IHP news 629 : It’s coming home …
( 9 July 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,
The Delta variant, that is ☹. Not sure the variant is also good at diving, but you have to admit there’s a certain sense of warped ‘justice’ about the fact that even rich countries that have hoarded vaccines like hell ( that is, most rich countries) can’t feel “safe” yet at this stage. Indeed, in the current global race against variants, the vaccines are still losing, as Tedros rightly argued this week. Once again sounding like a broken Edith Piaf record, he emphasized “the world is at a perilous point in the pandemic”.
In the run-up to the G20 (Finance ministers & central bankers’) meeting this weekend, the signatories of last week’s Kampala-Declaration on COVID-19 Vaccine Equity are among the many challenging the current vaccine injustice. But the situation is not just outrageous from a moral perspective. Earlier this week, Nick Dearden (Global Justice) pointed out “Vaccine inequality is now so severe that it's becoming a threat to global stability. Even the IMF, WTO and World Bank are speaking out against the shocking failure of rich governments to create even a façade of justice.” But as waiting for a truly multilateral (G 7/G20/… summit ) solution, let alone a “Global Vaccine Plan” (Guterres) feels like ‘waiting for Godot’, others (eg a Chatham House Expert Comment ) wonder whether in the current “era of rivalry”, vaccine competition could be the world’s best bet. Developing economies could turn this strategic rivalry to their own advantage, John Kampfner (who seems born for this new era) argues. I’m still hoping for the first option, though.
On a side note: with wave after wave, and variant after variant popping up, I’m probably not the only one wondering what the world will look like by the time we collectively reach the end of the Greek alphabet (and good there aren’t as many Greek letters as Chinese characters).
But with the current two-track pandemic, the Covid situation remains gloomy in many parts of the world, less “rich” in vaccines than the West. In sub-Sahara Africa, for example, at least 20 countries are currently experiencing a very nasty third wave of infections, according to Africa CDC, while WHO Afro declared the continent just experienced “its worst pandemic week ever”. Many health facilities are overwhelmed. Increasingly, you also hear that in addition to billions of doses that need to be delivered/donated to LMICs (plus tech transfer &Trips waiver), the sooner the better, “the focus for the short-term needs to shift away from vaccines to focusing instead on coping with the acute emergency unfolding in many African countries already”, see for example Dr Ayoade Alakija, co- chair of the Africa Union Vaccine Delivery Alliance “ …. Vaccines could help prevent another wave of infections but are too late to stop the “India-scenario” already unfolding across Africa, according to her. Instead, countries need oxygen, treatments, testing and field hospitals. …” But it’s vaccines ànd all of this, I guess. As of yesterday.
1
In this newsletter, we will also pay attention to increasing criticism of the G7 (and OECD) “historic” tax agreement. And at the High-Level Political Forum (HLPF), one of the key messages of the (dire) SDG 2021 report was: “We are at a critical juncture in human history”. Also not for the first time I heard this in the last decade.
The dire global outlook clearly doesn’t help, but nevertheless, IHP is slowly getting into a summer holiday mood. From 20 July on, we will take some weeks off. We hope you can do so too, in spite of our late capitalist times (with their trademark “benchmarking to the bottom”, or if the sector you happen to work in, is one of the greatest Ponzi schemes of all time ). A new counterculture movement (‘tangping’ – “lying down and doing as little as possible”) among Chinese millennials who have their belly full of the rat race and consumer society, might inspire you during your (well- deserved) holidays. They are certainly on to something, now that planetary health’s “mantra” (in perfect harmony with the Covid motto “Nobody is safe until everybody is safe” ) seems to be “Nowhere is safe”. According to a recent survey in 16 countries, more than half of consumers believe their own behavior can help to slow global heating. They’re probably right, but I suggest they borrow a Chinese tea leaf or two from these millennials, as it seems only when there’s a critical mass of people ‘not playing by the rules’ (anymore) that we might still have a chance to transform our destructive economic system (clearly unfit for the 21st century) in time, and avert the worst climate disaster scenarios. True, “tangping” is an option only available for (some) youth – as for the rest of us, responsible “adults” (who often have to provide for families), we need to frantically try transform this system (from within) and push it into a fairer and more sustainable direction. Knowing all too well that mankind is a dumb species, not exactly fit for purpose to deal with the many “risk society” challenges of the 21st century. To be kept in mind when drafting your ToC, and meticulously listing your KPIs !
Finally, as for “global health” ’s equally warped “Theory of Change”, we now have to follow meticulously a billionaire couple's divorce. #Ahum
Enjoy your reading.
Kristof Decoster
Featured Article
South Africa’s COVID-19 Vaccine Infodemic battle
André J van Rensburg (senior researcher in health systems at the Centre for Rural Health, University of KwaZulu-Natal, and a research fellow at the Centre for Health Systems Research & Development, University of the Free State; EV2016 )
The negative consequences of vaccine hesitancy are both clear and dangerous – think of Andrew Wakefield’s legacy, for instance. His now thoroughly debunked claim that there is a link between the MMR vaccine and colitis and autism continues to be the bedrock of the “antivaxx” movement, the consequences of which still emerge. Following visits and lobbying from Wakefield and his colleagues to a Somali-American community in Minnesota, US, MMR vaccine rates dropped substantially among
2
children in this migrant community, leading to the state’s largest measles outbreak in nearly three decades. The impact of this North American wave of anti-vaccination advocacy has, unfortunately, gone from strength to strength, finding backers from the most influential parts of society: political support from Trump and the Republicans, religious influence from evangelical Christian churches and the Vatican, and celebrity advocacy using mainstream media, like the Vaxxed films, film campaigns of Robert F. Kennedy, Jr. and Hollywood celebrities like Jenny McCarthy and Jim Carrey getting involved in driving the message home, a message that essentially boils down to trust: Do not trust the government, “mainstream” scientists or the medical community. They lie to you. While the message is simple, its real effectiveness lies in its delivery: creative, assertive, without doubt or grey areas, targeting common primal fears about government intentions, and relying on manufactured or amplified expertise of its spokespeople. Further, messaging is usually packaged in a repetitive way (thereby facilitating internalisation), using a deliberate use of pictures and GIFs, and creates a sense of legitimacy by referring to medical authorities and associations, uses pseudoscientific language in a convincing, readable style, includes accounts of individual experiences, and appeals to emotions (particularly fear, frustration and anger). A toxic but very effective cocktail.
Earlier this year, just as South Africa’s vaccine roll-out plans started to materialise, reports emerged about certain proportions of South Africa’s population not wanting to get vaccinated against COVID- 19. South Africa has a controversial history in peddling in conspiracy thinking in health policy - the HIV denialism that was closely intertwined with traditional beliefs, distrust of American foreign aid intentions, and pseudoscience, infamously resulted in at least 330 000 deaths due to the government throttling antiviral drugs in the public sector. The collective memory of this government betrayal remains, and it’s unclear to what extent such trust and other factors may influence vaccine acceptance in general. Findings from a survey investigating people’s willingness to take a COVID-19 vaccine just before the vaccine roll-out began, suggested that people tended to be more hesitant when they are white, have higher levels of education, identify with opposition political parties, or likely to judge government performance as bad. While the survey underplayed the role of conspiracy theories in vaccine acceptance, there certainly seems to be a strange connection between a subpopulation of white South Africans and post-truth, Trumpist conspiracy-thinking. It has been estimated that around 20 000 South Africans are active on anti-vaccination Facebook pages, largely fed by source materials from the USA. QAnon, the movement promoting the idea that “Donald Trump is waging a secret war against elite Satan-worshipping paedophiles in government, business and the media”, purportedly originated in South Africa. Such transnational propoganda flows are a perfect fit for the vehicle of social media – to virally spread, between communities, countries and across languages, driven by adaptation. It has also been used to great effect to spread a Western anti-vaccination sentiment in West Africa, for example. Marc Roffey, a South African psychiatrist, recently wrote that “Rather than read and evaluate information from reputable online sources, conspiracy theorists frequently favour online video discourses, prompting the creation of the internet meme: ‘Conspiracy theories are published on YouTube, science in peer-reviewed journals.’” South Africa’s stuttering vaccination roll- out certainly did not help matters. The first consignment of AstraZeneca vaccines was sold off to the African Union following reports that it might not be optimally effective against the beta strain that emerged locally, and then, just as the Johnson & Johnson vaccine roll-out was underway, it had to be paused after it emerged that 15 million doses were potentially contaminated in a Baltimore plant. This pause was particularly worrying for confidence levels, and concerns were raised that it would lead to spreading vaccine hesitancy.
There have been incredible health education efforts made during the past year – campaigns by governments and UN agencies, materials developed by educationalists and content developers in many countries. In South Africa, a good example is the Knowledge Translation Unit, whose guidelines, online training courses, posters and video materials manage to convey much of the complexities of COVID-19 in a visually striking way. Nonetheless, we live in Giddens’ Runaway World, in a period of
3
David Harvey’s Time–space compression, where technological advances and globalisation have excelled at such a rate that a search for truth often becomes obscured by the noise of billions of voices and opinions that change by the second. South Africa – and one suspects many other African countries – need additional strategies to battle misinformation. A recent recommendation in the Lancet Global Health highlighted an urgent need for “African governments, public health institutions, and other local stakeholders” to “take evidence-based COVID-19 risk and vaccine communication very seriously”. How and what should this look like? Especially given the apparent rise of misinformation spreading via social media and in many African communities? Some suggest a punitive stance, that governments should fine individuals and churches found guilty of spreading disinformation. This is not ideal, as more government aggression would do nothing more than – in their mind at least – confirm the conspiracy notions that drive disinformation. Further, this does not seem practical, there is simply no way where social media can be policed effectively without dangerously veering into “Chinese” territory. A more appropriate response might be to set up a tactical, strategic communication response plan that targets and debunks misinformation while also undermining non-factual statements on social media.
The WHO has already launched a “Stop the Spread” campaign, designed to address misinformation associated with the COVID-19 “infodemic”, while the Africa Infodemic Response Alliance (AIRA) “brings together fact-checking and media organisations, big data, AI and innovation bodies and leading inter-governmental and non-governmental organisations working in public health to respond to infodemics.” However, beyond evidence that tells us that people are hesitant and misinform, more research is required on why people are hesitant, as well as the multiple contextual influences that push and pull people towards and away from vaccination. Here, insights from psychology could be particularly helpful. A belief in conspiracy theories has been suggested to be driven by a range of motives, including understanding own’s environment, feeling safe in one’s environment, and maintaining a positive image in one’s social group. These motives are not necessarily satisfied by a belief in conspiracies, and this might present an opportunity for pro-vaccine messaging to focus on these needs. Similarly, people who believe fake news and are less able to discern truth, might lack careful reasoning, relevant knowledge and familiarity with a subject. A Nigerian study suggested that the sharing of COVID-19 related misinformation was strongly associated with altruism, an effort to inform others and engage in information sharing. Further, there seems to be a disconnect between what people believe, and what they share on social media, which suggests inattentiveness – nudging people towards accurate interpretation and relaying of information is a critical mechanism in correcting misinformation. An example of ground-up information activism is the Mistress of Science, a scientist who doubles as a false information debunker on social media. Another example: anonymous volunteers who participate in Facebook groups (particularly popular spaces for misinformation). Especially ones that involve young mothers, and nudge people away from misinformation towards evidence-based sources of knowledge. Such innovation and initiative should be applauded, awarded, and harnessed – surely there is a need for a well-supported, well-informed and local group of volunteers to engage with misinformation and uncertainty?
A coordinated effort has started to take shape in terms of identifying trends in misinformation – the National Department of Health has been releasing weekly reports, compiled by volunteers and partners, that describe trends in social media information. The latest SA COVID-19 and Vaccine Social Listening Report, compiled at the beginning stages of the third wave, describes substantial spikes in Google searches on a local conspiracy theorist predicting that all people who receive the vaccine will die (interestingly, the theory has very little traction online, suggesting that it is mainly being circulated via WhatsApp). Other rumours doing the rounds include dangers of COVID-19 vaccine spike proteins, that the WHO is now advising to stop vaccinating children, and different variations of a theory that compares the roll-out of the “experimental vaccine” to the 1950s thalidomide disaster. YouTube searches related to vaccine safety spiked considerably, as much as by 5000% compared to previous
4
weeks. The increased anxiety of COVID-19 waves seems to push a search for information, and this would make for valuable research. Ultimately through, there is a pressing need to not just monitor these information flows, but to intervene in creative and effective ways.
In a letter to The American Journal of Medicine, a physician asked: “What is our role as doctors and other health care professionals in this age of social media? Do we have a responsibility to fight against this new-age pandemic that spreads more widely and quickly than anything we have seen before? Like the current COVID-19 pandemic, social media is something that we very likely will continue to face for years to come. We must keep in mind this ever-looming threat to the integrity of our practice of medicine.” In sum, a critical goal in the COVID-19 fight is to identify misinformation, and counter it effectively by packaging evidence in a reliable, trustworthy and targeted way, always keeping in mind the realist adage of “what works, for whom, under which circumstances”.
Highlights of the week
High-Level Political Forum 2021 (6-15 July)
As mentioned last week already, in this year’s High Level Political Forum on sustainable development (HLPF), discussions focus on how to recover from the impact of the COVID-19 pandemic, and turn the deadly crisis into an opportunity for a major shift towards a more sustainable global economy.
See for example IISD - HLPF Opens With Calls to Use 2030 Agenda to Build Back Better
“…. High-level speakers discussed progress, missed opportunities, and the value of the 2030 Agenda for Sustainable Development as a guide to build back better from the global pandemic….”
