Compared to their Afghan sisters, many Pakistani women have been enjoying greater freedom and rights, certainly when comparing with the Taliban rule in the 90s. While there are elements within Pakistan that (want to) limit women’s rights, the state is generally supportive of women’s education, their rights to own property, and work. As women face again a greater threat under the Taliban in Afghanistan, there is major fear of these conservative “elements” trickling into the fabric of Pakistan’s society as well.
Highlights of the week
Hypertension
As we don’t always want to start with a Covid info overload, we kick off this week’s newsletter with this big hypertension (trend) news. Important NCD stuff (PS: both dr. Tedros & me suffer from this, I learnt this week. Although arguably, running WHO sounds like a tougher job :) ).
4
Lancet - Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population- representative studies with 104 million participants NCD Risk Factor Collaboration (NCD-RisC) ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01330-1/fulltext
Cfr the press release:
The Lancet: Number of people living with hypertension has doubled worldwide over past 30 years to more than 1.2 billion
“Most comprehensive analysis of its kind charting hypertension prevalence, diagnosis, treatment and control in 200 countries over past 30 years reveals more than half of people with hypertension, or 720 million, worldwide were untreated in 2019. Many high-income countries, including Canada, Switzerland, the UK and Spain report all-time low prevalence levels, but in low- and middle-income and central European countries such as Paraguay, Hungary, Poland, and Croatia hypertension rates remain high. High-income and some middle-income countries have made impressive improvements in treatment and control of hypertension including Canada, South Korea, Iceland, the USA, Costa Rica, and Germany; but there has been little change in most countries in sub-Saharan Africa and Oceania. Authors call for best practice in detection, treatment, and control from countries like Costa Rica, Chile, Turkey, Kazakhstan and South Africa to be replicated across low- and middle-income countries.”
“… Slow rollout of global treatment and control in poorest nations Treatment and control have improved in most countries since 1990, with particularly large improvements (of greater than 30 percentage points) seen in high-income countries … …. and in several upper-middle and middle-income countries such as Costa Rica—where more than 65% of adults with hypertension were treated and nearly half had their condition controlled in 2019 However, there has been little change in LMICs in sub-Saharan Africa and Oceania, Nepal, and Indonesia—where less than a quarter of women and less than a fifth of men with hypertension were being treated in 2019, and fewer than 10% had well controlled blood pressure…. “
• Related Lancet Comment: Global and national high blood pressure burden and control. Some excerpts:
“…. As reported in The Lancet by the NCD Risk Factor Collaboration (NCD-RisC), the number of people with hypertension globally in 2019 was over 1 billion and this number has doubled since 1990. In 2019, the prevalence of hypertension in adults aged 30–79 years was 32% in women and 34% in men and very similar to 1990 levels of 32% (95% credible interval [CrI] 30–34) in women and 32% (32–37) in men and consistent with other reports. However, what the authors more clearly explain is that this stable prevalence is the net sum of distinct differences across the world. The analysis highlights the stark differences in hypertension prevalence, treatment, and control, with some regions seeing substantial increases over time and others substantial decreases in prevalence. “
“… The data presented by the NCD-RisC show the importance of seeing the country-level data to gain a better understanding of the similarities and differences in prevalence, treatment, and control. Although the findings show some patterns common to economic regions of the world, there are also many outliers. … …. The disappointing message of this study, however, is that despite much
5
research, health systems, and global policy efforts, progress has been slow in the global control of hypertension. … …. There is an urgent need for a transformation and innovative approaches to reduce the burden of hypertension globally. We need better strategies to increase diagnosis and management, leveraging primary care or existing systems or identifying new methods to engage consumers in blood pressure management… …. Finally the standstill in global prevalence and the global control rates of approximately 20% should serve as an important global wakeup call that cardiovascular disease is going to be a main burden of disease for many years to come, especially if we carry on like this.”
• WHO & Imperial College London joint press statement – More than 700 million people with untreated hypertension
• UN News (Coverage) : High blood pressure now more common in low and middle-income countries, new report finds
“ The vast majority of people with high blood pressure, or hypertension …. live in low and middle- incomes countries, a World Health Organization (WHO) report released on Wednesday has revealed. The study, which was co-led by Imperial College London, found that 82 per cent of all people with hypertension, around one billion, live in low and middle-income countries. …. … About 580 million people with hypertension were unaware of their condition because they were never diagnosed. The study also indicated that more than half of people with hypertension, or a total of 720 million people, were not receiving the treatment that they needed….”
Afghanistan
Lancet World Report – Aid agencies reassess needs after Afghanistan takeover https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01901-2/fulltext
“Health and humanitarian organisations face uncertainty following the Taliban's takeover of the country. Sharmila Devi reports.”
Cidrap News - WHO airs concern over COVID control, medical supplies in Afghanistan https://www.cidrap.umn.edu/news-perspective/2021/08/who-airs-concern-over-covid-control- medical-supplies-afghanistan
(24 August) “At a briefing today, the head of the World Health Organization (WHO) Eastern Mediterranean office said the group is worried that upheaval in Afghanistan will fuel a spike in COVID-19 cases and that the country has only enough medical supplies to last 1 week. … The two groups (WHO & UNICEF) said they are committed to staying and helping the people of Afghanistan, with a network of 684 staff working in all 34 provinces. Last week, Doctors Without
6
Borders (MSF) also said its teams are staying put, with medical activities running in all five projects it runs. ….”
BBC - Afghanistan: World Bank halts aid after Taliban takeover
“The World Bank has halted funding for projects in Afghanistan after the Taliban seized control of the country. It cited concerns over how the Taliban's takeover will impact "the country's development prospects, especially for women". The move comes just days after the International Monetary Fund (IMF) suspended payments to Afghanistan…..”
HPW - Afghanistan’s Fragile Health System in Shatters as Taliban Assume Power – WHO Calls for ‘Humanitarian Airbridge’ https://healthpolicy-watch.news/afghanistans-fragile-health-system-in-shatters-as-taliban-assume- power/
From late last week.
“… On Sunday, amid the continuing airport chaos, WHO and UNICEF called jointly “for the immediate establishment of a humanitarian airbridge for the sustained and unimpeded delivery” of much-needed medicines and supplies to “millions of people in need of aid, including 300,000 people displaced in the last two months alone.” Said the statement: “While the main focus over the past days has been major air operations for the evacuation of internationals and vulnerable Afghans, the massive humanitarian needs facing the majority of the population should not – and cannot – be neglected. “With no commercial aircraft currently permitted to land in Kabul, we have no way to get supplies into the country and to those in need. Other humanitarian agencies are similarly constrained,” said the statement. Even prior to the events of the past weeks, Afghanistan represented the world’s third largest humanitarian operation, with over 18 million people requiring assistance….”
Link: UN News – Afghanistan: Negotiations to bring 500 tonnes of urgent medical supplies ongoing, says WHO
71st session WHO Afro
WHO Afro - African Health Ministers open meeting to shape continent’s health agenda https://www.afro.who.int/news/african-health-ministers-open-meeting-shape-continents-health- agenda
“African Health Ministers and representatives from countries gathered today for the Seventy-first session of the World Health Organization (WHO) Regional Committee for Africa, the preeminent meeting on public health in Africa. During the annual gathering, the Health Ministers set the health agenda for the next 12 months….”
7
“… To reinforce global solidarity, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, urged African countries to support an international treaty or other legal instrument to improve international cooperation on pandemic preparedness and response that will be discussed in November at a Special Session of the World Health Assembly…”
“… This year’s Regional Committee focuses on ways to scale up the COVID-19 response, renew the efforts to end all forms of polio, eliminate cervical cancer as well as enhance the use of health technologies. The meeting will also discuss measures to improve healthy ageing on the continent as well as reinforcing the fight against tuberculosis, HIV, sexually transmitted infections and hepatitis, and defeating meningitis by 2030 among other key health priorities….”
Link: WHO Afro results report
HPW – WHO Africa Chief Warns that COVID-19 Booster Shots Threaten Continent’s Ability to Fight the Pandemic https://healthpolicy-watch.news/89757-2/
“WHO regional director for Africa, Matshidiso Moeti, on Tuesday warned that moves by some wealthy countries to introduce booster shots threaten the African continent’s ability to fight the devastating pandemic. Richer countries should share their vaccine supplies with low-income countries instead of hoarding the drugs, she told delegates at the 71st Session of the WHO Regional Committee for Africa’s virtual meeting on public health in Africa….”
“… Dr Tedros, who also addressed the meeting, said he was concerned that only four countries in Africa had reached the targeted vaccination of at least 10% of their populations. Globally, some 140 countries have already reached this target. “I don’t need to tell you that the distribution of vaccines has been terribly unfair. More than 4.8 billion doses of vaccine have been administered globally. Just 87 million doses have been administered in the African region – less than 2 % of the global total.” Dr Tedros said. …. More than 44 million doses have been distributed to 40 African countries through the global vaccine-sharing facility, COVAX…..”
“… Governments on the African continent have faced several challenges since the start of the pandemic last year, said WHO’s Regional Emergency Director Dr Abdou Salam Gueye. These include the lack of multi-sectoral coordination of the pandemic response, weak health systems, limited funding, low public awareness, and low vaccination rates, and vaccine hesitancy. Added to this was the misinformation at all levels, including political leadership, health workers, and communities, which Gueye said made “the work harder”. Most shockingly, according to Gueye, is that many African countries are not clear about which variant they are dealing with due to, among other, poor genomic sequencing technology, gaps in surveillance, and data and information management….”
Links:
• WHO Afro - African Health Ministers review COVID-19 fight, plan for future shocks
“African health ministers met today to take stock of the continent's fight against COVID-19 as the pandemic continues to stretch health systems to breaking point in some countries and just 2% of all
8
Africans are fully vaccinated against the virus. Ministers assessed immediate actions needed to curb Africa’s third wave, which saw COVID-19 cases in Africa surpass 7 million, reach a record weekly peak of over 250 000 in early July and drive up deaths to a record weekly peak of over 6400 in early August. The third wave has declined over the last five weeks since the peak in early July, but 16 countries are still experiencing a surge in new cases. The special online session aimed to brief ministers on the state of COVID-19 across the World Health Organization (WHO) African Region, share approaches in tackling the pandemic and discuss how African countries can learn from COVID- 19 and build more sustainable systems to prevent, detect and respond to future health emergencies….”