UN (report) - The Sustainable Development Goals Report 2021 https://unstats.un.org/sdgs/report/2021/The-Sustainable-Development-Goals-Report-2021.pdf
“The Sustainable Development Goals Report 2021 uses the latest available data and estimates to reveal the devastating impacts of the (pandemic) crisis on the SDGs and point out areas that require urgent and coordinated action. The report was prepared by the United Nations Department of Economic and Social Affairs in collaboration with more than 50 international agencies….”
With respect to the key messages on health SDG 3, more in particular, see p. 33-35: Beyond millions of deaths worldwide, the full toll of the COVID-19 pandemic on health is not yet known; A decade of progress in reproductive, maternal and child health could be stalled or reversed by the pandemic; The COVID-19 pandemic is aggravating the burden of non-communicable diseases; Disruptions in detecting and treating communicable diseases could undo years of focused effort; Support for mental health is being recognized by the vast majority of countries in their COVID-19 response plans; COVID-19 is amplifying health inequalities; Countries are working hard to maintain essential health services despite the current crisis; Health and care workers – in short supply in many regions – have been stretched to their limits; A lack of data is the main stumbling block to understanding the true impact of COVID-19.
5
Coverage via UN News: Sustainable development report shows devastating impact of COVID, ahead of ‘critical’ new phase
“The world was not on track to meet the 17 Sustainable Development Goals (SDGs) before COVID- 19 struck, and now the challenge has been magnified many times over, according to a new flagship UN report that indicates countries must take ‘critical’ steps on the road out of the pandemic, during the next 18 months….”
And IISD - SDGs Report 2021: COVID-19 Led to First Rise in Extreme Poverty in a Generation
Global Tax Justice
There’s more and more criticism of the global tax reforms in the making now that the fine print is becoming clearer. Some reads:
Project Syndicate -How to Secure a Fairer Global Tax Deal
J A Ocampo et al ; https://www.project-syndicate.org/commentary/making-the-oecd-global- corporate-tax-agreement-fairer-by-jose-antonio-ocampo-and-tommaso-faccio-2021-07
“The recent agreement by 131 countries to reform international corporate taxation is not the end of the road. But to bring about a more equitable outcome, developing countries must now push for a higher global minimum tax rate and a bigger reallocation of taxing rights, and refuse mandatory arbitration….”
Tax Justice Network - Global minimum corporate tax: questions grow over OECD commitment to ‘inclusive’ reforms https://taxjustice.net/2021/07/05/global-minimum-corporate-tax-questions-grow-over-oecd- commitment-to-inclusive-reforms/
With Alex Cobham’s analysis.
Project Syndicate -The Global Tax Devil Is in the Details J Stiglitz; https://www.project-syndicate.org/commentary/problems-with-global-tax-reform- proposals-by-joseph-e-stiglitz-2021-07
In-depth analysis by Stiglitz of the reforms underway.
“Under existing tax rules, multinational firms can escape paying their fair share of taxes by booking their income in low-tax jurisdictions, or by moving some parts of their business to these jurisdictions. Will proposed reforms deliver on their promise to boost government revenues, especially in developing countries? It appears that the international community is moving toward what many
6
are calling a historic agreement to set a global minimum tax rate on multinational corporations (MNCs). It’s about time – but it may not be enough. …” “… an agreement to establish a global minimum tax of at least 15% is a major step forward. But the devil is in the details. The current average official rate is considerably higher. It is thus possible, even likely, that the global minimum will become the maximum rate. An initiative that began as an attempt to force multinationals to contribute their fair share of taxes could yield very limited additional revenue, much lower than the $240 billion underpaid annually. And some estimates suggest that developing countries and emerging markets would also see a small fraction of this revenue. …… Particularly problematic in the proposals advanced by the OECD is Pillar One, intended to address taxing rights, and applying only to the very largest global firms. …”
Tax Justice Africa - African Civil Society Organizations Call for Rejection of G7 Global Tax Deal https://taxjusticeafrica.net/african-civil-society-organizations-call-for-rejection-of-g7-global-tax- deal/
Listing four reasons why. And concluding: “We therefore call on the non G7 members of the G20 from the Global South, and especially South Africa, to reject the G7’s proposal and instead support the call for a truly inclusive, just and democratic process of international tax reform at the United Nations wherein the interests of the African continent are taken into account.”
See also VOA - G-7 Tax Reform Proposal Draws Fire from Smaller, Developing Countries
“ Smaller economies and developing nations are rallying behind a rival global tax reform plan to the one struck last week by the wealthy G-7 nations. …. Many back a rival plan that the U.N. Tax Committee has been developing which focuses specifically on the digital giants and grants additional taxation rights to countries where the digital services are provided and where the revenue is generated as opposed to where the country is headquartered, enabling developing economies to capture more income, too. India, Argentina, Ecuador, Ghana, Nigeria and Vietnam are among the emerging economies favoring the U.N. plan, arguing it reflects the economic needs of developing nations…..”
Ahead of the G20 summit (finance ministers & central bankers) in Venice (11 July)
Once again, coming with some expectations (naïve hopes?) from a number of observers.
Guardian - G20 urged to do more to support global vaccine distribution https://www.theguardian.com/society/2021/jul/05/g20-urged-to-do-more-to-support-global- vaccine-distribution
“New alliance of multilateral institutions warns vaccine inequity could curb economic recovery.”
7
“The International Monetary Fund director, Kristalina Georgieva, said the G7 agreement in Cornwall to distribute 870m surplus vaccines this year was not enough, and urged the broader G20 group to show more ambition when she spoke alongside the heads of the World Bank, the World Health Organization and the World Trade Organization (WTO). The four-strong alliance is an unprecedented step by the world’s largest multilateral bodies and reflects its growing feeling that elected political leaders, focused on domestic political audiences, are not grasping the scale of what is needed to grip the international pandemic under long-term control. … Georgieva urged the G20 to embrace a target of vaccinating 40% of the world population by the end of this year, and 60% next year….”
“… Ngozi Okonjo-Iweala, the WTO director, said: “Unless we do something quickly and dramatically, this inequity will continue to lead to a K-shaped recovery. We need to move really fast to move this gap […] Those countries that have vaccinated 50% or 60% of their population need to send their surplus vaccines to the world’s poorest countries.” She said she hoped by July she would have a good outcome on the issue of vaccine intellectual property transfer, adding that member states were negotiating on a detailed text. “There are just not enough vaccines to go round, so we need to manufacture more.” But she added the highly complex vaccine product supply chains made it harder to produce vaccines in Africa. Johnson & Johnson, she said, had told her that their vaccine contains 180 components manufactured at 67 sites in 12 countries. Pfizer’s vaccines contain 280 components produced at 86 sites in 19 countries….”
Devex - WTO chief to G-20: Donate 2-3B more COVID-19 vaccine doses https://www.devex.com/news/wto-chief-to-g-20-donate-2-3b-more-covid-19-vaccine-doses-100306
“Okonjo-Iweala encouraged G-20 countries to “[come] with a figure” to their Venice meeting on July 11, suggesting they agree on giving up to 3 billion doses.”
“World Trade Organization Director-General Ngozi Okonjo-Iweala called on G-20 leaders to “do more,” from donating more coronavirus vaccines to removing trade restrictions that affect the vaccine supply chain. “We need the G-20 to donate more doses right away. As they plan to meet next weekend, it would be good if they came with a figure, about 2, 3 billion more doses,” she said during an online panel event hosted by the Paris Peace Forum and ONE Campaign… She said the G- 20 should donate their doses to COVAX, the global COVID-19 vaccine procurement mechanism to achieve “not vaccine diplomacy, but an equitable allocation of these vaccines to the most vulnerable places where they are needed.” … … The WTO chief hopes to meet with vaccine manufacturers on July 21 to track how they are increasing vaccine production and “where they are making investments to see how fast” production can go. … … The WTO chief also hopes to get negotiations moving on the issue of technology transfers and intellectual property, which have been ongoing since last year as countries debate whether to waive IP on COVID-19 technologies during the pandemic. She expects discussions at the WTO “would move fast so that by July we have some kind of sensible answer that can help us then with the transfer of technology and a good outcome on the IP issue.” …. She also called on the G-20 to remove trade restrictions, which impact vaccine production….”
IMF (blog) Urgent Action Needed to Address a Worsening ‘Two-Track’ Recovery K Georgieva; https://blogs.imf.org/2021/07/07/urgent-action-needed-to-address-a-worsening- two-track-recovery/
8
“… The world is facing a worsening two-track recovery, driven by dramatic differences in vaccine availability, infection rates, and the ability to provide policy support. It is a critical moment that calls for urgent action by the G20 and policymakers across the globe. As our note to the G20 meeting points out, speed is of the essence. We estimate that faster access to vaccinations for high- risk populations could potentially save more than half a million lives in the next six months alone….”
PS: “….For its part, the IMF has stepped up in an unprecedented manner by providing $114 billion in new financing to 85 countries and debt service relief for our poorest members. We have received support to increase access limits, so we can scale up our zero-interest lending capacity. And we are exploring a new ‘vaccine window’ under our emergency financing facilities, which would support countries in financing vaccination programs if needed….”
Project Syndicate - The G20 Must Act Now to Vaccinate the World J Sachs et al ; https://www.project-syndicate.org/commentary/g20-finance-ministers-in-venice- must-adopt-covid19-vaccination-plan-by-jeffrey-d-sachs-and-juliana-bartels-2021-07?
“It is imperative that the G20 finance ministers' meeting in Venice this week act to provide the COVID-19 vaccines needed to achieve worldwide comprehensive adult immunization by early 2022. Given current production, this should not be a problem, so long as a global plan is quickly implemented. …”
Excerpt: “Our estimate is the following. Monthly production by all companies producing COVID-19 vaccines that have received emergency use listing by the WHO and national regulatory authorities, and that are being widely administered between July and December 2021, will average around one billion doses. The world’s population is 7.8 billion, and 5.8 billion are 15 or older. If we define comprehensive immunization as 80% coverage of the adult (15 and older) population in each country, the world should be aiming to immunize 4.6 billion individuals. As of June 30, about 850 million people have been fully immunized, and about 950 million more have received the first dose of the vaccine. To achieve 80% adult vaccination coverage globally, around six billion additional doses will be required. We have made a preliminary spreadsheet model showing that with about one billion vaccine doses delivered each month and approximately six billion doses required, we can achieve comprehensive vaccine coverage in about six months – by early 2022. The precise numbers depend on the specific combination of vaccines. But that will happen only if there is a global plan that includes a timetable to allocate the doses across all countries, a logistical plan to transport the vaccines, an implementation plan within every country, and a financing plan….”
FT (Editorial) - G20 must rise to the challenge of global crises https://www.ft.com/content/233d555f-3cff-4f97-b40d-0e908025b377
“The rich world must gain emerging countries’ trust to advance on pandemic and climate.”
“When finance ministers and central bankers from the world’s 20 largest economies meet in Venice this week, they must seize this crucial opportunity to make headway on the world’s biggest challenges: ending the pandemic worldwide, rallying a global effort to contain climate change and securing a solid economic recovery everywhere on the planet. On all three counts, time is running out….”
9
ODI - Four priorities for the G20 meeting of Finance Ministers and Central Bank Governors
A Prizzon et al ; https://odi.org/en/insights/four-priorities-for-the-g20-meeting-of-finance-ministers- and-central-bank-governors/
The authors suggest at least four priorities for the development agenda to support low and middle-income countries in the health emergency and recovery phase from the Covid-19 crisis. The first one, obviously, being: Finance Covid-19 vaccinations in low and middle-income countries.
And a link:
Guardian - Tax financial transactions to help Covid recovery, G20 told Letter by 100 economists.
Pandemic Treaty
Via Geneva Health Files : The new Bureau for a potential Pandemic Treaty, first meeting next week 15-16 July
“Politico reported “the countries chosen to chair new bureau that will lead on a report about a potential pandemic treaty are France, the U.S., Botswana, Singapore, Iraq and Indonesia, according to multiple diplomats.”
So, next week, discussions can start in earnest, on whether there’s a need for a pandemic treaty (or another new legal international instrument on GHS ). Wonder what that will give in this ‘age of rivalry’…
Trips Waiver, tech transfer, ….
While waiting for Geneva Health Files’ Friday “Deep Dive” update on the Trips waiver negotiations, some reads from this week already:
TWN – Progress in TRIPS waiver talks despite new hurdles created by EU https://www.twn.my/title2/health.info/2021/hi210701.htm
(8 July) “Amidst the groundswell of international support for the proposed TRIPS waiver at the World Trade Organization, the proponents of the waiver on 6 July expressed confidence and optimism on the progress being made in the ongoing small-group consultations in paving the way for an outcome on the waiver, said people familiar with the development. However, the European Union seems to have gone back on its assurances of constructive engagement in the small- group consultations on the revised TRIPS waiver proposal, and appears to be creating new hurdles in an act of bad faith, said people, who asked not to be quoted….”
10
Focus in this article on the informal WTO TRIPS Council meeting on 6 July.
Geneva Health Files – Trips Waiver update
Geneva Health Files;
From last week Friday’s issue. As you know, Geneva Health Files follows the Trips waiver discussions closely. This issue zoomed in on the TRIPS Council informal meeting (30 June). More no doubt in today’s GHF issue.
“formal negotiations on the TRIPS Waiver are yet to have begun…. …. WTO members met for an informal TRIPS Council meeting on June 30th, to discuss the TRIPS Waiver proposal. The meeting took stock of small groups consultations over past weeks and discussed ways to advance the talks…. …. The TRIPS Council is scheduled to meet informally on 6, 14 and 20 July, ahead of the General Council meeting on 27-28 July. Small group consultations will continue during this period….”