WHO Afro - African countries commit to ending all forms of polio at regional meeting
Covid key News
Among others, focusing on key WHO messages from the past week. But first the latest global update.
Cidrap News – WHO sees signs of global COVID-19 plateau https://www.cidrap.umn.edu/news-perspective/2021/08/who-sees-signs-global-covid-19-plateau
“After a steady rise for nearly 2 months, the pace of the world's COVID-19 cases seems to be plateauing, though levels continue to rise in the Western Pacific and Americas regions, the World Health Organization (WHO) said in its latest pandemic snapshot. The world reported 4.5 million cases last week, showing signs of stabilization, the WHO said in its situation report. However, cases in the Western Pacific region rose 20%, led by increases in places like Japan in the Philippines, while infections in the Americas, fueled by surges in the United States and other countries, increased by 8%. Globally, deaths stayed the same as last week, with 68,000 more fatalities reported. However, levels rose in the Europe and Americas region. At a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, warned that though stable, cases are still at a very high level, with the situation varying by region, country, province, and even town.”
PS: “… Meanwhile, the WHO's African regional office said in its latest weekly outbreaks and health emergencies report that cases have declined for the sixth week in a row in its third wave, which started in the middle of May. However, weekly cases were up by 20% or more in 16 countries. Vaccine supply is improving, with immunizations nearly tripling since June….”
See also Reuters - Africa's COVID-19 third wave stabilises as vaccine levels rise - WHO
“A third wave of COVID-19 infections in Africa has stabilised with 248,000 cases reported in the last week, the World Health Organization said on Thursday, while vaccines administered over the same period tripled to 13 million compared to the previous week….”
9
Reuters - WHO seeks 'best minds' to probe new pathogens that jump from animals to humans
Reuters;
From late last week. “The World Health Organization (WHO) said [last week] on Friday it was looking for the greatest scientific minds to advise on investigations into new high-threat pathogens that jump from animals to humans and could spark the next pandemic. Launching a request for applications, it said that its Scientific Advisory Group for the Origins of Novel Pathogens would also review progress on the next studies into the origins of the SARS-CoV-2 virus that emerged in China in late 2019. "We need to bring in the best minds here. And it needs to be multi-disciplinary," Maria van Kerkhove, head of WHO's emerging diseases and zoonosis unit, told Reuters. The panel, announced by WHO director-general Tedros Adhanom Ghebreyesus in July, will be composed of 25 experts expected to meet first virtually in late September, a statement said….”
See the WHO statement - Call for experts to join Scientific Advisory Group for the Origins of Novel Pathogens
And for some more info on the rationale for this group, see this (recommended) Stat News article - The WHO is looking for experts to help investigate the origins of pathogens — including the coronavirus (with the view of Maria van Kerkhove (WHO’s Covid technical lead))
Or Science - New WHO group aims to improve efforts to find pathogen origins (also Q&A with van Kerkhove)
Guardian - US intelligence study inconclusive on Covid origins, according to reports https://www.theguardian.com/world/2021/aug/25/us-intelligence-biden-inconclusive-report-covid- origins-wuhan-lab-animals
“A classified US intelligence report delivered to the White House was inconclusive on the origins of the Covid-19 pandemic, in part due to a lack of information from China, according to US media reports…..”
“The assessment received on Tuesday, which was ordered by President Joe Biden 90 days ago, was unable to definitively conclude whether the virus that first emerged in central China had jumped to humans via animals or escaped a highly secure research facility in Wuhan, two US officials familiar with the matter told the Washington Post. They said parts of the report could be declassified in the coming days. …. Despite Biden’s directive that the intelligence community “redouble their efforts” to untangle the origin debate, the 90-day review brought them no closer to consensus, the officials told the Post. Part of the problem is a lack of detailed information from China, according to the Wall Street Journal…..”
Link (from earlier this week):
• Reuters - U.S. review of COVID's China origin unlikely to solve vexing questions;
10
“Yet three U.S. government officials and a fourth person familiar with the scope of the investigation said they did not expect the review to lead to firm conclusions after China stymied earlier international efforts to gather key information on the ground. Instead, one official said the report would likely point to additional lines of inquiry that officials could pursue, including demands of China that are likely to further ratchet up tensions with Beijing at a time when the country's ties with Washington are at their lowest point in decades….” “… The report also comes as the U.S. intelligence agencies have come under pressure from within the administration and Congress over issues related to the handling of Afghanistan after the fall of Kabul to the Taliban came faster than many U.S. intelligence, defense and diplomatic analysts predicted…..”
More links:
• WSJ - New U.S. Intelligence Report Doesn’t Provide Definitive Conclusion on Covid-19 Origins
Meanwhile, from the Chinese side, they also seem to know a thing or two about ‘fake news’ : )
• Newsweek: China Pushes Own 'Lab Leak' Conspiracy As Biden's COVID Report Draws Near • See also Reuters - China criticises U.S. "scapegoating" as COVID origin report to be released
Already before the release of the report, “China criticised on Wednesday the U.S. “politicization” of efforts to trace the origin of the coronavirus, demanding a U.S. military laboratory be investigated, shortly before the release of a U.S. intelligence community report on the virus….”
And the Telegraph - Probe US lab leaks, China's UN ambassador tells the WHO
“… On Tuesday, Chen Xu, China’s permanent representative to the UN at Geneva, wrote to the WHO director general, Tedros Adhanom Ghebreyesus, alleging that the labs of Fort Detrick and University of North Carolina in the US should be the subject of investigation instead.”
Nature (Comment) - Origins of SARS-CoV-2: window is closing for key scientific studies https://www.nature.com/articles/d41586-021-02263-6
“Authors of the March WHO report into how COVID-19 emerged warn that further delay makes crucial inquiry biologically difficult.”
See also Politico - Experts on WHO team say search for coronavirus origins has stalled
“…In a commentary published in the journal Nature, the WHO-recruited experts said the origins investigation is at “a critical juncture” requiring urgent collaboration but has instead come to a standstill. They noted among other things that Chinese officials are still reluctant to share some raw data, citing concerns over patient confidentiality…. …. In their analysis, published in March, the WHO team concluded the virus probably jumped to humans from animals, and they described the possibility of a laboratory leak as “extremely unlikely.” But the WHO experts said their report was
11
intended only as a first step and added, “The window of opportunity for conducting this crucial inquiry is closing fast: any delay will render some of the studies biologically impossible.” “
“…. Marion Koopmans and her WHO-recruited colleagues listed a number of priorities for further research, including conducting wider antibody surveys that might identify places where Covid-19 was spreading undetected, both in China and beyond, testing wild bats and farm-raised animals as potential reservoirs of the virus, and investigating any credible new leads….”
PS: Maria Van Kerkhove already responded to this Nature comment at a media briefing on Wednesday, see HPW.
“…In response, WHO’s lead on COVID-19, Maria Van Kerkhove, said the global body was in the process of setting up the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) to “establish a standardised approach for studying where and when these pathogens emerge”. However, Van Kerkhove said that the origins group had identified “numerous further studies” that needed to be conducted in its March report – and there were many scientists in China who could do these. “One of the responsibilities of the SAGO would be to urgently prioritise what studies need to go forward,” said Van Kerkhove, adding that “we have heard from Chinese colleagues that studies are underway from some public statements that they have made recently”.”
Guardian - All theories on origins of Covid-19 outbreak still ‘on the table’, says WHO https://www.theguardian.com/world/2021/aug/25/us-intelligence-biden-inconclusive-report- covid-origins-wuhan-lab-animals
Though, if you read between the lines, some are clearly more likely than others, also in the eyes of higher WHO staff.
“The World Health Organization has said all theories on the origins of the Covid-19 outbreak, including the possibility of laboratory leak, are “on the table” and urged Chinese scientists to carry out their own investigations. WHO officials were answering questions from the press after a classified US intelligence report delivered to the White House on Tuesday was reported to be inconclusive on the question of the origins of the pandemic, in part due to a lack of information from China. “The current situation is that all of the hypotheses regarding to the origins of the virus are still on the table,” Michael Ryan, the head of the WHO’s health emergencies programme, in response to a question about the laboratory leak theory. “Some are more likely than others based on the current analysis, but all of those hypotheses require further elucidation and further inquiry and we will go and look where all of those leads take the WHO.” “
Cidrap News - Pfizer COVID vaccine gains full FDA approval China criticises U.S. "scapegoating" as COVID origin report to be released
“…. the US Food and Drug Administration (FDA) granted the mRNA COVID-19 vaccine made by Pfizer-BioNTech full approval, a milestone in the ongoing pandemic….”
12
See also HPW: Final US FDA Approval of Pfizer-BioNTech COVID Vaccine – Likely to Drive More Voluntary Jabs & Mandates
Reuters - WHO says no conclusive data yet on need for COVID-19 booster shot WHO says no conclusive data yet on need for COVID-19 booster shot | Reuters
“The World Health Organization Director General Tedros Adhanom Ghebreyesus said on Wednesday that the data on the benefits and safety of a COVID-19 vaccine booster shot is inconclusive. "When some countries afford to have the booster and others are not even vaccinating the first and second round, it's a moral issue," he said during a media briefing.”
HPW - Without Adequate Funding, World is Vulnerable to ‘Prolonged’ COVID-19 Pandemic https://healthpolicy-watch.news/without-adequate-funding-world-is-vulnerable-to-prolonged- covid-19-pandemic/
“Global health security is dangerously underfunded, making the world vulnerable to a “prolonged COVID-19 pandemic with repeated waves affecting all countries” and future pandemics, Singaporean Minister Tharman Shanmugaratnam told a World Health Organization (WHO) media briefing on Wednesday. Shanmugaratnam, who co-chairs the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, urged global governments to pledge at least $10 billion more every year to address this and future pandemics. His panel has recommended the establishment of a Global Health Threats Fund to mobilise money for pandemic surveillance and response….”
PS: “… WHO Director General Dr Tedros Adhanom Ghebreyesus told the briefing that the COVID-19 pandemic has stabilised over the past week (after rising for two months), “but at the very high rate of 4.5 million cases and 68,000 deaths”. Tedros described the next three months as “a critical period for shaping the future of pandemic preparedness and response”. WHO believes that “whatever structures and mechanisms emerge”, they have the engagement and ownership of all countries, be aligned with the constitutional mandate of WHO rather than creating parallel structures, involve partners from across the One Health spectrum, including animal, and environmental health, ensure coherence with the International Health Regulations, and be accountable to all member states, added Tedros. …”
Covid Science
Stat - Viral evolution 101: Why the coronavirus has changed as it has, and what it means going forward https://www.statnews.com/2021/08/20/viral-evolution-101-coronavirus/
“It’s impossible to say how the coronavirus will continue to evolve. Those changes, after all, are a result of random mutations. But there are some fundamental principles that explain why the
13
virus has morphed as it has, principles that could guide our understanding of its ongoing evolution — and what that means for our future with the pathogen. …. Below, STAT outlines some of the key questions about the virus’ evolution — and what it means going forward….”
Reuters - AstraZeneca's antibody therapy prevents COVID-19 in study Reuters;
“AstraZeneca (AZN.L) said [last week] on Friday its antibody therapy met the main goal of preventing COVID-19 disease in a late-stage study, putting the British drugmaker on track to potentially offer an alternative to vaccines for people with weakened immune systems….”
See also FT – AstraZeneca to seek approval for Covid antibody cocktail
“AstraZeneca will move to seek regulatory approval of its antibody cocktail after a study showed the drug significantly reduced the risk of developing symptomatic Covid-19. That would make it the first long-acting drug that is not a vaccine that has demonstrated prevention of the disease in a clinical trial. The Anglo-Swedish drugmaker said on Friday that its AZD7442 antibody combination showed a 77 per cent reduction in the development of symptomatic Covid compared with a placebo. There were no severe Covid cases or deaths in those treated with the drug, while the placebo arm accrued three cases of severe disease, including two deaths. …. … AstraZeneca has a deal with the US to supply up to 700,000 doses of the treatment for up to $726m. Antibody cocktails are difficult to administer and expensive to make, making them cost-effective only if their effects are significant….”
Reuters – India says homegrown mRNA COVID-19 shot safe in early trial
Reuters;
“Indian pharmaceutical firm Gennova Biopharmaceuticals' COVID-19 vaccine, the first homegrown mRNA-based shot, was found to be safe and effective in an early-stage study, the government said on Tuesday…..”
Nature News - COVID vaccines and blood clots: what researchers know so far https://www.nature.com/articles/d41586-021-02291-2
“Scientists are trying to understand why a small number of people develop a mysterious clotting disorder after receiving a COVID jab.”
Reuters - COVID jab protection wanes within six months - UK researchers COVID jab protection wanes within six months - UK researchers | Reuters
“Protection against COVID-19 offered by two doses of the Pfizer/BioNTech and the Oxford/AstraZeneca coronavirus vaccines begins to fade within six months, underscoring the need for booster shots, according to researchers in Britain…..”
14
“…Under a worst-case scenario, protection could fall below 50% for older people and healthcare workers by the winter, Tim Spector, principal investigator for the ZOE COVID study, said. "It's bringing into focus this need for some action. We can't just sit by and see the protectiveness slowly waning whilst cases are still high and the chance of infection still high as well," Spector told BBC television….”
Stat - Covid-19 vaccines flirted with perfection at first. Reality is more complicated https://www.statnews.com/2021/08/25/covid-19-vaccines-flirted-with-perfection-reality-more- complicated/
“….Now, however, our soaring expectations for Covid-19 vaccines are in the process of sinking back to earth. With the more transmissible Delta variant of SARS-2 circulating, it is increasingly apparent that, even if mRNA vaccines like Pfizer’s and Moderna’s offer impressive protection against severe Covid infections, they aren’t going to prevent infections in the upper respiratory tract of some proportion of vaccinated people….”
FT - J&J says Covid booster shot produced strong antibody response https://www.ft.com/content/32f524c1-d1ae-46b0-9d75-9ee9e142d726
“…A booster shot of Johnson & Johnson’s Covid-19 vaccine produced a strong and rapid antibody response against the virus, the pharmaceutical company said on Wednesday. The preliminary data from the world’s largest healthcare company comes as top US public health officials and rival vaccine makers say a booster shot programme is needed to protect against waning immunity. J&J said a second shot elicited a nine-fold increase in antibodies against Covid compared with levels seen 28 days after a single dose of the jab. “Significant increases” in antibody responses were seen in people aged 18 to 55, as well as those older than 65, who were given a lower dose….”
Science (Review) – Airborne transmission of respiratory viruses http://science.sciencemag.org/content/373/6558/eabd9149.full
“…Wang et al. review recent advances in understanding airborne transmission gained from studying the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and other respiratory pathogens. The authors suggest that airborne transmission may be the dominant form of transmission for several respiratory pathogens, including SARS-CoV-2, and that further understanding of the mechanisms underlying infection from the airborne route will better inform mitigation measures.”
Covax & ACT-A
From late last week: “Covax ….has delivered 209 million vaccine doses to 138 different countries, new figures show - a tenth of its target for this year.” And according to the latest Covax forecast, the expectation is to have 500 million doses delivered by end of September.
15
Reuters - WHO begins shipping Chinese vaccines despite some misgivings Reuters;
“ The World Health Organization's pandemic programme plans to ship 100 million doses of the Sinovac (SVA.O) and Sinopharm COVID-19 shots by the end of next month, mostly to Africa and Asia, in its first delivery of Chinese vaccines, a WHO document shows. The Chinese shipments will help the sputtering global COVAX vaccine sharing programme which is far behind its pledge to deliver 2 billion doses this year following supply problems and export curbs imposed by major producer India. …. Of the 100 million Chinese vaccines, half will be provided by Sinopharm and half by Sinovac, with deliveries planned for "July to September 2021", a WHO document dated July 29 says. … About 10 million Sinopharm shots had been shipped by mid-August, a spokesperson for the Global Alliance for Vaccines and Immunization (GAVI), which co-leads COVAX along with the WHO, told Reuters. …”
“The Chinese vaccines have been allocated to 60 countries, mostly in Africa, which is expected to receive a third of the 100 million doses. However, not all countries want the Chinese vaccines. South Africa is listed by COVAX as one of Africa's largest recipients of Chinese shots with an allocation of 2.5 million Sinovac doses, but a senior health official told Reuters the country was currently unable to accept the vaccines. … …. Nigeria, the main recipient of Chinese shots in Africa under COVAX with an allocation of nearly 8 million Sinopharm doses, has approved that vaccine but has called it a "potential" option for the country's inoculation campaign…. Officials from Kenya, Rwanda, Togo and Somalia, which are entitled to smaller COVAX shipments, said they had no concerns about the Chinese shots because they had been vetted by the WHO and more people needed to be inoculated as soon as possible….”
Other vaccine access news & other bottlenecks
FT - Western states finalise booster plans as developing world left behind https://www.ft.com/content/e126f315-9ebe-4677-8dc5-ad5fdea8abbe
“Wealthy countries are finalising plans to roll out coronavirus booster programmes to counter the threat from waning vaccine immunity, decisions that will further squeeze the supplies available to the developing world. France this week joined the US and at least two dozen other countries by confirming it would administer third vaccine doses — capping the debate over the use of boosters that has rolled on all summer. Doing so has meant going against the World Health Organization, which has called for a moratorium on boosters and for any spare doses to be given to less-vaccinated countries. … … A Financial Times analysis of programmes in Israel, Turkey and Chile, three of the countries giving out boosters, show in excess of 10m have been deployed, more than the total vaccine doses administered in half a dozen African nations combined….”
Politico – Rich countries look to third shots, poor countries to half-doses in ‘two- track’ pandemic https://www.politico.eu/article/coronavirus-vaccine-booster-shots-two-track-pandemic/
16
“Wealthy nations are moving ahead with third doses — while supply problems are leading low- income countries to consider lower doses.”
“…The fact that wealthy countries are looking at boosters while poorer countries consider half-shots only highlights the increasing inequality of distribution.”
Independent - G7 nations will have stockpiled a billion spare Covid vaccine doses by end of 2021, analysis shows https://www.independent.co.uk/news/science/covid-vaccine-doses-2021-rates-b1904061.html “Many of the world’s poorest nations will struggle to vaccinate even 20 per cent of their populations by early 2022, research shows … …. The G7 nations will have accumulated close to a billion spare vaccine doses by the end of 2021, analysis suggests, as campaigners warn that unequal access to the Covid jabs will prolong the pandemic and endanger millions of lives across the globe….”
Telegraph - ‘Glacial’ pace of global Covid vaccine rollout will cost $2.3 trillion in lost GDP, report warns Telegraph;
“The “glacial” pace of coronavirus vaccine rollout across much of the world will cost the global economy $2.3 trillion, according to a report from the Economist Intelligence Unit.”
“In a paper published on Wednesday, the organisation warned that countries which do not inoculate 60 per cent of their population by mid-2022 will be hit by GDP losses of $2.3 trillion (£1.6 trillion) between 2022 and 2025. Emerging economies will bear the brunt of the fallout, especially in Asia. Delayed vaccination timelines across the region – which is currently struggling to contain a surge in Covid cases – could result in cumulative losses of roughly $1.7 billion by 2025 (see chart below). The timeline for economic recovery will also be longer in poorer economies, partly due to the “expectation that social distancing measures will sometimes need to be re-imposed in countries where vaccination rates remain low”….”
“Beyond ethical and financial concerns, the report warns that vast disparities in vaccine coverage will “reshape the global political and social landscape” – fuelling resentment, increasing the risk of social unrest, rerouting tourism flows and paving the way for heightened vaccine diplomacy from China and Russia….”