HPW - Russia Pushes Ahead with Open License Approach to Sputnik V – Despite WHO Concerns Over Manufacturing Practices https://healthpolicy-watch.news/russia-pushes-ahead-with-open-license-approach-to-sputnik-v- despite-who-concerns-over-manufacturing-practices/
In-depth analysis of the Russian (Sputnik) approach re IP. Recommended.
“Despite the emergence of new WHO concerns over quality control at Sputnik V’s domestic production facilities, the Russian Direct Investment Fund (RDIF) is pushing ahead with a massive international “open-license” manufacturing effort for its Sputnik V vaccine – which breaks the traditional model of vaccine production and leverages existing capacity in poorer countries, desperate for doses. As such, RDIF has “broken the model of closed intellectual property” and adopted a vaccine scale-up model that is “fundamentally different” to most vaccine developers, Leena Menghaney, Global IP Advisor for MSF’s Access Campaign, told Health Policy Watch in an interview. But at the same time, a recent WHO review of manufacturing practices at one of the vaccine’s nine Russian plants identified a number of substandard manufacturing practices – illustrating how challenging quality control may be for the wider Russian model. …”
Among others, “… Instead of sealing exclusive licenses with a handful of manufacturers, the RDIF has shared its vaccine technology and know-how with some 27 manufacturers, predominantly based in India or upper middle income countries, according to the Geneva Graduate Institute’s COVID Vaccine Manufacturing Tracker. …”
Still, “…. RDIF’s open license approach clearly has its limits as well. For example, the company has not shared its vaccine recipe to the WHO-backed COVID-19 Technology Access Pool (C-TAP), Love noted. … … The RDIF also has given no signal, to date, about whether it would join the WHO co- sponsored global COVAX facility should its vaccine finally be approved by the WHO. …”
11
HPW - WHO Challenges Pfizer and Moderna to Openly Share Their Know-How to Accelerate COVID Vaccine Production https://healthpolicy-watch.news/who-urgest-pfizer-and-moderna-to-share-vaccine-know-how-to- speed-up-vaccine-production/
On last week Friday’s WHO media briefing. “In his most explicit appeal to date, WHO’s Director General Dr Tedros Adhanom Ghebreyesus called upon the global leaders in COVID mRNA vaccine manufacturing – Pfizer/BioNTech and Moderna to “share their know-how” in vaccine manufacturing with more manufacturers, particularly in low- and middle-income countries. “
“…The WHO DG also called upon countries that are beginning to issue COVID passports for travel, to recognize any WHO-approved vaccine – a thinly veiled jab at the brand new European Union COVID digital pass, which has been widely criticized for only recognizing vaccines approved by the European Medicines Agency – and not WHO-approved vaccines produced in India, China, or Korea. …”
The Prospects for an IP Waiver Under the TRIPS Agreement D Matthews et al ; https://blog.petrieflom.law.harvard.edu/2021/07/06/the-prospects-for-an-ip- waiver-under-the-trips-agreement/
Nuanced (and very much recommended) read. “… We do expect some sort of WTO Declaration on IP and COVID-19 to emerge by December 3, but whether this is anywhere close to current TRIPS waiver proposals remains to be seen. Watering down the current TRIPS waiver proposals to achieve a consensus or majority vote remains a very real possibility. Meanwhile, the academic debate has crystallized around almost diametrically opposed pro-waiver and anti-waiver positions. Our view is that both positions have their merits and their drawbacks, but that, in reality, pro- and anti-waiver arguments are not binary….”
ACT-A & Covax updates
Among others, with coverage of the ACT-A Facilitation Council briefing (6 July).
HPW - COVID Pandemic in a Dangerous and Fragile Phase, as Surges are Reported Globally https://healthpolicy-watch.news/88323-2/
“As many high-income countries are relaxing restrictions for the summer months, low- and middle- income countries are witnessing rises in cases, deaths, and overwhelmed hospitals. … the third wave is intensifying in several countries, with critical oxygen shortages rising in sub-Saharan Africa, Southeast Asia, and parts of Latin America. Some 19 countries are about to run out of oxygen….” “We face a two track pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, at the ACT-Accelerator Facilitation Council Briefing on Tuesday. “The countries that are now opening up their societies are those that have largely controlled the supply of life saving personal protective
12
equipment, tests, oxygen, and especially vaccines.” “Meanwhile, countries without access to sufficient supplies are facing waves of hospitalizations and deaths,” Tedros said. “
“… After weeks of decline, global COVID-19 cases are now on the rise in five of the six WHO regions. The African region is currently experiencing a fast-surging third wave that could pose a far greater threat to the continent than the second wave. … … Over 20 countries globally have an exponential growth in cases and “almost vertical transmission,” said Van Kerkhove (WHO Technical Lead). “ “ … While a global milestone of administering three billion doses has been reached, only 0.3% of those have gone to low-income countries. Of the 2.6 billion COVID tests performed globally, less than 4% have been administered in Africa, which accounts for 17% of the world’s population.”
As for the update on Covax: “… COVAX has shipped 95.9 million doses to 135 countries, including 69 low- and middle-income countries. Some 40 countries began their vaccination campaigns because of COVAX. “We should have been at a much higher level of distribution by now, perhaps between 300- and 400 million doses, but because of the constraints…we have yet to touch 100 million,” said Soumya Swaminathan, WHO Chief Scientist. …. …. WHO officials expect to have a “very strong increase” in vaccines available to COVAX in the fourth quarter of 2021 with additional vaccines getting WHO emergency use listing (EUL) and scale ups in vaccine manufacturing. … … The hope is also that exports of the AstraZeneca vaccine from the Serum Institute of India (SII), a major source of doses for the COVAX Facility, will resume in late 2021. … Boosting the availability of vaccines immediately will require dose sharing from countries with a surplus of vaccines. Several countries have committed over 530 million doses to COVAX, with the commencement of deliveries from France, New Zealand, and the US. Four new manufacturers have signed up with COVAX – Moderna, Novavax, Johnson & Johnson, and Clover, a Chinese biotech firm – committing 1.5 billion doses. As a result of the new deal and ongoing negotiations, COVAX expects “substantial volumes” of vaccines through 2021 and early 2022, said Nguyen. “We are forecasted to have approximately 1.9 billion doses available for delivery by the end of 2021 and of this, the advanced market commitment participants, the 92 lower-income economies, are expected to receive 1.5 billion doses of that,” said Nguyen….”
Tweet Carl Bildt: “Meeting today of the @ACTAccelerator Facilitation Council … focus on the $ 16.8bn financing gap and hope that @g20org FinMin will act and in the grave gap with only 0,3% of the 3bn vaccines doses having been available to the low/medium income countries..”
More coverage via UN News: Equitable distribution of vaccines, equipment only way out of pandemic: WHO chief
“Tedros added that the financing mechanism supporting COVAX, known as the Advanced Market Commitment, is fully funded for this year “but there are still substantial risks in the vaccine supply forecast.”
ACT Accelerator Facilitation Council Briefing for members and WHO Member States (6 July ) https://www.who.int/news-room/events/detail/2021/07/06/default-calendar/act-accelerator- facilitation-council-briefing-for-members-and-who-member-states
Objectives were: Outline current urgent requirements for COVID-19 tests, treatments and PPE and the critical steps to improve access to these tools. Update & engage Council members and Member
13
States on the Vaccine Manufacturing Working Group, ACT-A Strategic Review & Health Systems Connector workplan. Outline the current COVAX vaccine supply outlook and urgent needs.
Check out key materials (ppts) of the meeting.
Reuters – COVAX aims to deliver 520 mln vaccine doses to Africa this year https://www.reuters.com/world/africa/covax-aims-deliver-520-mln-vaccine-doses-africa-this-year- 2021-07-08/
“The global vaccine distribution scheme COVAX aims to deliver 520 million COVID-19 vaccine doses to Africa this year, its director said on Thursday….”
“Aurelia Nguyen, managing director of COVAX, told a news conference organised by the World Health Organization's Africa region that the scheme was not happy with progress supplying doses so far, but that deliveries should ramp up from September. … Nguyen said so far COVAX had delivered around 25 million doses to 44 African countries. … By the end of the first quarter of 2022, COVAX now aims to supply nearly 850 million vaccine doses to the continent.”
• And via Devex:
“COVAX hit a milestone this week: delivering more than 100 million doses of COVID-19 vaccines to 135 countries and territories. The majority of the shipments were AstraZeneca vaccines delivered between February and April. But supply shortages now mean many of the nations that received early deliveries aren’t getting their second doses….”
• And via Politico:
“The single-shot Covid vaccine produced by Johnson & Johnson will start reaching countries through COVAX this week, company officials said. J&J is expected to supply the global vaccine program with 200 million doses by the end of this year, providing poor countries with another option that’s easy to distribute and store. How quickly that happens is unclear. Though the J&J vaccine in the U.S. has been beset by production problems, those appear unlikely to affect COVAX deliveries. The company has manufacturing partnerships with nine companies on four continents, including Aspen in South Africa and Biological E in India, said chief scientific officer Paul Stoffels. Vaccines from some of these facilities will require emergency authorization from the World Health Organization before they can be shipped out through COVAX, said COVAX managing director Aurélia Nguyen. This could potentially delay some deliveries, which would mean the lagging COVAX effort may not get an immediate jolt from J&J doses coming online. By the end of this month, COVAX is expected to reach 210 million doses delivered, far short of the 600 million doses expected initially….”
HPW – As Africa Experienced ‘Worst Pandemic Week’, COVAX Promises Accelerated Delivery of Vaccines from September https://healthpolicy-watch.news/as-africa-experienced-worst-pandemic-week/
“As Africa recorded its worst pandemic week, the COVAX Facility announced on Thursday that it has taken steps to quickly resume the delivery of vaccines to African countries including diversifying its
14
portfolio of COVID-19 vaccines. Aurélia Nguyen, Managing Director of the COVAX Facility based at Gavi, the Vaccine Alliance, said the COVAX portfolio now consists of nine vaccines and vaccine candidates. “We have legally binding contracts in place for 2.8 billion doses. We also have commitments for further 1.3 billion doses,” Nguyen told the World Health Organization (WHO) Africa’s weekly COVID-19 briefing on Thursday. COVAX will have supplied 520 million doses by the end of 2021 and nearly 850 million by the end of the first quarter of 2022, said Nguyen. “These are all funded following our successful fundraising summit that we had in early June. Now we have the resources in place to be able to protect up to 30% of the population in every eligible African country,” she added….”
“…The majority of the doses will be delivered from September onwards and in the interim, COVAX will be getting countries with excess doses to share with countries that do not have….
NPR - It's A Tricky Balancing Act For Countries Awaiting Vaccine Doses NPR;
“…With the promise of vaccination still months away for most people, these COVAX countries have a tricky balancing act in front of them: They have to plan a communication campaign to keep people interested and ready to get a shot, says Steven Neri of Project Hope. at the same time they need to set realistic expectations for when that will actually be possible.” With focus on a number of countries in Latin America & Africa.
Devex – How countries are adapting to AstraZeneca vaccine shortages https://www.devex.com/news/how-countries-are-adapting-to-astrazeneca-vaccine-shortages- 100319
“Countries that received vaccine shipments through COVAX are now waiting for the second shot. Some have started mixing vaccines, while others are looking at other means to secure doses.”
More Global Health Governance, Financing & GHS news
NYT -Bill Gates Can Remove Melinda French Gates From Foundation in Two Years Following their divorce, https://www.nytimes.com/2021/07/07/business/bill-gates-melinda-gates-divorce-foundation.html
See also WSJ - Gates Foundation Reveals Plan in Case Co-Chairs Can’t Work Together
“The Gates Foundation said that Melinda French Gates could eventually depart from its leadership if she and Bill Gates determine they can’t work together, as the philanthropy laid out plans for its future oversight. The Bill & Melinda Gates Foundation said Wednesday that it would add trustees and that its controlling philanthropists will add an additional $15 billion to the foundation’s $49.9 billion endowment, their largest single contribution since 2000. The money will be used to fund grants across the foundation’s work on issues including infectious diseases, gender equality and
15
U.S. education, Mark Suzman, the foundation’s chief executive officer, said in an interview. Under a private agreement that is part of their planned divorce, Ms. French Gates would resign as co-chair and trustee if after two years either of the co-chairs decides they can no longer work together to lead the foundation, Mr. Suzman said. Should that happen, he said, Ms. French Gates would receive funds from Mr. Gates separate from the foundation’s endowment for her own philanthropic work….”
See also a statement by Gates CEO, Suzman Moving forward.
And FT – Gates Foundation makes contingency plans for break-up
“…Its introduction marks the first time French Gates has publicly broached the idea of leaving the $50bn foundation since she and Gates announced in May that they were ending their 27-year marriage….”
BMJ GH Commentary - Equity and expertise in the UN Food Systems Summit N Nisbett, S Friel et al ; https://gh.bmj.com/content/6/7/e006569
“The UN Food Systems Summit is bold but controversial, with important implications for global food systems and public health. Alongside claims of corporate capture, many have noted insufficient attention paid to human rights and to rebalancing power in the food system. These issues speak to wider issues of participation and equity in the summit itself. Narrow definitions of equity only consider income inequities in outcomes and coverage. Broader definitions consider why such inequities persevere and are interlinked via processes that can be historical and intergenerational. The summit’s science group is slanted in disciplinary expertise: it lacks sufficient expertise in equity, health, noncommunicable diseases or representatives with expertise in indigenous knowledge. It is not too late to rectify this in the summit structures, as we approach the September summit meeting.”