Bloomberg - India to Resume Covid Vaccine Exports in 2022, Official Says https://www.bloomberg.com/news/articles/2021-08-24/india-aiming-to-restart-coronavirus- vaccine-exports-by-next-year
“India will likely restart exporting Covid-19 vaccines next year once it has immunized its own adult population, the head of an influential government expert panel said.”
“ “Almost 60 countries are hardly having any access to vaccine and India should be able to provide a substantial portion in 2022,” N.K. Arora, chairman of the National Technical Advisory Group on Immunization in India, said in an interview with Bloomberg Television on Tuesday. “As soon as we are through with our adult population we should have sufficient vaccine to share with the rest of the
17
world.” The South Asian nation, which has the second largest Covid outbreak with 32.5 million infections, should have six locally-developed shots by the end of 2021, Arora said…”
The World Economy (review) - How COVID-19 vaccine supply chains emerged in the midst of a pandemic C Brown & T Bollyky; https://onlinelibrary.wiley.com/doi/10.1111/twec.13183
“ …. This paper provides a simple analytical framework through which to view the contours of the vaccine value chain. It then creates a new database that maps the COVID-19 vaccines of Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, Johnson & Johnson, Novavax and CureVac to the product- and location-specific manufacturing supply chains that emerged in 2020 and 2021. It describes the choppy process through which dozens of other companies at nearly 100 geographically distributed facilities came together to scale up global manufacturing. The paper catalogues major pandemic policy initiatives—such as the United States’ Operation Warp Speed—that are likely to have affected the timing and formation of those vaccine supply chains. Given the data, a final section identifies further questions for researchers and policymakers.”
See also Cidrap News - COVID vaccine supply chains evolved over time
“ This month, the nonprofit and nonpartisan Peterson Institute for International Economics released its analysis of the COVID-19 vaccine supply chain to begin answering two questions: Could more vaccine doses have been manufactured faster some other way? Would alternative policy choices have made a difference?" The 50-page report goes over general supply chain needs, the development and supply chain of the top COVID-19 vaccine candidates, major policy interventions, and further points of reflection, such as the effects of international interdependence….”
Guardian - UK scientists look at reducing boosters to save vaccine for rest of the world https://www.theguardian.com/world/2021/aug/22/uk-scientists-look-at-halving-boosters-to-save- vaccine-for-rest-of-the-world
“Scientists in Britain are examining whether smaller doses of Covid vaccine could be used as part of booster programmes, amid hopes that the approach could also increase the supply of jabs across the world. The use of so-called “fractional doses” has been proposed as a way of ensuring that precious supplies can immunise as many people as possible in parts of the world where there are shortages, while still providing high levels of protection from the virus. Several members of the Joint Committee on Vaccination and Immunisation (JCVI), which advises the UK government, are said to be interested in the idea….”
BMJ (Feature) - How the world is (not) handling surplus doses and expiring vaccines https://www.bmj.com/content/374/bmj.n2062
“Wealthy countries, including the UK, have secured hundreds of millions of covid vaccines that they no longer need or cannot use. Now they stand accused of wasting lifesaving vaccines, reports Jane Feinmann.”
18
“… Donating surplus doses is not as easy as it sounds. Vaccine hesitancy, concerns over the AstraZeneca vaccine, and waning domestic demand are occurring in many countries at the same time. And the cautious shelf life given for vaccine doses manufactured from around December 2020 onwards mean that many surplus stocks are now reaching their expiry date. The Pfizer, Moderna, AstraZeneca, and Janssen (Johnson & Johnson) vaccines were put on the market with emergency use authorisation of up to six months. This compares with a shelf life of two to three years for most vaccines and other medicines. …. … Vaccine manufacturers are monitoring batches of vaccines with the aim of providing a longer shelf life, probably the usual two years. Martini says, “I can assure you that regulators and manufacturers are in discussion at this moment.” Yet these discussions will not help with the hundreds of millions of vaccine doses already purchased and distributed that are now reaching their use-by dates.”
“…The problem threatens to undermine donations from wealthy countries to the international Covax initiative for equal covid vaccine distribution, as well as the comparatively high level of vaccine acceptance observed in low and middle income countries. Donated vaccines close to expiry are viewed with suspicion—“giving leftovers to the needy” is how Ayoade Alakija, co-chair of the Africa Union’s Vaccine Delivery Alliance, described it to the Telegraph6—a view that jars with the World Health Organization’s proposal to transfer expired doses to other countries after it has assessed their efficacy (WHO has asked countries to hold on to expired doses while it explores the viability of this). …. … At the same time, the Africa Union Vaccine Delivery Alliance is concerned that vaccines are being rushed into countries with next to no preparation. Donor countries and organisations must support advance planning of donated vaccines to avoid a situation where poorer countries are suddenly overwhelmed with significant numbers of doses, says Casey of Airfinity.
‘There will be a need to boost the infrastructure before any country is able to suddenly quadruple the number of doses it can administer to its population,” she says. “This is particularly true in countries with already weakened health systems and limited capacity.” “
WHO Afro - WHO support to countries rolling out multiple COVID-19 vaccines https://www.afro.who.int/news/who-support-countries-rolling-out-multiple-covid-19-vaccines
“With 620 million COVID-19 vaccine doses set to arrive in Africa through COVAX alone by the end of 2021, African countries are set to roll out a range of different vaccines, each with their own unique storage, transport and administration requirements…..”
The Nation –Sure, Biden’s Better on Covid Than Trump. That’s Not Good Enough. Gregg Gonsalves; https://www.thenation.com/article/society/biden-covid-criticism-vaccines/
Criticism of Biden is increasing, also on his (global) Covid track record: “If the Biden administration doesn’t step up now—on vaccine mandates and production, testing, mask supplies, and protections for essential workers—millions more will die.”
Quote: “…The worst failure of the Biden administration thus far—…. is the complete disaster that is US policy on global vaccine access. Hundreds of experts have written to the president asking him to establish public production of the currently approved (by EUA) vaccines, ramp up support for the World Health Organization vaccination hubs, and airlift unused doses to countries who need them now. Plans for doing this have come from various NGOs and public health leaders, but Biden either
19
has no interest in what is happening around the globe, sees domestic political concerns as overriding here, and/or does not want to confront the monopoly control of Pfizer, Moderna, or the other vaccine makers….”
NYT – Biden Falls Short on Pledge for U.S. to Be the World’s Vaccine ‘Arsenal,’ Experts Say https://www.nytimes.com/2021/08/25/us/politics/biden-coronavirus-vaccine.html?smid=tw- share
(recommended read) “Congress appropriated $16 billion to ramp up Covid-19 countermeasures, but a new report found that the Biden administration had spent very little of it on vaccine manufacturing capacity.” Just $145 million of possible $16B was spent on scaling up vaccine manufacturing capacity, according to a PreP4All report.
Hindu Business - Who’s aware of WHO’s vaccine redressal? https://www.thehindubusinessline.com/specials/pulse/whos-aware-of-whos-vaccine- redressal/article36042839.ece
“The global health body’s ‘no-fault’ compensation programme for Covid vaccine recipients needs a booster shot of visibility.” “… a “global vaccine injury compensation mechanism” had been announced by the World Health Organization (WHO) in February. The scheme, though, is in need of a massive shot of visibility. … But no one seems to have tapped into this programme….” “… In fact, WHO says, “”By providing a no-fault lump-sum compensation in full-and-final settlement of any claims, the COVAX programme aims to significantly reduce the need for recourse to the law courts, a potentially lengthy and costly process.” A compelling enough point that begs attention from countries, in the interest of speedy redressal for vaccine recipients and manufacturers.”
Global Fund – Transforming the medical PPE ecosystem - Joint action can protect healthcare workers with effective and high-quality personal protective equipment https://www.theglobalfund.org/media/11243/publication_ppe-synthesis_paper_en.pdf
“…This working paper was produced as part of ‘Rethinking PPE’, a collaborative effort of over 50 individuals from different global organisations active in the health sector.
“The COVID-19 pandemic revealed several issues in the PPE ecosystem… Transforming the PPE ecosystem will require five coordinated shifts. …. “ The report also lays out what WHO, governments, funders, development banks and finance institutions, and manufacturers can do.
And some bits & pieces:
Via One’s Aftershocks newsletter:
20
* On herd immunity: “The Economist Intelligence Unit also reported that the target for herd immunity from COVID-19 now stands at around 90% - a goalpost that some global health leaders, including Dr. Anthony Fauci, have been quietly moving since last winter. The higher threshold is due to the highly transmissible nature of the Delta variant, which leaves patients with 300 times the viral load of those with the original variant. Reaching 90% immunity globally is looking unlikely due to vaccine inequity and hesitancy, which would make COVID-19 endemic and our battle with the virus the new normal. If that is the case, the disease-carrying burden will likely shift to children. So far, this group has been spared from the worst of the pandemic’s health consequences, but they face significant mental and emotional hurdles, especially in Africa….”
* “1.79 million: The highest daily number of vaccines administered in Africa, recorded on August 22. (COVID-19 Africa Tracker)”
Via Cidrap News:
“PAHO said during a briefing yesterday that it launched a new collaboration to work on ways to produce COVID-19 vaccine in Latin America and the Caribbean regions, part of an effort to ease the shortage and more equitably distribute supplies. Leaders from financial organizations, governments, and public health groups will meet for the first time tomorrow to discuss technology transfer issues and how to maximize current production of mRNA vaccines. Similar efforts are under way to boost vaccine production in the African region.”
Covid analysis
GFO – The time is ripe for an Africa Commission of inquiry to investigate the Covid-19 response S Muniu & A Whiteside; https://www.aidspan.org/en/c/article/5703
“Africa requires a commission of inquiry for fact-finding on why it took long for the pandemic to reach the continent, and how African response has been hampered. The commission should comprehensively document the response to COVID-19 and come up with recommendations for dealing with false narratives and misinformation. Also, it should synthesize best practices and lessons learned to guide a debate on structural changes required post-COVID-19. Importantly, the commission should be forward-looking, all-encompassing, and provide Africa a blueprint for responding to the next pandemic. This commission should be African-owned and African-led.”
IHME - COVID-19 policy briefings http://www.healthdata.org/covid/updates
With regular updates per region (and for some countries). IHME projections.
Eg (19 August) - COVID-19 Results Briefing: The African region
21
ODI (paper) - Official development assistance financing for social protection: lessons from the Covid-19 response
A McCord et al ; https://odi.org/en/publications/official-development-assistance-financing-for- social-protection-lessons-from-the-covid-19-response/
“This paper is part of a series: ‘Social protection response to Covid-19 and beyond: lessons learned for adaptive social protection’. This working paper examines trends in overseas development assistance (ODA), overall and for the social protection sector, with a focus on developments since the onset of the Covid-19 crisis. It discusses implications for both short-term crisis response and recovery, and the financial sustainability and strengthening of social protection systems in the longer term. In particular, it asks: what do we know about the role ODA has played in the social protection sector since the onset of the crisis; how well has ODA performed in enabling the timeliness and adequacy of response; what factors enabled or hindered effective ODA support to social protection response; and what are the emerging issues, trade-offs and lessons for the financing of social protection crisis response and broader ‘routine’ social protection system-building from the international financing perspective?”
Atlantic - Messing With Our Brains
The Atlantic;
“The earthquakes and wildfires and wars keep piling up. When does our empathy run out?” Poignant question.
BMJ Open - How many infants may have died in low-income and middle-income countries in 2020 due to the economic contraction accompanying the COVID-19 pandemic? Mortality projections based on forecasted declines in economic growth G Shapira, D de Walque et al ; https://bmjopen.bmj.com/content/11/9/e050551
« While COVID-19 has a relatively small direct impact on infant mortality, the pandemic is expected to indirectly increase mortality of this vulnerable group in low-income and middle-income countries through its effects on the economy and health system performance. Previous studies projected indirect mortality by modelling how hypothesised disruptions in health services will affect health outcomes. We provide alternative projections, relying on modelling the relationship between aggregate income shocks and mortality. «
« We estimate 267 208 (95% CI 112 000 to 422 415) excess infant deaths in 128 countries, corresponding to a 6.8% (95% CI 2.8% to 10.7%) increase in the total number of infant deaths expected in 2020…..”
BMJ essay – Polarisation, incivility, and scientific debate during covid-19—an essay by Agnes Arnold-Forster https://www.bmj.com/content/374/bmj.n1888
22
“Over the course of the covid-19 pandemic, scientific debate has become increasingly polarised and politicised. Rather than being a new cultural moment, Agnes Arnold-Forster argues that anger, incivility, and unprofessional conduct have always played a part in topical scientific debates.”
“…The covid-19 pandemic did not make medicine political or polarising, but it did make these aspects of the profession and its practice evident to more people….”
Trips Waiver negotiations, tech transfer, …
As you know, Trips waiver negotiations (or say, “discussions”) will be continued early September. Meanwhile, some other IP & tech transfer related news/advocacy:
MSF Access - Following full FDA approval, Pfizer and BioNTech must urgently share COVID-19 vaccine know-how to increase global production and supply https://msfaccess.org/following-full-fda-approval-pfizer-and-biontech-must-urgently-share-covid- 19-vaccine-know-how
“Sharing mRNA vaccine technology with manufacturers in low- and middle-income countries – including in Africa where seven manufacturers could begin production within 10 months – could offer sustainable, equitable access to COVID-19 vaccines.”
“… Following today’s full approval of the Pfizer-BioNTech mRNA COVID-19 vaccine by the US Food and Drug Administration (FDA), Médecins Sans Frontières/Doctors Without Borders (MSF) called again on Pfizer and BioNTech to immediately share the vaccine technology and knowledge with manufacturers on the African continent that could help boost global vaccine supply. They should do this via the World Health Organization’s (WHO) mRNA vaccine technology transfer hub hosted in South Africa. “
“… In fact, since July 2020, we’ve observed Pfizer-BioNTech and Moderna facilitate mRNA vaccine production with manufacturers in Switzerland, Spain and Germany, all within 8 months, so it is clearly feasible for other manufacturers to swiftly produce mRNA vaccines. The only reason these vaccines aren’t being produced more widely is because Pfizer-BioNTech and Moderna are refusing to share mRNA vaccine technology and information with manufacturers—including those in Egypt, Morocco, South Africa and Tunisia that could have the capacity to produce up to 100 million doses annually within a 10-month timeframe.” In an analysis by Imperial College of London commissioned by MSF, the estimated total cost needed for starting up mRNA vaccine manufacturing in an existing manufacturing site and producing 100 million doses is approximately US$127 million for BioNTech-Pfizer’s vaccine and $270 million for Moderna’s vaccine….”
See also HPW: Final US FDA Approval of Pfizer-BioNTech COVID Vaccine – Likely to Drive More Voluntary Jabs & Mandates
“In a parallel move, Pfizer/BioNTech recently announced a vaccine production deal with the Cape Town-based firm Biovac – but the company has so far deferred from joining the WHO collaboration…..”
23
FT - Seoul urges Biden to break vaccine IP deadlock https://www.ft.com/content/66adc278-7191-4b8b-a0fc-b33e915d4631
“South Korea poised to spend billions of dollars expanding factories as jab shortage looms.”
“Seoul is calling on the Biden administration to help Korean companies access intellectual property for producing Covid-19 jabs, as the highly infectious Delta variant prompts a reassessment of global vaccine requirements. South Korea’s failed attempts to gain access to US companies’ mRNA vaccine technology strikes at the heart of the rising divergence between the interests of pharmaceutical companies and the views of some international medical experts over jab supply shortages. “We have asked Washington to transfer technology for vaccine production, but US officials said it is something that should be decided by the private sector,” said a senior official in Seoul, who asked not to be named. “
“… South Korea’s biotech sector, which enjoys heavy state backing, is poised to plough billions of dollars to expand factories to produce 1bn vaccines annually. Korean companies have already signed deals to manufacture vaccines for AstraZeneca, Novavax and Russia’s Sputnik jabs. Samsung BioLogics, one of the world’s biggest pharmaceutical contract manufacturers, will this month start late-stage “fill and finish” vials for Moderna. But South Korean companies are struggling to secure IP licensing deals with US pharma groups Pfizer and Moderna, despite a broad vaccine partnership agreed in May by President Joe Biden and Moon Jae-in, his South Korean counterpart. Such deals would enable Korean groups to produce jabs under contract for US companies….”
VaxPaL – COVID-19 vaccines patent landscape https://medicinespatentpool.org/what-we-do/disease-areas/vaxpal/
Resource: “…VaxPaL, the Medicines Patent Pool (MPP)’s new patents database devoted to COVID-19 vaccines. VaxPaL builds on MPP’s 10-year experience in mapping patents on key health technologies through MedsPaL, the world’s leading tool on the patent status of essential medicines in low- and middle-income countries (LMICs)….”
WSJ - Pfizer’s Global Covid-19 Vaccine Rollout Depends on Two Expert Staffers https://www.wsj.com/articles/pfizers-global-covid-19-vaccine-rollout-depends-on-two-expert- staffers-11629464010?st=k2gebsqt8qob1mj&reflink=desktopwebshare_twitter
On Pfizer’s tech transfer. “As countries hunt for more doses, vaccine makers like Pfizer call on staffers with rare skills for transferring the technology to contractors.”
“Pfizer Inc.’s PFE -2.66% ability to supply billions of doses of its Covid-19 vaccine hinges on two employees working on opposite sides of the world. From her home in Andover, Mass., Amy Genest scouts for companies that can make Pfizer’s shot. After finding a partner, she hands over the project to Poonam Mulherkar, an engineer in Gandhinagar, India, who manages the top-secret transfer of the vaccine’s blueprint and manufacturing. The women belong to a select group of drug-industry staff who may hold the key to helping countries overcome limited supplies of doses—and accelerating the world’s vaccination campaign against the pandemic. Vaccine makers like Pfizer, though they have significantly increased their output of shots, can only make so much at their own
24
plants. Mses. Genest and Mulherkar are among a relatively small number of professionals with the rare skill set to enable other companies to produce the shots. Their work, requiring expertise in biochemical engineering to pharmaceutical manufacturing, is called technology transfer….”
WSJ - Pfizer, BioNTech Expand Covid-19 Vaccine Manufacturing Into Latin America https://www.wsj.com/articles/pfizer-biontech-expand-covid-19-vaccine-manufacturing-into-latin- america-11629974701
More tech transfer. “Pfizer Inc. and BioNTech SE said they are partnering with a Brazilian pharmaceutical company to help manufacture their Covid-19 vaccine in Latin America, which could help meet growing demand for the shot in the region. Eurofarma will produce at least 100 million doses annually for distribution in the region, Pfizer and BioNTech said Thursday….”
Canadian Firm Scathing On Obstacles To Compulsory Licensing https://pink.pharmaintelligence.informa.com/PS144384/Canadian-Firm-Scathing-On-Obstacles-To- Compulsory-Licensing
“Biolyse Is Determined To Manufacture J&J’s COVID-19 Vaccine.” (from 27 May)
Reuters - Pfizer, Moderna get EU nod for boosting mRNA COVID-19 vaccine output
Pfizer, Moderna get EU nod for boosting mRNA COVID-19 vaccine output | Reuters
“ Europe's medicines regulator has approved additional manufacturing sites for mRNA-based coronavirus vaccines developed by Pfizer-BioNTech (PFE.N), (22UAy.DE) and Moderna (MRNA.O) to help boost production amid a resurgence in infections. The European Medicines Agency (EMA) said on Tuesday its human medicines committee had approved a site at Saint Remy sur Avre in France for making the Pfizer-BioNTech vaccine, Comirnaty…. …. The regulator also said it had approved a new manufacturing line at BioNTech's site at Marburg in Germany, which would help boost capacity for the vaccine's active substance by about 410 million doses this year…. … The EMA also gave its go-ahead for an additional site at Bloomington, Indiana in the United States for Moderna's vaccine and several other locations involved in testing and packaging….”