WHO - Working Group on Sustainable Financing https://apps.who.int/gb/wgsf/
All documentation so far.
Geneva Health Files - The clock is ticking on securing WHO's finances
P Patnaik; Geneva Health Files;
Do subscribe to this must-read newsletter!!
Last week Friday’s issue’s Deep Dive zoomed in on the meeting of the ‘sustainable financing’ working group on 23-25 June: Financing WHO: How much must countries pay & what are essential functions: An update from the Sustainable Financing Working Group Meeting. “The inter- governmental working group on sustainable financing might be making more progress than
16
skeptics would care to admit. Our deep dive this week, looks at some of the options on the table, and what they might mean for the future of the organization.”
A few quotes & excerpts:
“Discussions among countries on ways to fund WHO in a predictable manner are reaching an important phase with an emerging view that member states must pay more to protect the role of WHO in global health. So while many countries may, in principle be ready to cough up more, it is far from clear by how much and by when would they agree to do so. Countries also appear undecided on the ways to prioritize essential functions of WHO, sources familiar with the discussions at the intergovernmental Sustainable Financing Working Group told us….”
“… The meeting last week on 23-25 June, discussed the recommendations made by the Independent Panel On Pandemic Preparedness And Response, and the other committees. The working group also put forward its deliberations on the costing of certain essential functions of the WHO, including health emergency preparedness and response; delivering on normative functions; strengthening essential public health functions in countries; advancing research and innovation for global health; functions to improve transparency and accountability to mitigate severe corporate risks….” …. … The working group now has only a narrow window of opportunity in getting WHO member states on board to find ways in arriving at a sustainable financed model of operations for WHO. With only two meetings scheduled, ahead of submitting its report in early 2022, it is not clear yet whether countries will be able to muster up enough political will to address the urgent issue of WHO finances, even the midst of the worst health emergency in 100 years. …. … Geneva global health organizations, including The Global Fund and Gavi are considering changes in strategy to align with shifting policy priorities in the context of an expanding agenda on global health security as a result of the COVID-19 pandemic. This could edge out WHO further into the periphery. The emergence of the ACT Accelerator has swiftly relegated WHO into a coordinating role, even as countries recognize the leadership of the organization in the response to the pandemic. Without reliable funds of its own, WHO will have little political or financial muscle to fight these sweeping changes and preserve its space.”
For more on this Working group (so far), see also KEI - WHO Working Group on Sustainable Financing out of the starting blocks to identify how to better fund “essential” functions of the organization
“…. the WHO’s Working Group on Sustainable Financing is charged with identifying pathways to finance the “essential functions of WHO” in a sustainable manner….”
“Since its inception, the WGSF has met three times – 29-31 March 2021, 28-30 April 2021, and 23- 25 June 2021; the WGSF will prepare an interim report to be considered at the regional committee meetings in 2021. The final report with recommendations will be presented to the 150th session of the WHO Executive Board in January 2022. The WGSF is identifying options to determine what constitutes the essential functions of the organization including an “elaboration of the contents of normative functions, including public health goods” … The WGSF is chaired by Björn Kümmel of Germany …”
17
Politico - Virus lab leak theory dogs Democrats eager to keep focus on Trump's Covid failings https://www.politico.com/news/2021/07/04/wuhan-lab-leak-theory-democrats-497902
On the link between the ‘lab leak’ story and murky domestic US politics.
“Democrats worry that murky conclusions that don’t identify the origin of the virus could play into the Republicans’ hands. … … Congressional Democrats are having to balance escalating calls to investigate whether Covid-19 escaped from a lab in China with their efforts to highlight the Trump administration’s response to the pandemic and the ongoing push to stamp out the virus. … The dilemma shows how much shaping a narrative of the health crisis ahead of the 2022 midterms is already consuming lawmakers as new outbreaks emerge in parts of the country. And it puts Democrats who control the congressional agenda in a bind, as they wrestle with the possibility of stoking potentially unprovable claims about a man-made crisis or facing accusations from Republicans of engineering a cover-up….”
PS: see also a new (month-long) Vanity Fair investigation - The Lab-Leak Theory: Inside the Fight to Uncover COVID-19’s Origins Focusing on the toxic politics and hidden (science/gain-of function…) agendas re this theory.
WHO - Contingency Fund for Emergencies: 2020 Annual Report https://www.who.int/publications/i/item/WHO-WHE-2021.06
Published on 2 July.
The Elders urge heads of state to demonstrate personal leadership on pandemic prevention
The Elders;
“ The Elders today called on world leaders to take direct, personal responsibility for leading efforts to prevent a future global pandemic and manage the continued threat posed by COVID-19, by publicly committing to decisive actions in the collective public interest. Following their first in-person meeting for over twenty months in Washington DC, The Elders appealed to heads of state to take the initiative and implement the recommendations of the Independent Panel on Pandemic Preparedness and Response (IPPPR), by agreeing to a Political Declaration at a special summit during the United Nations General Assembly (UNGA) in September 2021. In particular, heads of state should personally commit at UNGA to implementing the IPPPR’s recommendation to establish a Global Health Threats Council. Such a body can better coordinate international preparedness efforts, and avoid the catastrophic failures that have occurred throughout the COVID- 19 pandemic in all parts of the globe…..”
18
Lancet Viewpoint - 7-1-7: an organising principle, target, and accountability metric to make the world safer from pandemics T Frieden et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01250- 2/fulltext
“We suggest a new global target of 7-1-7 (panel) whereby every suspected outbreak is identified within 7 days of emergence, reported to public health authorities with initiation of investigation and response efforts within 1 day, and effectively responded to—as defined by objective benchmarks—within 7 days (appendix p 1). This 7-1-7 target can provide a global basis for accountability, be applied at country level to assess and improve performance, and can also be applied locally to promote equity in detection and context-appropriate response capabilities….”
Newsweek - Never Let a Crisis Go to Waste: Preventing the Next Pandemic | Opinion D Miliband, J O’Neill & J-A Rottingen ; https://www.newsweek.com/never-let-crisis-go-waste- preventing-next-pandemic-opinion-1605717
“… It is time to challenge the inertia, short-termism and myopia that dogs pandemic preparedness and response. Sitting on three independent international panels—the Independent Panel on Pandemic Preparedness and Response, the Pan-European Commission on Health and Sustainable Development and the G20 High Level Independent Panel on Pandemic Financing—we believe there are three principles that are key to preventing another catastrophic pandemic.”
The first being, “pandemic preparedness and response must be understood in a new way—as a global public good. The reason is that the world has been solving the wrong type of problem when it comes to pandemic preparedness and response. International systems have treated pandemics solely as health issues. Governance and accountability have therefore sat with the World Health Assembly and the World Health Organization. Financing has relied on domestic budgets supplemented by development assistance for health. This is how we govern and finance many health issues such as primary health care, nutrition, family planning and the management of both communicable and non-communicable diseases…..” “But there is a critical difference between the management of pandemics (alongside other truly global health threats such as antimicrobial resistance) and these other health issues….”
Think Global Health - How to Build a Global COVID-19 Surveillance Program Scott Layne; https://www.thinkglobalhealth.org/article/how-build-global-covid-19-surveillance- program
“A call to action and a blueprint to pave the way.”
“…. Below is outlined a provisional "blueprint" for a global COVID-19 surveillance program that could solve the problems keeping us one step behind beating this virus. The blueprint proposes four operational levels—diplomatic, administrative, scientific and regional— with each offering a concrete basis for debate, improvement, and implementation….”
19
Covid key news – Tragic milestone of 4 million (official) deaths
With key trends, WHO messages, …
Devex - COVID-19 deaths reach 4 million globally https://www.devex.com/news/covid-19-deaths-reach-4-million-globally-100318
“While it has taken less than three months to reach the 4 million deaths — with the world reaching 3 million deaths in April — experts including those from the World Health Organization, have said that the official death toll is likely an undercount. “Our own estimates are that the true death toll [of COVID-19] is at least two to three times higher,” Soumya Swaminatha, WHO’s chief scientist, told Devex last month. …”
The countries with most deaths in this wave: “… During the period of April 9 to July 6, India accounted for almost a quarter of the deaths as it battled a deadly second wave in April that overwhelmed medical facilities across the country, and led to a massive appeal for oxygen. Brazil remains the second country with the largest number of new deaths, accounting for 18% of the additional million deaths. Mexico and Russia remain in the top 10 countries reporting additional COVID-19 deaths, although Mexico has seen a significant decline in deaths during the period of Jan. 16, with 65,905 deaths, to April 8, with 26,669. …”
HPW - Countries Urged to Reopen with Caution as World Surpasses Four Million COVID Deaths https://healthpolicy-watch.news/countries-urged-to-reopen-with-caution-as-world-surpasses-four- million-covid-deaths/
On Wednesday’s media briefing: “The world is at a perilous point in this pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the WHO press conference on Wednesday. …“More than two dozen countries have epidemic curves that are almost vertical right now,” said Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead. …”
“…Cases on Rise in Most Parts of World: “Indeed, after sharp declines in most regions and key countries of the world over the past eight weeks, new cases are now on the increase almost everywhere – except for Latin America which had been riding an enormous fourth COVID wave, now in decline … …This was followed by a 15% increase in cases in the African region, 11% increase in the Eastern Mediterranean region, 10% increase in the Western Pacific region, and 7% increase in the Southeast Asia region.
“In Africa, which has very low vaccine rates as well as hospital capacity, deaths per capita are approaching the all time peaks seen in January 2021, during Africa’s second wave. Even more worrisome, the African region, which also lacks hospital and oxygen capacity, has witnessed a sharp increase in mortality by 23% over just the past week, the highest out of all six WHO regions, WHO said. …”
20
• And via Devex:
“According to Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, 21 African countries are currently dealing with a “very severe” third wave of COVID-19 infections, with 10 of those countries experiencing an “extremely aggressive” third wave. …”
• See also WHO Afro (8 July) - Africa’s COVID-19 surge tops second wave peak as vaccine deliveries pick up (recommended read)
“Africa marked its worst pandemic week ever, surpassing the second wave peak during the seven days ending on 4 July 2021. Yet, as the COVID-19 cases climb sharply, there are signs of progress on vaccine deliveries to the continent…..” And in July/August, vaccine deliveries should really pick up on the continent.
• Record COVID in Southeast Asia - see Cidrap News: “In other global developments, some countries including Indonesia, Vietnam, and Bangladesh, reported new record daily highs for infections…” See also Cidrap News - Delta COVID variant surges in Asia, casts shadow on Olympics (8 July)
UN News - COVID variants ‘winning the race against vaccines’ warns WHO chief https://news.un.org/en/story/2021/07/1095432
“Variants like Delta are “currently winning the race against vaccines” said the World Health Organization (WHO) chief, Tedros Adhanom Ghebreyesus on Wednesday, pinning the blame squarely on a lack of equitable vaccine production and distribution.”
Tedros also blasted (again) wealthy nations for hoarding vaccines and moving on to offering booster shots for their citizens while those in other countries wait for initial shots.
Guardian - Vaccines ‘outpaced by variants’, WHO warns, as Delta now in 98 countries https://www.theguardian.com/society/2021/jul/03/vaccines-outpaced-by-variants-who-warns-as- delta-now-in-98-countries
Same message already on last week Friday’s media briefing. “Proposals to extend Covid jabs to children in west would delay worldwide rollout, say experts, and allow deadly variants to develop elsewhere.
See also UN News - COVID-19 Delta variant detected in 98 countries, continues to evolve and mutate, warns WHO
“The head of the World Health Organization (WHO) [last week] on Friday urged leaders to push back against daunting new COVID surges through increased vaccination efforts and public health
21
measures, warning that with Delta quickly becoming the dominant strain in many countries ‘we are in a very dangerous period of the pandemic’.
"In those countries with low COVID-19 vaccination coverage, terrible scenes of hospitals overflowing are again becoming the norm. But no country is out of the woods yet”, said Tedros Adhanom Gebreyesus, during his biweekly press conference. …. …. Meanwhile, the WHO chief explained that there are ‘essentially’ two ways for countries to push back against the new COVID-19 surges. "Public health and social measures like strong surveillance, strategic testing, early case detection, isolation and clinical care remain critical. As well as masking, physical distance, avoiding crowded places and keeping indoor areas well ventilated", he said. The second way, said Tedros, was through the global sharing of protective gear, oxygen, tests, treatments and vaccines…..”
See also HPW - Dangerous Delta Variant Continuing to Evolve
“His appeal came as the Delta variant continues to spread across the globe, detected in at least 98 countries so far, according to WHO. Africa, which had escaped more easily from previous pandemic waves is now facing a sharp increase in new cases, with infection rates climbing faster than previous waves, and “new, and and faster spreading variants fuelling the continents surging third wave,” in the words of a WHO African region briefing [last week] on Thursday. For the first time since the beginning of the pandemic, infection rates in African countries are well outpacing those of India, Latin America or higher income Americas or Europe – where the virus had rampaged last year. “
“… …. The WHO also called out rich countries for failing to share enough vaccines – saying that sharing so far has been “still only a trickle, which is being outpaced by variants. …. And Tedros urged global leaders to ensure that at least 10% of people in every country are vaccinated by the end of September – building up to 70% of the world’s population by the same time next year. “By the end of this September, we’re calling on leaders to vaccinate at least 10% of people in all countries,” he said. “This would protect health workers and those at most risk, effectively ending the acute stage of the pandemic and saving a lot of lives….”