Pandemic Treaty ( / pandemic preparedness & response)
UN News - Coming months critical for future pandemic preparedness: WHO chief https://news.un.org/en/story/2021/08/1098472
“The next three months will be a critical period for stepping up global collective action against future pandemics, the head of the World Health Organization (WHO) said on Wednesday, pointing to three major meetings on the international agenda. “
25
“He pointed out that with the UN General Assembly in September, followed by the G20 Summit in October, and a special session of WHO’s governing body set for November, the next three months represent “a critical period for shaping the future of pandemic preparedness and response”.
Last month, a high-level independent panel established by the G20 published its report, which is being discussed now. … The report outlines three priorities, starting with strengthening WHO. It also calls for repurposing the World Bank, the International Monetary Fund (IMF) and other multilateral development banks, so that they can help countries during normal times and speedy response whenever a pandemic emerges. The panel has also proposed the creation of a Global Health Threats Fund to mobilize $10 billion annually, and establishment of a new governance mechanism that brings together financial and health decision-makers. ….”
Geneva Health Files (guest essay) - "Do We Really Need a Pandemic Treaty?"
Geneva Health Files;
From last Friday. “…. guest essay from lawyers affiliated with The Third World Network. Nithin Ramakrishnan and K M Gopakumar recently authored a comprehensive report: “Proposal for a WHO treaty on pandemics raises concerns”. In this piece, they elaborate on some of the key issues that need to be considered by WHO member states when discussions on the treaty resume in a few weeks…. “
Among others: no shared understanding on what constitutes a pandemic; IHR Reforms v. Pandemic Treaty Proposal; …
Geneva Health Files - COVID-19 & The Political Imperative for Health Security P Patnaik; https://genevahealthfiles.substack.com/p/covid-19-and-the-political-imperative
From Tuesday’s intro: “… The pandemic has been a huge opportunity for the global health security complex. Its inexorable push to securitize global health discussions in definitive terms cannot be underestimated. And yet, the next few months in Geneva and beyond will reveal, how this moment in time will be shaped by prevailing geopolitics, and the politics of nationalism and insecurity. What will this mean for what we understand as global health? What will it mean for you and me, or any other common man or woman on the street, and our future generations? We expect a considerable amount of push back against this narrative, whether it will be strong enough to fight this, is another matter. After all, the health security ecosystem is well-oiled with deep pockets….”
Global Health Governance & financing (& other Global Health Security news/analysis)
Bloomberg – IMF urges 650 Billion SDR injection to be directed to Covid’s hardest hit
Bloomberg;
26
“The IMF’s record $650 billion resource injection came into effect Monday, with Managing Director Kristalina Georgieva urging wealthy states to direct some of their portion to countries lacking the means to cope with the Covid crisis…”
See also FT – Wealthy nations under pressure to pass IMF stimulus on to poor countries
“Wealthy countries are under mounting pressure to hand over their share of a historic IMF support package to the world’s poorest economies, which are struggling with the impact of the coronavirus pandemic. …. “ “… the funds were allocated to the IMF’s 190 member countries roughly in proportion to their share of the global economy. As a consequence, low-income nations received just $21bn, according to the fund. Overall, emerging and developing countries got $275bn. The remaining $375bn went to about 40 of the world’s richest countries — despite many already being well on the way to economic recovery, benefiting from the widespread availability of vaccines and abundant liquidity provided by their central banks.”
“….The IMF estimates that low-income countries will need $450bn over the next five years to fund their recovery from the coronavirus crisis. In June, the G7 group of the world’s richest nations agreed in principle to channel $100bn to the most vulnerable countries, either in the form of SDRs or loans, but no action has yet resulted. … “
“… plans under consideration involve lending the newly allocated SDRs, not donating them. … “ (read why)
“ One option is to use the IMF’s poverty reduction and growth trust, designed to help the world’s poorest countries. Governments could lend their SDRs to the trust, which could then use them as the basis for fresh lending. Since last year rich countries have pledged $24bn, including $15bn from existing SDRs, to support it. The IMF hopes more will come from the new SDR allocation. The IMF is also considering a new resilience and sustainability trust to provide longer-term support to poor and vulnerable countries, possibly including those not eligible for the PRGT. However, critics say that rather than relieving fiscal pressures, this will add to low-income countries’ debts….”
And Oxfam International - SDRs have landed in IMF member countries’ accounts. Now what?
BMJ blog - The global health security agenda rewards rich nations for their selfish behaviour
A Benton, G Yamey et al; BMJ;
Quote: “ … Another thing is very striking about the hoarders: on the Global Health Security Index (GHSI), which ranks 195 countries based on a set of “global health security capabilities,” they tend to have higher scores. In other words, nations that are ranked as “best prepared” on this index are also more likely to be covid-19 vaccine hoarders. “
Conclusion: “The vaccine apartheid that we saw during the 2009 H1N1 pandemic, and now during covid-19, shows us that we need a different way of conceptualizing global health security. We fully support the need to have stockpiles of pandemic vaccines, and to be able to surge both vaccine manufacturing capacity and surge the health workforce during pandemics, but the agenda and the locus of action must go beyond the nation state. Stockpiles should be regional or global, and there should be an agreed upon allocation system to ensure equitable distribution of vaccines to susceptible people across all nations in the event of a pandemic. The global health security
27
agenda, and the metrics supporting it, should stop rewarding rich nations for their selfish behaviour and start prizing international collective action.”
The Afghanistan Disaster and U.S. Foreign Policy on Global Health: The Taliban’s triumph has terrible implications for past, present, and future U.S. foreign policy on global health
D Fidler; https://www.thinkglobalhealth.org/article/afghanistan-disaster-and-us-foreign-policy- global-health
Recommended analysis. Some excerpts:
“…The Taliban now control what happens to public health, health services, and social determinants of health in Afghanistan—a harrowing reality for the Afghan people. For the United States, the Afghan government’s collapse destroyed a nation-building project in which health was important in the strategy designed to defeat the insurgents. The project’s ignominious end threatens to haunt U.S. foreign policy on global health. President Joe Biden’s approach to global health emphasizes U.S. leadership, democracy’s capabilities, the rule of law, and human rights—just as the U.S. government did in Afghanistan. With the Taliban’s flag flying over Kabul, the credibility of U.S. foreign policy on global health has suffered a serious blow….”
“… The grim future for Afghan health flows from the failure of the U.S.-led counterinsurgency campaign. In counterinsurgency strategy, providing physical security and essential services, including public health and health care, are interdependent objectives, an approach that connects to broader policy discourse about the relationship between health and security. Better security and improved health demonstrate a government’s capabilities and turn the population against the insurgents. As the U.S. Counterinsurgency Field Manual (2006) explained, “Victory is achieved when the populace consents to the government’s legitimacy.” However, the counterinsurgent coalition never improved security sufficiently to make efforts on health matter in the conflict. …”
“… U.S. involvement in Afghanistan was never about global health, so caution is needed in connecting failure there with U.S. foreign policy on global health. Even so, what has transpired in Afghanistan after twenty years of U.S. effort has implications for U.S. foreign policy on global health. In responding to the COVID-19 pandemic, President Biden has emphasized the need to reassert U.S. global leadership, demonstrate that democracies can handle twenty-first century threats, operate within a rules-based international order, and protect human rights, particularly women’s rights. Improving global health serves the strategic purposes of advancing U.S. power, influence, interests, and ideology. The debacle unfolding in Afghanistan provides scant evidence of U.S. global leadership, the competence of democracies, respect for a rules-based international order, and the protection of human rights. The similarities between the purposes of U.S. foreign policy on global health and the U.S.-led counterinsurgency campaign’s objectives in Afghanistan make comparing the two contexts valid and necessary. The gap between President Biden’s cold, narrow justification for leaving Afghanistan and his administration’s rhetoric on global health is unsettling, hard to explain, and ripe for adversaries to accuse the United States of incorrigible hypocrisy….”
28
PNAS - Intensity and frequency of extreme novel epidemics https://www.pnas.org/content/118/35/e2105482118
Cfr press release (Duke) - Statistics Say Large Pandemics Are More Likely Than We Thought
“Most people are likely to experience an extreme pandemic like COVID-19 in their lifetime, a new study shows.”
The COVID-19 pandemic may be the deadliest viral outbreak the world has seen in more than a century. But statistically, such extreme events aren’t as rare as we may think, asserts a new analysis of novel disease outbreaks over the past 400 years. The study, appearing in the Proceedings of the National Academy of Sciences the week of Aug. 23, used a newly assembled record of past outbreaks to estimate the intensity of those events and the yearly probability of them recurring. It found the probability of a pandemic with similar impact to COVID-19 is about 2% in any year, meaning that someone born in the year 2000 would have about a 38% chance of experiencing one by now. And that probability is only growing, which the authors say highlights the need to adjust perceptions of pandemic risks and expectations for preparedness.
… the data also show the risk of intense outbreaks is growing rapidly. Based on the increasing rate at which novel pathogens such as SARS-CoV-2 have broken loose in human populations in the past 50 years, the study estimates that the probability of novel disease outbreaks will likely grow three- fold in the next few decades. Using this increased risk factor, the researchers estimate that a pandemic similar in scale to COVID-19 is likely within a span of 59 years, a result they write is “much lower than intuitively expected.”….”
CGD (blog) – The Next Pandemic Could Come Soon and Be Deadlier https://www.cgdev.org/blog/the-next-pandemic-could-come-soon-and-be-deadlier
“Last month, CGD hosted an event on predicting the frequency and scale of future pandemics to discuss what’s to come after the COVID-19 pandemic and the critical task of preparing for future outbreak probabilities. This blog highlights three key takeaways from the event….”