Guardian - WHO warns of ‘epidemiological stupidity’ of early Covid reopening https://www.theguardian.com/world/2021/jul/07/countries-should-not-relax-covid-rules-too- quickly-says-who-official-mike-ryan
Never one to mince words, Mike Ryan. (on Wednesday)
“As England moves towards an anticipated “big bang” lifting of coronavirus restrictions on 19 July, a senior World Health Organization official has warned countries to lift their Covid-19 restrictions slowly so as “not to lose the gains that [they] have made”. The comments from the UN global health body’s head of emergencies, Mike Ryan, were not aimed directly at Boris Johnson’s much- trumpeted reopening. However, they will be interpreted as grist to the mill of those health experts who have been arguing that England is moving too fast at a time when infections are surging. Ryan did, however, address reactions to Johnson’s announcement earlier this week amid claims by some that the new policy appeared to be to allow new infections on top of vaccinations so that the country could reach herd immunity, saying he did not believe that was the intention. Ryan said the idea of letting people get infected with Covid-19 earlier rather than later was “epidemiological stupidity”.
22
“His comments came at a briefing where the WHO once again urged countries to share Covid-19 vaccines to protect health and care workers and elderly and vulnerable people in low-income countries before expanding vaccination programmes to children….”
See also Reuters Health – WHO urges countries 'not to lose gains' by prematurely lifting COVID-19 measures
“The WHO also urged countries including the United States and Switzerland that are vaccinating 12- to 15-year-old children to instead donate doses to the vaccine sharing programme COVAX, to improve access for healthcare workers and the elderly in low-income countries….”
Lancet Correspondence - Science, not speculation, is essential to determine how SARS-CoV-2 reached humans https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01419-7/fulltext
Among the authors, many familiar names: Peter Daszak, Christian Drosten, J Farrar, …
By the authors who wrote on Feb 19, 2020, as “a group of physicians, veterinarians, epidemiologists, virologists, biologists, ecologists, and public health experts from around the world, (who] joined together to express solidarity with our professional colleagues in China.”
This piece answers whether they still support what they said in early 2020 (yes) and second, whether their second aim of the original Correspondence still stands as well – “to express our working view that SARS-CoV-2 most likely originated in nature and not in a laboratory, on the basis of early genetic analysis of the new virus and well established evidence from previous emerging infectious diseases, including the coronaviruses that cause the common cold as well as the original SARS-CoV and MERS-CoV.”
Their answer: “…. The critical question we must address now is, how did SARS-CoV-2 reach the human population? This is important because it is such insights that will drive what the world must urgently do to prevent another tragedy like COVID-19. We believe the strongest clue from new, credible, and peer-reviewed evidence in the scientific literature is that the virus evolved in nature, while suggestions of a laboratory-leak source of the pandemic remain without scientifically validated evidence that directly supports it in peer-reviewed scientific journals…..”
Coverage of the letter in the Telegraph - Strongest evidence yet suggests natural origins for Covid, say scientists “Two dozen experts have reaffirmed their view that the pandemic has natural origins in a new letter to The Lancet.”
“…three scientists who contributed to the first letter have not signed the second article, including Prof Bernard Roizman, a virologist at the University of Chicago…”
COVID death toll passes 4 million: Global Vaccine Plan essential, declares Guterres https://news.un.org/en/story/2021/07/1095462
23
“The global death toll due to COVID-19 officially passed four million late on Wednesday, marking yet another “grim milestone” and underlining the urgent need for the world to put a Global Vaccine Plan in place to get the pandemic under control, said the UN chief in a statement. “Bridging the vaccine gap requires the greatest global public health effort in history”, he said, calling for a Global Vaccine Plan to at least double production of vaccines and ensure equitable distribution, using the UN-supported COVAX international COVID inoculation facility, as the main platform.”
“Mr. Guterres said an effective global plan would support implementation and financing; increase countries’ readiness and capacity to roll out immunization programmes, and tackle “the serious problem of vaccine hesitancy.” “To realize this plan, I am calling for an Emergency Task Force that brings together all the countries with vaccine production capacities, the World Health Organization (WHO), the global vaccine alliance GAVI, and international financial institutions able to deal with the relevant pharmaceutical companies and manufacturers, and other key stakeholders.”…”
And some links:
Cidrap News - COVID-19 surges accelerate in Southeast Asia
Other Covid vaccine access news & other bottlenecks
Nature News - COVID vaccines to reach poorest countries in 2023 — despite recent pledges
Nature news;
Nice helicopter view of current state of affairs. “Amid a COVID surge in Africa, vaccine promises from richer nations are not enough to bring an early end to the pandemic, experts say.”
“Most people in the poorest countries will need to wait another two years before they are vaccinated against COVID-19, researchers have told Nature. … Around 11 billion doses are needed to fully vaccinate 70% of the world’s population against COVID-19. As of 4 July, 3.2 billion doses had been administered. At the current vaccination rate, this will increase to around six billion doses by the end of the year, researchers from the International Monetary Fund, based in Washington DC, project. But so far, more than 80% of the doses have gone to people in high-income and upper-middle-income countries. Only 1% of people in low-income countries have been given at least one dose, according to the website Our World in Data. …. … Andrea Taylor, a health policy researcher and the centre’s assistant director, says these pledges are unlikely to get more vaccines to the world’s poorest people more quickly. In March, her group projected that the world would be vaccinated in 2023; Taylor says that date still stands. “
“… The extra pledges will be offset by restrictions on exports….”
“… COVAX has pledged to vaccinate one-fifth of the population of each LMIC by delivering two billion doses by the end of this year. It has purchased 2.4 billion doses — up from 1.1 billion in March, according to data from the Duke Global Health Innovation Center. But as of 2 July, COVAX had shipped 95 million doses, up from 65 million in May. … Overall, between February and May, African
24
countries received only 18.2 million of the 66 million doses they had expected through COVAX. Out of nearly 1.3 billion people in Africa, just 2% have received one dose of a COVID-19 vaccine. And a little over 1% — 26 million people — are fully vaccinated, according to the WHO’s Africa office. … An SII spokesperson told Nature that the company expects to resume global exports by the end of 2021. A COVAX spokesperson says that in spite of the delays, the organization is confident that it can meet its goal of supplying two billion doses by the end of the year. …”
“… With India’s manufacturers out of the picture for now, the United States is emerging as the world’s leading supplier of vaccine doses to LMICs, Taylor explains, and has begun to distribute some of its surplus supplies. …. However, according to WHO chief scientist Soumya Swaminathan, this could be too late. “The inequitable distribution of vaccines has allowed the virus to continue spreading,” she says. Unvaccinated populations are already at risk, especially from new coronavirus variants, such as Delta (also known as B.1.617.2). “We need countries with substantial supply to donate 250 million doses for September,” Swaminathan says….”
Telegraph - ‘Silent mass drowning’: Africa facing worst pandemic week yet as Blair joins calls for action Telegraph;
“… Africa is facing a “perfect storm” of Covid-19, former British prime minister Tony Blair has warned, with cases surging by almost 2,000 per cent in just a month in some parts of the continent. It is an “urgent, vital necessity” to increase vaccine supply to Africa as the delta variant begins to take hold in countries across Africa, Mr Blair wrote in the foreword of a new report, published on Tuesday.
“However, other leading figures said that the focus for the short-term needs to shift away from vaccines to focusing instead on coping with the acute emergency unfolding in many African countries already. …. Vaccines could help prevent another wave of infections but are too late to stop the “India-scenario” already unfolding across Africa, according to Dr Ayoade Alakija, co-chair of the Africa Union Vaccine Delivery Alliance. Instead, countries need oxygen, treatments, testing and field hospitals, she said. …”
The Globe and Mail - Canada ships COVID-19 vaccines to 134 of its diplomatic missions in countries where vaccines are scarce The Globe and Mail;
“The federal government, using military aircraft and couriers, has shipped thousands of COVID- 19 vaccine doses to 134 of Canada’s diplomatic missions to ensure the mass vaccination of its foreign-based staff and their families in countries where vaccines are scarce. The government says it has a legal obligation, known as a “duty of care,” to ensure that its overseas staff have reasonable access to health care, including vaccines. Health activists in low-income countries, however, are worried that the shipments are helping promote a covert two-tier system of vaccine access in lower-income countries. “
“… Health activists say the wealthy countries are creating a parallel distribution system, ensuring their staff have full access to vaccines in lower-income countries where local people have little or
25
no access. “This is vaccine apartheid, and this is shameful,” said Fatima Hassan, a human-rights lawyer and founder of Health Justice Initiative, a South African group….”
Stat - Can we stretch existing Covid vaccines to inoculate more people? Experts are divided https://www.statnews.com/2021/07/08/stretch-existing-covid-vaccines-experts-divided/
“…. The idea of splitting doses of Covid vaccines is not universally supported, however; a number of experts contend that the vaccines should be used in the dose size tested during clinical trials and cleared for use by regulatory agencies….”
But some argue for a ‘public health approach’, focusing on populations instead of individuals, see for example this Nature Medicine Comment - Fractionation of COVID-19 vaccine doses could extend limited supplies and reduce mortality
But, “…Even Cowling acknowledged that given that lower doses would need to be tested, the opportunity to go this route in this pandemic may be slipping from the world’s grasp. And he worries that even if the idea was adopted, fractional dose vaccines might be deemed as unacceptable in some countries; they might see it as sub-par product. “One of my specific concerns is that, right now, if [WHO’s vaccine experts] were to convene to discuss fractionation for places like Africa or South America or parts of Asia that have had relatively low supply so far, that those places would be unhappy about the idea of using fractional doses when the developed world has been using full doses,” he said.”
Reuters - S.Korea in talks with mRNA vaccine makers to make up to 1 bln doses - govt official https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-skorea-talks-with-mrna- vaccine-makers-make-up-1-bln-doses-govt-2021-07-05/
“South Korea is in talks with mRNA vaccine makers including Pfizer (PFE.N) and Moderna (MRNA.O) to produce COVID-19 shots in the country and is ready to offer the capacity to make up to 1 billion doses immediately, a senior government official said…..”
WHO Afro - Leveraging lessons from Africa’s COVID-19 vaccine rollout https://www.afro.who.int/news/leveraging-lessons-africas-covid-19-vaccine-rollout
“From exemplary mass-vaccination stations in Angola, to complex cold-chain logistics in Rwanda and model communications to boost trust in vaccines in Ghana, the World Health Organization (WHO) is documenting key lessons emerging from Africa’s rollout of COVID-19 vaccines. The Vaccines Learning Agenda team are building a dynamic database of valuable information for African countries, and are set to create case studies on a range positive vaccine experiences and overcoming risks and challenges. So far, eight African countries have shared experiences in regional webinars to share knowledge and best-practices across borders.”
26
“…. The beneficial lessons identified so far are categorized into four areas. They are early planning, delivering vaccines across the life-course, digital platforms and risk communications strategies. “
UNICEF signs COVID-19 vaccine supply agreement with Janssen Pharmaceutica NV https://www.unicef.org/press-releases/unicef-signs-covid-19-vaccine-supply-agreement-janssen- pharmaceutica-nv
“UNICEF has signed a long-term agreement with Janssen Pharmaceutica NV for the supply of COVID-19 vaccine on behalf of the COVAX Facility. Through the supply agreement, UNICEF, along with procurement partners including the Pan-American Health Organization (PAHO), will have access to up to 200 million doses of the single-dose vaccine in 2021 for 92 countries supported by the Advance Market Commitment and also some self-financing countries. This is the 6th such agreement that UNICEF has completed for COVID-19 vaccines, previous agreements have been announced with the Serum Institute of India, Pfizer, AstraZeneca, Human Vaccine and Moderna. … Deliveries are expected to begin towards the end of the third quarter of 2021. “
UNICEF signs first COVID-19 vaccine agreement to supply African Union https://www.unicef.org/press-releases/unicef%E2%80%AFsigns-first-covid-19- vaccine%E2%80%AFagreement-supply-african-union
“UNICEF has signed an agreement with Janssen Pharmaceutica NV to supply up to 220 million doses of the J&J single-dose vaccine for all 55 Member States of the African Union (AU) by the end of 2022. Some 35 million doses are to be delivered by the end of this year. The agreement between UNICEF and Janssen Pharmaceutica NV will help implement the Advance Purchase Commitment (APC) signed between the African Vaccine Acquisition Trust (AVAT) and Janssen in March of this year. That agreement secured an option to order another 180 million doses, bringing the maximum access up to a total of 400 million doses by the end of 2022. …”
Reuters - EU says it plans more COVID-19 vaccine donations as world faces two- track pandemic EU says it plans more COVID-19 vaccine donations as world faces two-track pandemic | Reuters
“…John Ryan, a senior European Commission health official, told a briefing that the bloc hoped to donate a further 100 million doses of COVID-19 vaccines to low and middle income countries by year-end, using the COVAX facility as the main channel….”
Politico - Amid fresh virus surge, Africa sets out to save itself on vaccines procurement https://www.politico.eu/article/africa-coronavirus-vaccine-procurement-covax-john-nkengasong/
“The continent isn’t waiting for COVAX to save it,’ says Africa CDC chief. … John Nkengasong, director of the Africa Centre for Disease Control and Prevention, delivered some good news this week: Africa is expecting the first vaccine doses from the sizable deal secured through the AU's African Vaccine Acquisition Task Team (AVATT) to start arriving in the next two to three weeks….”
27
HPW - 15 European Countries Recognize India’s Covishield Vaccine for EU Travel Pass; Only 10 Adopt All WHO-Approved Jabs https://healthpolicy-watch.news/15-european-countries-recognize-indias-covishield-vaccine-for-eu- travel-pass-only-10-adopt-all-who-approved-jabs/
“Nearly half of the 31 European nations using the European Union’s new digital COVID travel certificate have recognized the India-made version of the AstraZeneca vaccine, Covishield, alongside its European-made counterpart, Vaxzevria, an analysis by Health Policy Watch has revealed. But other major countries, including France, Poland, and Italy, seem to be holding out, authorizing only those vaccines recognized by the European Medicines Agency (EMA). …”
Links:
• Guardian - Million Pfizer jabs face being dumped after Israel-UK swap deal fails Caused a lot of commotion, obviously.
Reuters - Israel says negotiating Pfizer surplus with other countries
“Israel is in talks with other countries about a deal to unload its surplus of Pfizer/BioNtech (PFE.N), COVID-19 vaccines, doses of which are due to expire by the end of the month, officials said on Sunday….”
Which led eventually to: Reuters - S. Korea is to get 700,000 COVID-19 vaccines doses from Israel
“South Korea said it will receive 700,000 doses of Pfizer-BioNTech's (PFE.N) coronavirus vaccine from Israel on loan this week, in an attempt to speed up immunisation following a surge in infections around the capital Seoul.”
• (Queen Mary Law Research) Paper - Compulsory Licensing of Trade Secrets: Ensuring Access to COVID-19 Vaccines via Involuntary Technology Transfer
• Reuters - Morocco’s Sothema to produce China’s Sinopharm vaccine
“ Moroccan pharmaceutical firm Sothema (SOT.CS) will soon start production of 5 million doses a month of China's Sinopharm (1099.HK) COVID-19 vaccine in the North African country, state news agency MAP reported on Monday.”
• MSF Briefing document - Local diagnostics to meet local health needs Recommendations to improve local production of diagnostics in LMICs.
See also via Politico: “The Global Fund and other international organizations involved in the worldwide response planned to buy 120 million tests for poor countries last fall, but so far have enough money for 85.5 million. The organizations are looking to raise almost $7 billion this year to buy tests, hoping to increase daily testing rates in poorer countries to at least 100 per 100,000 people. Planning and training of health care workers are also needed, and the Global Fund and its partners have trained 20,000 of them to administer testing in about 200 countries, Sands said. ….”
28
Covid science
HPW - Finally, Therapeutics for Severe COVID-19 – But They Come With Hefty Price Tags https://healthpolicy-watch.news/finally-therapeutics-for-severe-covid-19/
“After months with virtually no therapeutic options for people with severe COVID-19, the World Health Organization (WHO) recommended the use of a class of medicines called interleukin-6 antagonists on Tuesday. The medicines, tocilizumab and sarilumab, reduced the risk of death and ventilation when combined with corticosteroids, according to a study published the same day in the Journal of the American Medical Association (JAMA). … … The use of these drugs reduced the odds of death by 13% in severely ill and critical patients, and the odds of them needing mechanical ventilation by 28%, compared with standard care. These are the first drugs found to be effective against COVID-19 since corticosteroids were recommended by WHO in September 2020 – but they are costly. “These drugs offer hope for patients and families who are suffering from the devastating impact of severe and critical COVID-19. But IL-6 receptor blockers remain inaccessible and unaffordable for the majority of the world,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus….”
“… Meanwhile, Médecins Sans Frontières (MSF) called on the Swiss pharmaceutical company, Roche, the world’s only producer of tocilizumab, to lower its price “to make it affordable and accessible for everyone who needs it”. “Even though tocilizumab has been on the market since 2009 for treatment of rheumatologic diseases, access has remained a challenge,” according to MSF. “Roche kept the price of this drug very high in most countries, with price tags ranging from US$410 in Australia, $646 in India to $3,625 in the USA per dose of 600mg for COVID-19.” Julien Potet, Policy Advisor at MSF’s Access Campaign, called on Roche to “take urgent steps to make this drug accessible and affordable for everyone who needs it by reducing the price and transferring the technology, know-how and cell lines to other manufacturers”….”
Roche seems to have listened:
See HPW - Roche Suspends Patents on Tocilizumab in LMICs After WHO Recommends it as Treatment for Severe COVID-19 “Swiss pharmaceutical company Roche has suspended its patent rights on the medication tocilizumab in low- and middle-income countries (LMICs) for the duration of the pandemic, the company announced Tuesday…..”
Independent - Anti-malarial drug shows promise in treating Covid-19 https://www.independent.co.uk/news/health/covid-anti-malarial-drug-mefloquine-b1877042.html
“Japanese scientists suggest mefloquine could be used to fight Covid-19.”
FT - Pfizer vaccine less effective against Delta variant, Israeli study finds https://www.ft.com/content/0b3da41e-6390-4f4b-866c-da5c6aec7f5e
29
“Data suggest 64 per cent chance of halting infection among those fully inoculated … … However, the figures, first reported in the Ynet news portal, indicate the vaccine is 93 per cent effective against serious illness and hospitalisation…..”
HPW - Bharat’s Covaxin Vaccine’s Promising Results Are Marred by Corruption Claims in Brazil https://healthpolicy-watch.news/bharats-covaxin-vaccine-promising-results-marred-by-corruption- scandal-in-brazil/
“Despite a series of controversies, Bharat Biotech, which produces Indian homegrown vaccine Covaxin, hopes for World Health Organization (WHO) emergency use listing (EUL) soon, following last week’s publication of its promising Phase 3 results. … … However, the company has also been embroiled in a corruption scandal in Brazil, which resulted in the suspension last week of a 20 million-dose order of the vaccine worth $324-million pending the outcome of investigations. The allegations of irregularities reach as high as President Jair Bolsanaro, according to Quartz….”
Science News - COVID-19 affects men and women differently. So why don’t clinical trials report gender data? https://www.sciencemag.org/news/2021/07/covid-19-affects-men-and-women-differently-so-why- don-t-clinical-trials-report-gender
“Some countries combine men, women in reports of cases and vaccinations, too.” Coverage of a new paper in Nature Communications. “…But out of 45 COVID-19 randomized controlled trials whose results were published by December 2020, only eight reported the impact of sex or gender, according to a paper published today in Nature Communications. Other recent data show even simple counts of cases and vaccinations are not broken down by sex and gender….”
Nature News – Mounting evidence suggests Sputnik COVID vaccine is safe and effective Nature News;
“ Russia's vaccine is in use in nearly 70 nations, but its adoption has been slowed by controversies and questions over rare side effects, and it has yet to garner World Health Organization approval.”
COVID and the brain: researchers zero in on how damage occurs https://www.nature.com/articles/d41586-021-01693-6
“Growing evidence suggests that the coronavirus causes ‘brain fog’ and other neurological symptoms through multiple mechanisms.”
“How COVID-19 damages the brain is becoming clearer. New evidence suggests that the coronavirus’s assault on the brain could be multipronged: it might attack certain brain cells directly, reduce blood flow to brain tissue or trigger production of immune molecules that can harm brain cells….”
30
Nature - Will COVID become a disease of the young? https://www.nature.com/articles/d41586-021-01862- 7?utm_source=twt_nat&utm_medium=social&utm_campaign=nature
“A growing share of infections among unvaccinated youths in countries with high vaccination rates is putting the spotlight on the role of young people in the pandemic.”
Links:
• Deadlier than Delta: Lambda strain detected in over 30 countries, says Health Ministry
“A new Covid-19 strain that is much more dangerous than the Delta variant has been detected in more than 30 countries in the past four weeks, says the Health Ministry. “The Lambda strain was reported to have originated from Peru, the country with the highest mortality rate in the world,” it said in a tweet on Monday (July 5)….”
• Guardian - Oxford drugs firm gains $1.5m Gates grant for Covid-19 therapy
“….The new grant is provided by the Covid-19 Therapeutics Accelerator, an initiative by the Gates Foundation, Wellcome and Mastercard aimed at speeding up the response to the coronavirus pandemic. ….”
• Stat - Gene hunters turn up new clues to help explain why Covid-19 hits some people so hard Based on a new report in Nature.
Covid analysis
Lancet Editorial - COVID-19 in Latin America—emergency and opportunity https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01551-8/fulltext
This week’s editorial. Must-read.
“Latin America and the Caribbean (LAC) have been hit the hardest by the COVID-19 pandemic, with 25% of recent global infections occurring in the region. Of the top ten countries with the highest death rate globally, eight are from LAC. The deaths from COVID-19 in the region stand at nearly 1.3 million people, but the pandemic will continue to drive excess mortality because of disrupted health services, economic instability, and deepening of existing inequalities. In addition, countries with high levels of infection can result in the emergence of more transmissible and vaccine-resistant variants. The region has not garnered global attention and now it faces new challenges that will likely worsen the situation and pose a threat to the rest of the world…..”
31
Project Syndicate - Lipstick and COVID-19 Sarah Hawkes & Kent Buse; Project Syndicate;
“The pandemic is a stark reminder that gender is a powerful, deep-rooted, and universal social determinant of health. Ushering in the healthier societies we seek requires viewing gender equality as a public good.” By the coordinators of the world’s largest tracker of sex-disaggregated data on the pandemic.
Cfr tweet Kent Buse: “Cheeky title belies substantive call to revive social medicine – with #COVID19 having made crystal clear that health & disease an outcome of society itself.”
Chatham House (Expert Comment) - Vaccine competition may now be the world’s best bet https://www.chathamhouse.org/2021/06/vaccine-competition-may-now-be-worlds-best-bet
John Kampfner explores why, if the US, Europe, China, and Russia fail to work together on vaccine provision, developing economies could turn this strategic rivalry to their own advantage.
“…This is the first in a series of three reports on cooperation in an era of rivalry, drawing on expert analysis and recommendations from Chatham House. ….”
Covid resources
Path - COVID-19 Oxygen Needs Tracker https://www.path.org/programs/market-dynamics/covid-19-oxygen-needs-tracker/
Neat (interactive) resource.
Economist - The global normalcy index https://www.economist.com/graphic-detail/tracking-the-return-to-normalcy-after-covid-19
“Is the world returning to pre-pandemic life? Find out with our interactive tracker.”
“The Economist has devised a “normalcy index” to track how behaviour has changed, and continues to change, because of the pandemic. Our index comprises eight indicators, split into three domains. The first grouping is transport and travel: public transport in big cities; the amount of traffic congestion in those same cities; and the number of international and domestic flights. The second looks at recreation and entertainment: how much time is spent outside the home; cinema box-office revenues (a proxy measure for cinema attendance); and attendance at professional sports events. The third is retailing and work: footfall in shops; and occupancy of offices (measured by workplace footfall in big cities). Our index covers 50 of the world's largest economies that together
32
account for 90% of global GDP and 76% of the world's population. Our aggregate measure is the population-weighted average of each country's score. The pre-pandemic level of activity is set at 100 for ease of comparison. The tracker is updated with new data once a week.”
Planetary Health
Lancet Planetary Health (July issue) https://www.thelancet.com/journals/lanplh/issue/vol5no7/PIIS2542-5196(21)X0008-3
Do start with the Editorial - Modelling health futures
“So far the health impacts of climate change have not seen a high degree of coordinated modelling effort despite the fact that human health is a key concern that can motivate climate policy and has been shown to be sensitive to many climatic parameters, thus requiring adaptation to those changes that are already here or now locked in. A lack of coordination makes model projections of climate impacts on health hard to compare and overall effects very difficult to estimate. Greater cross- discipline cooperation and collaboration is certainly warranted and coordinated modelling frameworks and associated research structures potentially offer an important shared goal and coordinating mechanism to facilitate more joined up research and policy on the health effects of climate change. …. This issue is largely given over to a series of papers which use harmonised input data and common simulation protocols from the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to investigate the impacts of climate change on: temperature-related mortality in Europe and globally, enteric pathogens, dengue and malaria transmission, vibriosis, and labour supply and productivity. Each Article is summarised and contextualised in a linked Viewpoint which highlights the benefits of this approach and outlines some priority areas that would strengthen the evidence base for modelling health burdens under climate change…..”
See also Guardian coverage of one of the new studies - Climate crisis ‘may put 8bn at risk of malaria and dengue’
“More than 8 billion people could be at risk of malaria and dengue fever by 2080 if greenhouse gas emissions continue to rise unabated, a new study says. … Researchers predict that up to 4.7 billion more people could be threatened by the world’s two most prominent mosquito-borne diseases, compared with 1970-99 figures. The figures are based on projections of a population growth of about 4.5 billion over the same period, and a temperature rise of about 3.7C by 2100. The study, led by the London School of Hygiene & Tropical Medicine (LSHTM) and published in the Lancet Planetary Health journal, found that if emission levels continue to rise at current rates, the effect on global temperatures could lengthen transmission seasons by more than a month for malaria and four months for dengue over the next 50 years….”
Guardian - World ‘must step up preparations for extreme heat’ https://www.theguardian.com/science/2021/jul/07/world-must-step-up-preparations-for-extreme- heat
33
“The world needs to step up preparations for extreme heat, which may be hitting faster and harder than previously forecast, a group of leading climate scientists have warned in the wake of freakishly high temperatures in Canada and the US. … A first analysis of the heatwave, released on Wednesday, found that human-caused climate change made the extreme weather at least 150 times more likely. … the authors of the new study said the latest warming surge exceeded even the worst-case scenarios of climate models….”
Guardian - Small majority believe there is still time to avert climate disaster – survey https://www.theguardian.com/environment/2021/jul/05/small-majority-believe-there-is-still-time- to-avert-climate-disaster-survey
“A small majority of people believe there is still time to make a difference and slow global heating, a survey of consumer attitudes in 16 countries reveals. People aged 55 and over believe most strongly that their behaviour can make a positive difference to the environment. People in Brazil, Spain, Canada, Italy, China and Thailand are the most optimistic that if we act now there is still time to save the planet, the survey by Mintel found. On average, 54% of those who were surveyed agreed that there was time to save the planet, and 51% believed their behaviour could make a positive difference to the environment….”