BMJ GH (Analysis) - Organising knowledge to prevent global health crises: a comparative analysis of pandemic preparedness indicators A Kentikelenis et al; https://gh.bmj.com/content/6/8/e006864
“… This article examines the construction of the three main cross-national indicators of pandemic preparedness: a database with self-reported data by governments, external evaluations organised by the WHO and a global ranking known as the Global Health Security Index. Each of these presents a different model of collecting evidence and organising knowledge: the collation of self- reports by national authorities; the coordination of evaluation by an epistemic community authorised by an intergovernmental organisation and on the basis of a strict template; and the cobbling together of different sources into a common indicator by a transnational multi-stakeholder initiative. We posit that these models represent different ways of creating knowledge to inform policy
29
choices, and each has different forms of potential bias. In turn, this shapes how policymakers understand what is ‘best practice’ and appropriate policy in pandemic preparedness.”
Coming up in autumn: yet another G20 Summit …
Project Syndicate - The G20's COVID Agenda J Frankel; https://www.project-syndicate.org/commentary/g20-rome-summit-covid-agenda-by- jeffrey-frankel-2021-08
“Heads of state and government from the world's largest economies will have plenty on their plate at this year's G20 summit in Rome on October 30-31. But with the COVID-19 pandemic still raging, it is clear what their immediate priorities should be.”
That is: “… Most importantly, the US and other rich countries must allocate more of their massive spending packages to make COVID-19 vaccines available to low- and middle-income countries. It is ridiculous for the US to chase after its own vaccine skeptics without at the same time doing more to bring the benefits of this scientific miracle to the rest of the world. Ruchir Agarwal and Gita Gopinath of the IMF have proposed a plan of action to get more vaccines produced and distributed…”
PS: The G20 Health Ministers’ Meeting 2021 will take place in Rome from 5-6 September 2021. So coming up soon, that one.
AMR
Cidrap News - Global group urges limits on antimicrobials in food production https://www.cidrap.umn.edu/news-perspective/2021/08/global-group-urges-limits- antimicrobials-food-production
“Warning of the potentially devastating impact on human and animal health and food systems, world leaders today called for an urgent reduction in the use of antimicrobials in food production. In a statement, the Global Leaders Group on Antimicrobial Resistance (AMR) called on all countries to stop using, for growth promotion in food-producing animals, antimicrobials that are critically important in human medicine. The statement also urged limiting the amount of antimicrobials that are used to prevent infections in animals and plants, eliminating or reducing over-the-counter sales of veterinary antibiotics, and improving infection prevention and control in agriculture and aquaculture.”
“… The statement was issued ahead of next month's United Nations (UN) Food Systems Summit, which takes place on Sep 23. It's the first official statement from the Global Leaders Group on AMR, formed in 2020 by the World Health Organization (WHO), the UN Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) to provide political leadership for global, regional, and national efforts to address drug resistance in humans, animals, and the environment. Among the priorities for the group—which includes stakeholders in
30
agriculture, health, development, and food production—is advocating for best practices on antimicrobials (including antibiotics, antifungals, and anti-parasitics) across all sectors, using a One Health framework….”
Link:
Guardian - UN criticised over statement on overuse of antibiotics in farming
“… critics say the statement is “a real missed opportunity”, pointing to its failure to set reduction targets or even call for a ban on the use of antibiotics for animal growth promotion….”
Decolonize Global Health
BMJ GH (Commentary) - Dialogical reflexivity towards collective action to transform global health H J Liwanag et al ; https://gh.bmj.com/content/6/8/e006825
“Decolonising global health has gained momentum in recent years and has called for more reflexive individuals. However, the call to be reflexive may run the risk of becoming lip service without clarity on what reflexivity requires. We diverge from reflexivity’s usual place in qualitative research, bring it closer to individual positionalities and frame it as comprising of: (a) self- understanding; (b) dialogue with peers; and (c) insights-to-action. We argue that reflexivity that is either in isolation or without action will not contribute to global health transformation. We present insights and action points from our journeys in global health to demonstrate examples of what may emerge from dialogical reflexivity as we have framed it here. We call on peers to build a culture of reflexivity by sparking dialogues in their institutions and translating their insights into collective action.”
Planetary Health
WPR - Climate Change Is Putting the SDGs Further Out of Reach P Stewart; https://www.worldpoliticsreview.com/articles/29907/absent-mitigation-climate-change- also-threatens-the-sdgs
Recommended analysis of the expected impact of the climate crises on all (respective) SDGs.
“This month’s harrowing report from the Intergovernmental Panel on Climate Change has particularly disquieting implications for the world’s poor. Global warming and associated biodiversity loss will hinder progress toward each of the Sustainable Development Goals, or SDGs, a set of 17 internationally agreed objectives for advancing global prosperity, social welfare and environmental conservation through the end of the decade. COVID-19 has already dealt these aspirations a massive blow. But these pandemic setbacks pale in comparison to the long-term
31
challenges that climate change presents for meeting and exceeding basic human needs, and placing developing countries on the path toward sustained—and sustainable—growth…..”
PS: “The biggest wild card may be how climate change affects domestic governance, political stability and the threat of violence, particularly in the world’s 40-odd fragile states. … “
SRHR
Guardian - ‘Use your £11bn climate fund to pay for family planning,’ UK told https://www.theguardian.com/global-development/2021/aug/26/use-your-11bn-climate-fund-to- pay-for-family-planning-uk-told
“The UK government has been urged to open up its £11bn pot of climate funding to contraception, as research from low-income countries shows a link between poor access to reproductive health services and environmental damage. In a letter to Alok Sharma, president of the UN Cop26 climate conference, an alliance of more than 60 NGOs has called for the funding eligibility rules to be changed to allow projects concerned with removing barriers to reproductive healthcare and girls’ education to access climate funds….”
Other news of the week
Google dismantles Health unit in favor of tried-and-tested ‘throw everything at the wall’ strategy https://www.theverge.com/2021/8/24/22639075/google-health-team-dispersed-strategy-change
“Once again, Google is headed back to the drawing board to rethink its healthcare strategy. As first reported by Business Insider, the tech giant is dissolving its single, unified Google Health division, founded in 2018, in favor of a distributed approach to building health products. The head of the division, David Feinberg, is leaving the company, while an unknown proportion of Google Health employees will be sent to other teams at Google (like Search and Fitbit) to work on specific services, according to Google’s AI head Jeff Dean…..”
Global Health Law Consortium newsletter https://globalstrategylab.us6.list- manage.com/subscribe?u=0a908bb178a4fffc0dba26008&id=730e74d412
New and quarterly newsletter “to stay up to date with all the latest developments in Global Health Law”.
32
Some papers of the week
Health Promotion International - Health literacy—politically reloaded
I Kickbusch; https://academic.oup.com/heapro/advance- article/doi/10.1093/heapro/daab121/6355991#.YSHpmXMAnv8.twitter
“Twenty years ago, Don Nutbeam proposed three levels of health literacy: functional health literacy, interactive health literacy and critical health literacy (Nutbeam, 2000). I have found them helpful to analyze health literacy in the context of COVID-19 and to consider actions that need to be taken from a health promotion perspective. Many of these are in the political sphere and require interventions beyond the health system and even at the global level. This reinforces Evelyne de Leeuw’s analysis (de Leeuw, 2012) of 10 years ago that a third wave of health literacy is beginning to address a broader ecosystem and the political determinants of health. There is of course also a growing recognition of health literacy as a crucial concept to address the COVID-19 crisis (Van den Broucke, 2020). I suggest four action areas for health promotion in response to this development: improve scientific literacy, address the infodemic, address health data extraction and address the political dimension of health literacy….”
Journal of Equity in Health - ‘Doing’ or ‘using’ intersectionality? Opportunities and challenges in incorporating intersectionality into knowledge translation theory and practice https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01509-z
Commentary by C Kelly et al.
WHO (Research brief) - Using multidimensional poverty and vulnerability indices to inform equitable policies and interventions in health emergencies https://www.who.int/publications/i/item/9789240031852
“To prevent or mitigate the health equity impacts of health emergencies, or the health dimensions of humanitarian emergencies, analysts and decision-makers require an evidence-base to inform equitable planning, policy making, and interventions. In addition to several existing emergencies rapid assessment tools, multidimensional poverty and vulnerability indices (MPIs or MVIs) have been used for measurement, analyses, and policy guidance in several countries around the world. This research brief provides an overview of the use of MPIs and MVIs in health emergencies, with the goal of sharing insights and lessons learned. This brief shares experiences from Afghanistan, Colombia, Honduras, Iraq, and select countries in southern Asia. This research brief will also inform national health authorities when looking for ways to reinforce health equity into their measurement approaches in their policies before, during and after a health emergency.”
Links:
International Health - International stem cell tourism: a critical literature review and evidence- based recommendations
33
Some blogs of the week
CGD - Contrary to Conventional Wisdom, Mining Companies Seem To Pay More Taxes in Lower-Income Countries E Werker et al; https://www.cgdev.org/blog/contrary-conventional-wisdom-mining-companies- seem-pay-more-taxes-lower-income-countries
“With pressures to lower taxes and project-based incentives, and the possibility of kickbacks in exchange for favorable deals, lower-income countries seem like the kind of place where companies get away with paying a smaller share of mining profits to host governments. Yet our open-access paper in the October 2021 issue of World Development shows exactly the opposite: in countries with higher country risk, which tend to be lower-income countries, government “take”—or share of total project returns—is actually higher….”
CGD – The Future of Development: Lessons from China’s Success (and Failures) S Devarajan et al ; https://www.cgdev.org/blog/future-development-lessons-chinas-success-and- failures
“What we should—and should not—learn from the most dramatic development success of the past century: China.”
Some tweets of the week
John Nkengasong “The battle against Covid-19 in Africa is unprecedented and unpredictable. @AfricaCDC is calling for a “social contract” - unity in vaccination - I sign a “social contract” to protect myself, my neighbor, my love ones, and my community.”
Zain Rizvi “India is not considering boosters yet but, in an ominous sign for COVAX, its largest expected supplier (Serum Institute) has begun requiring boosters for employees after six months. Indian decision will have profound consequences for global vaccine access.”
Kevin Watkins
Commenting on this FT news - UK orders 35m more Pfizer Covid jabs for next year
“UK hoarding of surplus vaccines (we can already vaccinate the population 5x over) is pushing Africa and other regions with large unvaccinated populations to the back of the queue.”