Guardian (op-ed) - The climate crisis will create two classes: those who can flee, and those who cannot
P Gleick; https://www.theguardian.com/commentisfree/2021/jul/07/global-heating-climate-crisis- heat-two-classes?CMP=Share_AndroidApp_Other
“Nearly 700 million people worldwide live in low coastal zones vulnerable to sea-level rise and coastal storms. That number could reach a billion by 2050…”
WHO Small Island Developing States (SIDS) Summit
HPW - ‘Our economies are shattered’: Island Countries Cry Out for Help to Fight COVID-19 & Climate Change https://healthpolicy-watch.news/our-economies-are-shattered/
Coverage from late last week. “Small island states need more help to deal with the effects of climate change as well as the new challenges brought on by the COVID-19 pandemic, the first World Health Organization (WHO) Small Island Developing States (SIDS) Summit concluded this week. Following a two day virtual SIDS Summit: For a healthy and resilient future in Small Island Developing States, heads of state, ministers of health, and other stakeholders released an outcome statement prioritising actions that would help them deal with the “acute and existential health and development threats” that they face….”
34
See also Devex - Focus on NCDs, climate at small island developing states health summit
UHC
WB (report) Walking the Talk: Reimagining primary health care after COVID-19 World Bank;
See also last week’s IHP news.
“Strong primary health care (PHC) saves lives and money and makes health systems work better for all people. The current COVID-19 crisis exacerbated pre-existing weaknesses and inflicted devastating health and economic costs. However, it also created a once-in-a-generation chance for transformational health-system change. This report charts an agenda toward reimagined, fit-for- purpose PHC. It reflects a renewed understanding of global and local vulnerabilities and opportunities in the post-COVID world. It shows how governments can remake their primary health care systems and how partners like the World Bank can support this vital work. First, by outlining three priorities for reimagining primary health care and four structural shifts in how PHC is designed, financed and delivered….”
See also the press release: Well-designed Primary Health Care Can Help Flatten the Curve during a Health Crisis like COVID-19 “New World Bank Report Calls for Significant Investment in Primary Health Care in Developing Countries.”
UHC 2030 - The Coalition of Partnerships for UHC and Global Health https://www.uhc2030.org/what-we-do/voices/advocacy/the-coalition-of-partnerships-for-uhc- and-global-health/
“UHC 2030 launches a „coalition of partnerships“ for UHC and global health”. “ The new Coalition of Partnerships for UHC & Global Health unites health leaders & advocates to achieve #UHC and advance the #SDGs.
“…Recognizing the need for greater collaboration and harmonization across health stakeholders and programmes, the Coalition of Partnerships for UHC and Global Health unites health leaders and advocates in a common goal to align advocacy and accountability efforts to achieve UHC and advance the SDGs….”
“…The Coalition of Partnerships for UHC and Global Health will work together to assist Member States and other stakeholders in: (1) Accelerating high-level political efforts around socio-political accountability based on country-led, evidence-based progress reviews that involve all stakeholders in order to enhance accountability under the past UN HLM political declarations and ensure UHC delivers for vulnerable populations, including women, children and adolescents. (2) Supporting coordination among the various existing health initiatives and joint follow-up actions of UN HLMs (e.g. UHC, HIV/AIDS, AMR, TB, NCDs) for the preparation of the future UN HLMs on health agenda,
35
including emergency preparedness. (3) Strengthening existing SDG accountability mechanisms, such as the High-Level Political Forum follow-up mechanisms, to identify gaps and solutions and to scale up efforts on health-related SDGs by 2023 and beyond.”
SPARC (Topic Brief ) - Is Performance-Based Financing a Pathway to Strategic Health Purchasing in Sub-Saharan Africa? https://sparc.africa/wp-content/uploads/2021/06/SPARC_Topic_Brief_PBF-Pathway_L6b_noCIT.pdf
This evidence review examines whether and how PBF influences strategic purchasing within a country’s health financing arrangements.
Lancet Global Health -Keeping an eye on eye care: monitoring progress towards effective coverage S Keel et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00212-6/fulltext
“The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.”
WHO – Health Systems for Health Security https://apps.who.int/iris/bitstream/handle/10665/342006/9789240029682- eng.pdf?sequence=1&isAllowed=y
Linking UHC (and HSS) with global health security.
56 p. “a framework for developing capacities for international health regulations, and components in health systems and other sectors that work in synergy to meet the demands imposed by health emergencies.”
“Health Systems for Health Security is an approach that harmoniously brings together efforts to strengthen resources and capacities required for implementation of the International Health Regulations, components in health systems and those in other sectors for effective management of health emergencies, while maintaining the continuity of essential health services throughout.”
And a link:
36
HP&P - Barriers to uptake of community-based health insurance in sub-Saharan Africa: a systematic review (by Z Shewamene et al) “…The findings revealed that barriers to uptake of CBHI in sub-Saharan Africa were multidimensional in nature. Lack of awareness about the importance of health insurance, socio-economic factors, health beliefs, lack of trust towards scheme management, poor quality of health services, perceived health status and limited health benefit entitlements were reported as barriers that affect enrolments into CBHI and membership renewals….”
Decolonize Global Health
2 new BMJ GH Commentaries- reflecting some tensions in the DGH movement
BMJ GH - Decolonising global health: where are the Southern voices? (by S Oji Oti et al)
“…. (recent) calls for decolonisation have largely been led by global health practitioners based at institutions in the Global North. At face value, it appears that global health institutions and practitioners in the Global South have not been visible or vocal amidst the calls for decolonisation. In this commentary, we address this misconception by highlighting recent efforts of global health practitioners in Africa, which emphasise pragmatic approaches aimed at decolonising global health.”
On the “Global Health Decolonisation Movement in Africa or GHDM-Africa. The GHDM-Africa is all about pragmatism. It has developed a framework that provides what it calls ‘common-sense approaches’ to decolonising global health…”
BMJ GH - Decolonising global health: beyond ‘reformative’ roadmaps and towards decolonial thought (by M M Chaudhuri et al)
Response to M Khan’s previous BMJ Global Health piece. “… As a colonial structure, the global health industry cannot be reformed with metrics, checklists and incremental steps. Decolonisation must address the pillars of colonialism including white supremacy, racism, sexism and capitalism. The decolonising global health movement should be more introspective and engage histories of social theory including scholars such as Paulo Freire, Michel Foucault, Andre Gorz and Achille Mbembe….”
EClinical Medicine - Racial Inequity in Health - Part 1 https://info.thelancet.com/eclinm-racial-inequity-in-health-collection?dgcid=product%20homepage- carousel_feature_ECLINM_PRO_7-2021
“Clinical research focusing on the specific needs of racial minorities, their health outcomes and disparities has the potential to significantly improve lives in our societies. The EClinicalMedicine Racial Inequity in Health Collection outlines and discusses racial and ethnic inequality across global settings. This two-part Collection demonstrates that disparities are caused by structural racism and without tailored action the inequalities are maintained and reinforced. By highlighting these issues, we provide practitioners and policy makers with the power to create better, trusted, and fairer healthcare systems for all. This first part of the Collection highlights relevant
37
research on socioeconomic deprivation, pregnancy outcomes, hepatocellular carcinoma, communicable diseases, and much more….”
More on the Generation Equality Forum (from last week)
WHO pledges extensive commitments towards women’s empowerment and health https://www.who.int/news/item/05-07-2021-who-pledges-extensive-commitments-towards- women-s-empowerment-and-health
“The World Health Organization announced multiple commitments to drive change for gender equality and the empowerment of women and girls in all their diversity at the Generation Equality Forum, held last week in Paris. The WHO commitments focused on ending gender-based violence; advancing sexual and reproductive health and rights; and supporting health workers as well as feminist movements and leadership. ….”
Some papers & reports of the week
Social Science & Medicine - How democracy alters our view of inequality— and what it means for our health https://www.sciencedirect.com/science/article/pii/S0277953621005220
“Political systems may alter the messages individuals receive about inequality. In democracies people are more likely to learn about rising inequality via media. Self-rated health is lower among those who believe that inequality has risen. Being more aware of inequality can negatively affect self-rated health. Democracies may not be unambiguously positive for self-rated health.”
Devex - OECD: Discontent could slow countries' rebound from pandemic https://www.devex.com/news/oecd-discontent-could-slow-countries-rebound-from-pandemic- 100316
“ Even before the COVID-19 pandemic, global discontent was on the rise, according to a newly launched report by the OECD Development Centre. While this surge in dissatisfaction is not limited to low-income countries, its causes — including deepening inequality — and the effects it has in exacerbating social fragmentation pose a specific threat to their ability to rebound from the current crisis. Amid this collective threat of discontent, there is also an opportunity to re-imagine political, economic, and social systems — including multilateral institutions that have helped contribute to the dissatisfaction, according to a panel assembled for the report’s launch Tuesday….”
“… The OECD Development Centre identified four key drivers: inequality, uneven progress in improving well-being beyond income, worsening labor conditions, and the climate crisis.
38
Underlying these are complex factors involving identity and economic systems, sometimes introduced and perpetuated by multilateral organizations in pursuit of development….”
IJHPM - The Multiple Lenses on the Community Health System: Implications for Policy, Practice and Research H Schneider et al ; https://www.ijhpm.com/article_4077_81fe5390eb70c86f3110c705a6e4a32c.pdf
Framing paper for a special issue of IJHPM on the CHS to be launched in the coming months. The issue will have 9 empirical papers adopting the different lenses from across the globe.
“Community health systems (CHSs) have historically been approached from multiple perspectives, with different purposes and methodological and disciplinary orientations. The terrain is, on the one hand, vast and diverse. On the other hand, under the banner of UHC and the SDGs, a streamlined version of ‘community health’ is increasingly being consolidated in global health and donor communities. With the view to informing debate and practice, this paper seeks to synthesise approaches to the CHS into a set of ‘lenses,’ drawing on the collective and multi-disciplinary knowledge (both formal and experiential) of the authors, a collaborative network of 23 researchers from seven institutions across six countries (spanning low, middle and high income). With a common view of the CHS as a complex adaptive system, we propose four key lenses, referred to as programmatic, relational, collective action and critical lenses. The lenses represent different positionalities in community health, encompassing macro-level policy-maker, front-line and community vantage points, and purposes ranging from social justice to instrumental goals. …”
Other news of the week
Guardian - Britain found to have funded ‘conversion therapy’ clinics in Africa https://www.theguardian.com/global-development/2021/jul/02/major-aid-donors-found-to-have- funded-conversion-therapy-clinics-in-africa
See also last week’s IHP News. “Investigation finds UK Aid and USAid money went to centres where ‘condemned’ practice is routinely offered to LGBTQ+ people.”
Scientific American - Bill Gates: Stop Telling Africans What Kind of Agriculture Africans Need https://www.scientificamerican.com/article/bill-gates-stop-telling-africans-what-kind-of-agriculture- africans-need/?previewid=0144FCCA-AADD-4DA3-A978B39874AD14D2
Scientific American exposes the Bill Gates-funded "Cornell Alliance for Science".
Excerpt: “Africans have long been told that our agriculture is backward and should be abandoned for a 21st-century version of the Green Revolution that enabled India to feed itself. Western science and technology, in the form of seeds modified by science and technology, synthetic fertilizers and
39
pesticides, petroleum-fueled machinery and artificial irrigation were key to that miracle, we are informed, and we too need to tread that path. A primary proponent of this view is the Cornell Alliance for Science (CAS), founded in 2014 to “depolarize the charged debate” around genetically modified (GM) seeds. With $22 million in funding thus far from the Bill and Melinda Gates Foundation, the CAS in fact consistently defends GM seeds, arguing that they are healthy, productive and environmentally friendly, while attacking agroecology as economically and socially regressive. In contrast, the Alliance for Food Sovereignty in Africa (AFSA), which represents more than 200 million farmers, fishers, pastoralists, indigenous peoples, women, consumers and others across all but five African countries, holds that agroecology is what our continent needs. Small-scale, ecofriendly cultivation methods using indigenous knowledge and inputs and cutting-edge science increase the variety, nutritive value and quantity of foods produced on farms while stabilizing rural economies, promoting gender equity and protecting biodiversity…..”
Devex - Toilets, taps, and the trillions they could generate https://www.devex.com/news/toilets-taps-and-the-trillions-they-could-generate-100311
“Investing in universal access to toilets and taps now would mean trillions of dollars in global economic gains over the next two decades, according to a new WaterAid report. The report “Mission-Critical: Invest in Water, Sanitation and Hygiene for a Healthy and Green Economic Recovery” states that access to toilets with safely managed sanitation could yield up to $86 billion per year in greater productivity and reduced health costs, basic hygiene facilities could mean an extra $45 billion per year, and taps in the home could equate to an annual $37 billion globally. Additionally, 6 billion cases of diarrhea and 12 billion cases of helminths could be avoided between 2021 and 2040…..”
Some blogs and mainstream articles of the week
Branko Milanovic (blog) - Towards global progressiveness https://glineq.blogspot.com/2021/07/towards-global-progressiveness.html
“Is it possible to define a series of approaches to global problems for the group of people who may be called “global progressives” (GPs)? “
“… What are the areas were such global approaches can be defined? The seven areas listed here move from the final objective which is higher income (and the attendant greater “happiness”) to the means to realize it, which concern capital, labor, technology, and taxes…..”
No need to agree with everything – his understanding of the climate emergency remains rudimentary – but well worth a read.
WB - New World Bank country classifications by income level: 2021-2022 https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2021- 2022
40
Check them out. Ten economies are moving to a different category this year.