34
Global governance of health
Reuters - ANALYSIS-China pushback on COVID-19, rights trumps push for better relations with West https://www.reuters.com/article/china-diplomacy-idUSL4N2OV1TJ
“Zhao Lijian, China’s combative foreign ministry spokesperson, suggested in May 2020 that U.S. military athletes brought COVID-19 to Wuhan, the central Chinese city that was ground zero for the pandemic. The United States expressed outrage at the assertion, which is not supported by any public evidence, and Zhao’s colleagues did not step up to support him. Fourteen months later, when Zhao resurfaced the idea, his boss Hua Chunying and the ruling Communist Party’s mouthpiece newspaper joined in, calling on the United States to “release the data” on the athletes and open up a military lab near Washington for investigation….”
“Beijing’s doubling down on fringe theories about COVID-19 is part of an upsurge in China’s attempts to deflect criticism on issues ranging from the pandemic to human rights, as it savages Western rights records, experts and diplomats say. … Beijing’s aggressive strategy, while popular domestically, suggests it could be giving up on improving relations with the West as a siege mentality forms domestically, experts and diplomats say….”
“They’re telling the rest of the world that they’re standing up for their interests,” said Bonnie Glaser, an Asia expert at the German Marshall Fund of the United States. “I’m sure it resonates well at home.” She said she was not sure what China hoped to achieve diplomatically with the approach. “Maybe they want to very clearly signal to the United States, ‘Your approach is not working - try something else.’” … In China’s highly controlled media environment, a narrative has taken hold where the country is “under siege from the wider world,” said Rana Mitter, professor of Chinese history and politics at the University of Oxford….”
UHC
Health Systems & Reform - Making Health Insurance Pro-poor: Lessons from 20 Developing Countries
J Watson et al ; https://www.tandfonline.com/doi/full/10.1080/23288604.2021.1917092#.YSeoaZhw0kg.twitter
Also from the Adam Wagstaff special issue.
European Journal of Health Economics - Examining the density in out-of-pocket spending share in the estimation of catastrophic health expenditures A Jbaily et al; https://link.springer.com/article/10.1007/s10198-021-01316-x
“Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial risk protection (FRP) from out-of-pocket
35
(OOP) health expenditures is a critical objective of the Sustainable Development Goal for Health. In tracking country progress toward UHC, analysts and policymakers usually report on two summary indicators of lack of FRP: the prevalence of catastrophic health expenditures (CHE) and the prevalence of impoverishing health expenditures. In this paper, we build on the CHE indicator: we examine the distribution (density) of health OOP budget share as a way to capture both the magnitude and dispersion in the ratio of households’ OOP health expenditures relative to consumption or income at the population level. We illustrate our approach with country-specific examples using data from the World Health Organization’s World Health Surveys.”
And a link:
Plos Med - Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report (J Davies et al)
“Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define—for the first time—the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally….”
Planetary health
Scientists, researchers and academics call for a Fossil Fuel Non-Proliferation Treaty https://fossilfueltreaty.org/open-letter
“We, the undersigned, call on governments around the world to adopt and implement a Fossil Fuel Non-Proliferation Treaty, as a matter of urgency, to protect the lives and livelihoods of present and future generations through a global, equitable phase out of fossil fuels in line with the scientific consensus to not exceed 1.5ºC of warming. …”
Do sign.
Net Zero - Economic impacts of tipping points in the climate system https://net-zero.blog/bookshelf/economic-impacts-of-tipping-points-in-the-climate-system
Cfr tweet Mathew Hampshire-Waugh:
“My summary of an important new paper by @GernotWagner et al. which demonstrates that by including tipping point damages into assessment models the predicted damages from climate change could increase by 25% and maybe even 100% or more.”
36
And a link:
• Water Witness (report) - How fair is fashion’s water footprint? “Tackling the global fashion industry’s destructive impacts on Africa’s water and workforce health.”
“How fair is fashion’s water footprint? reports on the water-related impacts of textile and apparel production in Africa to supply the ever-growing needs of the global fashion industry. It represents the results of research by Water Witness in five case study countries, analysis of data from across Africa and interviews with experts in government, business, and civil society….”
“Although pockets of good practice exist, our research shows that production of clothing, including for high street brands in Europe, the UK and the USA is killing Africa’s rivers through polluting discharges of untreated industrial wastewater. We find that the sector competes with communities and nature for access to scarce water, and that in some cases, factory needs are prioritised over the human right to water. We also find that factory workers, around 80% of whom are women, often lack access to safe water, washing facilities and toilets, and that this undermines their dignity, wellbeing and health, including through exposure to Covid-19 transmission. Notably, a lack of access to clean water and toilets in the workplace is a widely recognised indicator of modern slavery….”
Infectious diseases & NTDs
Economist (daily chart) - Infections caught in laboratories are surprisingly common Infections caught in laboratories are surprisingly common | The Economist
“… According to the American Biological Safety Association (ABSA), which maintains a database of such incidents, laboratory-acquired infections (LAIs) are disturbingly common. The majority are relatively mild: the most common type of pathogen involved in LAIs is Brucella, a type of bacteria that can cause flu-like symptoms and is easily treated. But some cases, such as Presnyakova’s, are severe. Since 1970 there have been eight other incidents involving Ebola, and five involving SARS. Laboratory workers have been infected with Dengue fever, HIV and Zika virus….”
The Telegraph – Drug and vaccine combo could cut child malaria deaths by 70 per cent, study shows Telegraph;
“ Giving the RTS,S vaccine, the world's first, on a seasonal basis in the trial also made it considerably more effective, the research shows.”
See also the Guardian - Malaria trial shows ‘striking’ 70% reduction in severe illness in children
And a few links:
37
• Global Public Health - Addressing tuberculosis through complex community-based socioeconomic interventions in low- and middle-income countries: A systematic realist review
• Asia emerges as a hotbed of diagnostic innovations for tuberculosis (by J Bigio et al)
AMR
Nature Technology - Innovative tools take aim at antibiotic-resistant microbes https://www.nature.com/articles/d41586-021-02292-1
“Diagnostics that rely on bacterial movements, genomics and machine learning could help to address a global crisis.”
Link:
Globalization & Health - Global research publications on irrational use of antimicrobials: call for more research to contain antimicrobial resistance
NCDs
STOP (report) – In 2021, the tobacco industry is projected to spend an estimated $105 million on Formula 1 sponsorship. https://exposetobacco.org/campaigns/driving-addiction/
“The staggering amount confirms a concerning trend: Tobacco industry spending in F1 has increased, reaching its highest levels since 2006—the year tobacco companies were supposed to be banned from the sport….”
IJHPM - Policy Instruments for Health Promotion: A Comparison of WHO Policy Guidance for Tobacco, Alcohol, Nutrition and Physical Activity http://www.ijhpm.com/article_4104.html
Findings & conclusion: “Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity….. The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that “harder” instruments still appear to be underutilized in nutrition and physical activity. “
38
Link:
HP&P - Getting to the root of the problem: the international and domestic politics of junk food industry regulation in Latin America (by E Gomez)
Sexual & Reproductive / maternal, neonatal & child health
Links:
• Lancet Comment - Inadequate evidence on stillbirths: rethinking public health
Comment linked to a new Lancet Analysis - Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment Authors estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time.
• IJHPM - What You Don’t Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition (K Russ, D McCoy et al)
Conclusion: “…The commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC (Codex Alimentarius Commission), and functions of the WTO. This poses serious concerns for countries’ abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.”
• Agenda (Empowering women for gender equity) - Whose bodies are they? Conceptualising reproductive violence against adolescents in Ethiopia, Malawi and Zambia
• The Conversation – Adolescent sexual and reproductive health research is patchy in Africa
Linked to a recent BMJ Global Health paper.
Access to medicines
Links:
Global Health Action - Knowledge, use (misuse) and perceptions of over-the-counter analgesics in sub-Saharan Africa: a scoping review Objective: “To conduct a scoping review of the uses and misuses of OTC analgesics in sub-Saharan Africa, to inform strategies for correct use.”
Globalization & Health - Advancing sustainable development goals through immunization: a literature review (by C Decouttere et al)
39
Extra Covid section
Stat - A lucky few seem ‘resistant’ to Covid-19. Scientists want to know why https://www.statnews.com/2021/08/23/lucky-few-seem-resistant-to-covid19-scientists-want-to- know-why/
And me too : ) Brazilian researchers are studying 100 COVID-discordant couples to understand why the coronavirus only hit one of the couple.
Imperial College London - 8 in 10 UK citizens willing to donate their COVID-19 booster dose if not needed https://www.imperial.ac.uk/news/225753/10-uk-citizens-willing-donate-their/
“The vast majority of people in the UK and US would donate their COVID-19 vaccine booster dose to poor countries if a test showed they didn’t need it. This is according to a new Imperial College London report, based on nationally representative survey data collected from almost 3,500 people in June. Booster doses are those given to people already fully vaccinated as a way to enhance immunity to the disease….”
The Atlantic - The Coronavirus Could Get Worse https://www.theatlantic.com/science/archive/2021/08/coronavirus-evolution- vaccines/619875/?utm_source=twitter&utm_medium=social&utm_campaign=share
Interesting read. “Delta is far from the last variant. But what shape the virus takes next depends on us.”
Links:
• HPW - Soaring Cases and Little Vaccination: As Delta Spreads, A COVID-19 Middle East Snapshot
• ZyCoV-D, world’s first plasmid DNA vaccine, okayed (in India)
“Indigenously developed by Ahmedabad-based Zydus Cadila, three-dose shot safe for children.”
• WP - Third Pfizer dose significantly lowers risk of infection in seniors, Israeli data shows
• Reuters - Llama antibodies blunt COVID variants in lab trial, says Belgian start-up
• HP&P - How systems respond to policies: intended and unintended consequences of COVID- 19 lockdown policies in Thailand
40
• Vox: How a cheap antidepressant emerged as a promising Covid-19 treatment
“Most Covid-19 drug treatments that have been included in trials haven’t panned out. A large new study suggests fluvoxamine might be different.”
41