BMJ Opinion - Viral cyber attacks: a threat to human health A Murray; BMJ Opinion;
“Cyberattacks on health systems are not black swan events and must be addressed in a robust manner with comprehensive cybersecurity strategies, policy, and adequate resourcing to prevent recurrence.”
Links:
• LSE (blog) – How to build and maintain trust at the interface of policy and research, insights from a century of boundary spanning
• BMJ Opinion - Time to assume that health research is fraudulent until proven otherwise? (by Richard Smith)
Tweets of the week
Deborah Lupton “As a sociologist, the term 'non-pharmaceutical interventions' for COVID-19 cracks me up each time I read it. Such a medicalised viewpoint on the extremely complex sociocultural, spatial and political dimensions of the crisis.”
Patrick Wintour “IMF WHO WTO and World Bank leaders have set up a joint war room to coordinate plans to get 40% of world population vaccinated this year & 60% next. An implicit rebuke to meagre ambition shown by elected G7 leaders in Cornwall, and a call for G20 chaired by Italy to up its game.”
Global governance of health
Devex Newswire: Can Guterres shift from defense to offense? https://www.devex.com/news/devex-newswire-can-guterres-shift-from-defense-to-offense-100298
“Biden’s administration is chock full of officials with intimate knowledge of the U.N. and its operations. That includes USAID Administrator Samantha Power, the former U.N. ambassador, and now her deputy nominee Isobel Coleman, a former representative to the U.N. for management and reform. “Expect close cooperation between the U.N. system and USAID,” Peter Yeo, president of the Better World Campaign, tells me…..”
41
CGD (Policy paper) - Financing the Humanitarian Public Good: Towards a More Effective Humanitarian Financing Model
P Saez, J Konyndyk et al ; https://www.cgdev.org/publication/financing-humanitarian-public-good- towards-more-effective-humanitarian-financing-model#.YOWvbzm2ROE.twitter
“The international humanitarian system provides a global public service but is financed on a voluntary basis. The way official donor funding is mobilised and allocated is unpredictable and haphazard, reducing efficiency and effectiveness. Donors should overcome the collective action problem that is inhibiting change and reach a critical mass of finance delivered through collective mechanisms. This paper outlines the case for - and obstacles against – change. It suggests three ways to make some progress: a multi-year common replenishment model for protracted and predictable crises; rebalancing country-level pooled mechanisms; and aligning core funding to agencies with agreed core functions.”
Related read:
CGD blog - Beyond the Grand Bargain: The Humanitarian Financing Model Needs More Radical Change (by P Saez et al)
Planetary health
Guardian - Call for global treaty to end production of ‘virgin’ plastic by 2040 https://www.theguardian.com/environment/2021/jul/01/call-for-global-treaty-to-end-production- of-virgin-plastic-by-2040
“A binding global treaty is needed to phase out the production of “virgin” or new plastic by 2040, scientists have said. The solution to the blight of plastic pollution in the oceans and on land would be a worldwide agreement on limits and controls, they say in a special report in the journal Science….”
Guardian - Human activity influencing global rainfall, study finds https://www.theguardian.com/environment/2021/jul/07/human-activity-influencing-global-rainfall- study-finds
“Anthropogenic warming of climate has been a factor in extreme precipitation events globally, researchers say.” Based on a new study in Nature Communications.
Infectious diseases & NTDs
Nature News - Vaccine made of live malaria parasites shows early success https://www.nature.com/articles/d41586-021-01806-1
42
“Strategy uses a combination of parasites and medicines to generate immunity while avoiding symptoms.”
Reuters - HIV generic drug for babies distributed in Africa, says UNITAID https://www.reuters.com/world/africa/hiv-generic-drug-babies-distributed-africa-says-unitaid- 2021-07-05/
“Aid agencies have distributed a strawberry-flavoured tablet for children living with HIV in six African countries, the first generic pediatric version of a key anti-retroviral, global health agency UNITAID said on Sunday….”
The Star - Irony as Kenya to return Sh1bn HIV cash to Global Fund https://www.the-star.co.ke/news/2021-07-02-irony-as-kenya-to-return-sh1bn-hiv-cash-to-global- fund/
“Kenya is set to return over Sh1 billion to the Global Fund in an ironic twist for a country struggling to raise funds for healthcare of its citizens..”
“The cash will be taken back to the donors following the failure of the concerned health ministry agencies to utilise the money within the project period. The money was for the management of the HIV/Aids epidemic under the “Expanding HIV Prevention, Care, and Treatment Services” to reach universal access by 80 per cent.”
Stat - Why aren’t diseases like HIV and malaria, which still kill millions of people a year, called pandemics? Peter Sands; https://www.statnews.com/2021/07/06/why-arent-diseases-like-hiv-and-malaria- which-still-kill-millions-of-people-a-year-called-pandemics/
Peter Sands wonders about this in this op-ed.
“the furor about vaccine nationalism and sharing doses of Covid-19 overshadows a fundamental issue: What is an equitable definition of what counts as a pandemic? The use of that word isn’t just semantics: It’s about who we care lives or dies. As high levels of vaccination coverage in high-income countries enable their citizens to gradually resume normal life, much of the focus in the capitals of G7 countries is shifting from fighting Covid-19 to preventing future pandemics. It makes sense for them to seize the moment to make themselves safer from future threats. For the rest of the world, though, this looks disturbingly like the repeat of a previous pattern: Once a pandemic stops being an acute threat to life in high-income countries, the urgency drops, the focus shifts, and resource flows dwindle.
… Covid-19 should be a catalyst to a radical rethinking of approaches to shared global health. Rebranding old notions of global health security as pandemic preparedness and response isn’t enough. In the same way that climate change demands a bolder, more inclusive global response, so
43
too does the threat of pandemics. Everyone, everywhere, should be protected from the deadliest infectious diseases, those we face today and those we will inevitably face tomorrow….”
Links:
Global Health Research and Policy - The influence of gender dynamics on polio eradication efforts at the community, workplace, and organizational level
“…The Global Polio Eradication Initiative, one of the largest globally coordinated public health programs in history, has faced and worked to address gender-based challenges as they emerge. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs….”
AMR
Link:
Journal of Pharmaceutical Policy and Practice - Strengthening multisectoral coordination on antimicrobial resistance: a landscape analysis of efforts in 11 countries.
NCDs
WHO - New recommendations for screening and treatment to prevent cervical cancer https://www.who.int/news/item/06-07-2021-new-recommendations-for-screening-and-treatment- to-prevent-cervical-cancer
“Too many women worldwide – particularly the poorest women – continue to die from cervical cancer; a disease which is both preventable and treatable. Today, WHO and HRP have launched a new guideline to help countries make faster progress, more equitably, on the screening and treatment of this devastating disease….”
Coverage via HPW - New Cervical Cancer Guidelines Advocate DNA Tests, While Experts call for Activism
IJHPM - Advice for Food Systems Governance Actors to Decide Whether and How to Engage With the Agri-Food and Beverage Industry to Address Malnutrition Within the Context of Healthy and Sustainable Food Systems Comment on “Challenges to Establish Effective Public-Private Partnerships to Address Malnutrition in All Its Forms” V Kraak; http://www.ijhpm.com/article_4074.html
44
“The effectiveness of public-private partnerships (PPPs) to address malnutrition will depend on the issue, engagement purpose, policy context and actors’ interactions. This commentary offers advice for governments, United Nations (UN) and civil society organizations to decide whether and how to engage with industry actors to improve diets for populations….”
And a link:
Lancet Global Health - Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000–20
Sexual & Reproductive / maternal, neonatal & child health
GAVI - 6 million children benefitting from the first ever multi-antigen vaccination campaign https://www.gavi.org/news/media-room/6-million-children-benefitting-first-ever-multi-antigen- vaccination-campaign
Zimbabwe. “UNICEF, Gavi, the Vaccine Alliance and WHO have partnered with the Ministry of Health and Child Care to launch a new vaccine campaign introducing typhoid conjugate vaccine (TCV) into the routine immunisation schedule across the country. The TCV campaign, the first of its kind in the region, was made possible through funding from Gavi and the multi-donor Health Development Fund (HDF) supported by the European Union, the United Kingdom, Sweden, Irish Aid and Gavi….”
Some links:
Globalization & Health - Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia
Public Health - Applying the Realist Evaluation Approach to the Complex Process of Policy Implementation—The Case of the User Fee Exemption Policy for Cesarean Section in Benin (by JP Dossou et al)
Human Resources for Health
Link:
HP&P - Transitioning health workers from PEPFAR contracts to the Uganda government payroll
45
Research
TMIH - What factors affect patients’ ability to access healthcare? An overview of systematic reviews B Dawkins et al ; https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13651
“This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) versus high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. …. …. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs there is much greater emphasis on patient experience; in LMICs it is on the physical absence of care..”
JAMA - Gender Disparity in Citations in High-Impact Journal Articles JAMA ;
Articles written by women and published in high-impact journals had far fewer citations than those written by men, according to this new study. Researchers analyzed …. five high-impact journals — the Annals of Internal Medicine, the New England Journal of Medicine, two JAMA journals, and the BMJ — between 2015 and 2018.
Extra Covid section
JAMA viewpoint - Potential COVID-19 Endgame Scenarios: Eradication, Elimination, Cohabitation, or Conflagration? A Kofman et al ; https://jamanetwork.com/journals/jama/fullarticle/2781945
“This Viewpoint considers 4 possible scenarios—eradication, elimination, cohabitation, and conflagration—for the resolution of the COVID-19 pandemic, depending on vaccination rates, viral variants, and deadly disease waves.”
ODI (Working paper) - Social protection response to Covid-19 and beyond: emerging evidence and learning for future crises F Bastagli et al ; https://odi.org/en/publications/social-protection-response-to-covid-19-and- beyond-emerging-evidence-and-learning-for-future-crises/
“…If the Covid-19 crisis and social protection crisis response to date are to make a difference to progress towards inclusive, adaptive and sustainable social protection moving forward, harnessing the momentum around social protection and institutionalising learning to date are key. This paper aims to contribute to such efforts. With a focus on some of the population groups most adversely affected by the crisis and on measures adopted in low- and middle-income countries in the early
46
months from the onset of the Covid-19 pandemic, and within the first year, it provides new evidence on social protection crisis response effectiveness and identifies emerging policy lessons to help ensure countries are better prepared for future crises. This is the framing and synthesis paper of the ODI study on Social protection response to Covid-19 and beyond. …”
NYT - Why the Delta Variant Could End Australia’s Pursuit of ‘Covid Zero’ https://www.nytimes.com/2021/07/02/world/australia/delta-covid-zero.html
“The country’s current outbreak bears a warning: Without much more widespread vaccinations, the usual tactics of lockdowns and blanket testing may no longer be enough….”
The Healthiest goldfish - What stories will we tell about COVID-19?
Sandro Galea ; Sandro Galea;
“today’s Healthiest Goldfish will suggest four key narratives which emerged from the broader story of the pandemic and which have the potential to help define the overall COVID narrative in the years to come…”
“The first narrative which has come to define the COVID moment is that of scientific excellence. … This leads to the next core narrative of the pandemic, and arguably the central one—the presence of inequities … … Third, the story of COVID would be incomplete without an honest reckoning with widespread loss of trust in institutions, and the consequences of this for public health. ….… Finally, a core narrative of the pandemic, one which could well characterize our future memory of this time, is that, as bad as COVID was, it could have been far worse. I realize that this may seem strange, even unfeeling, in the context of mass death and suffering. But it is nevertheless true. COVID has been a disaster. Yet the virus itself, when compared to past pandemics, is nowhere near as lethal as it might have been.”
“… Each of these stories represents a key part of the broader narrative of COVID. When we look back on this moment, it will likely be through the lens of scientific excellence, inequities, the erosion of trust in institutions, and how it all could have been fundamentally worse…”
Economist Briefing – The unvaccinated are at risk as evolution accelerates the covid-19 pandemic https://www.economist.com/briefing/2021/07/03/the-new-variants-of-sars-cov-2-are-much-more- dangerous-to-the-unvaccinated
Always worth a read, these Economist briefings.
Guardian - Crackdown on ‘vaccine sommeliers’ as Covid pandemic grips Brazil https://www.theguardian.com/world/2021/jul/06/crackdown-on-vaccine-sommeliers-as-covid- pandemic-grips-brazil
47
“Although four vaccines are available, some shots are deemed by some more desirable than others.”
BMJ Feature - The covid-19 lab leak hypothesis: did the media fall victim to a misinformation campaign? https://www.bmj.com/content/374/bmj.n1656
“The theory that SARS-CoV-2 may have originated in a lab was considered a debunked conspiracy theory, but some experts are revisiting it amid calls for a new, more thorough investigation. Paul Thacker explains the dramatic U turn and the role of contemporary science journalism.”
Science (Perspective) – Networks of SARS-CoV-2 transmission https://science.sciencemag.org/content/373/6551/162
“Individual and network heterogeneity should inform respiratory pandemic responses.”
BMJ GH - World Committee on Tourism Ethics (WCTE) recommendation on COVID-19 certificates for international travel
H Matsuura; https://gh.bmj.com/content/6/7/e006651
“WHO has not yet endorsed the COVID-19 certificates. However, the European Union, nation states and the airline companies recently introduced, or will soon introduce COVID-19 certificates to open their borders to vaccinated visitors. The World Committee on Tourism Ethics, an independent and impartial body under the aegis of the World Tourism Organization, issued a Recommendation, requesting governments and other entities to implement COVID-19 certificates for international travel in free, universally available and non-discriminatory manner. The recommendation also limits its use and time as well as the provision of vaccines and certificates as a part of international holiday packages.”
48