IHP news 632 : A grim week (/era)

( 20 August 2021)

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

Dear Colleagues,

Frankly, the week felt grim enough, so no need for an apocalyptic intro, you can just watch the daily news.

On a side note, though, I wonder what the Afghan tragedy (and geopolitical fall-out) will mean for the pandemic treaty negotiations, starting in earnest in September. More in general, I tend to side with Celia Almeida’s view (in a new Think Global Health piece) that “health security should no longer drive global health policy”. Though it remains an important part, of course.

As for ‘planetary health’ (this section clearly needs some re-labelling, how about ‘planetary mess’ ?), I hope that the acceleration of the climate crisis will lead to something more (in the months and years ahead) than just ‘apocalypse accounting’, with report after report laying out “how things are going” (hmm, not well). At COP 26 for example? Though perhaps aliens might still benefit from Sapiens’ top-notch bookkeeping, some day, when they enjoy Richard Branson’s ‘overview’, visiting our fragile planet.

As for the global vaccine inequity, this week’s BMJ piece on pandemic profiteering by Fatima Hassan et al really said it all. “Companies and rich nations are creating a deadly covid-19 vaccine “protection racket”.” Exactly. It’s PPP – Pandemic Profiteering on a Planetary scale. And it has to stop. The authors also pointed to our complicity in this. “…Yet we too are complicit by our silence. Why are workers and shareholders at vaccine companies not speaking out? Where are the academics clamouring to make the “fruits of the scientific enterprise” available to all? Where are the lawyers demanding global justice and corporate accountability? Which leaders of rich nations are pressuring vaccine companies to make their people safe by making the world safe? Where is the grassroots mobilisation of scientists and health workers to fight for fair access to vaccines?” In the meantime, Biden’s shortsighted booster decision certainly won't improve things.

PS: For the ones who missed it, do have a look at the catch-up IHP issue of the past month (since mid-July more or less, see here)

Enjoy your reading.

Kristof Decoster

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Featured Article

Vaccine equity: where are the voices of those with no access?

Raffaella Ravinetto & Remco van de Pas (both ITM)

Twenty years ago, the world was facing a morally unbearable situation. On the bright side: there was – at last - an effective treatment for people living with HIV/AIDS (PLWHA). Patients in high-income countries could benefit from the antiretroviral tri-therapy, and their life-expectancy was restored. On the negative side: this therapy was, due to the high prices, mostly unavailable in lower-income countries. Access advocates including many PLWHA called for exceptions to patents, in order to bring prices down and scale up treatment everywhere. Countries like Brazil and Thailand, Malawi, … showed the way, and organizations such as Doctors without Borders also demonstrated the feasibility of treatment in fragile health systems. Meanwhile, the World Trade Organization (WTO) affirmed in the Doha Declaration on the TRIPS agreement and public health (2001) that intellectual property provisions should not prevent Members from taking measures to protect public health, thus providing reassurance that health can -and must- be prioritized over commercial interests.

Eventually, HIV treatment was scaled up – sadly, with a delay of some years, which caused millions of preventable death among disadvantaged communities. Among the factors that favored the scaling up of antiretrovirals in the developing world, were: WHO’s Medicines Prequalification, which since 2001 provides clear guidance on the availability of quality-assured generic antiretrovirals and makes it possible to believe that everyone in the world can have access to safe, effective, and affordable medicines; and the mobilization of civil society as powerful advocacy stakeholders. Activists and PLWHA, often representing grass-roots organizations from the global South and global North, were regularly attending WHO, UNAIDS and other high-level meetings, contributing to designing access strategies, while sharing the voices of those directly affected. Some examples: GMHC (formerly Gay Men's Health Crisis), founded in January 1982 in New York City, or the Treatment Action Campaign, founded in December 1998 in South Africa; and people like Fatima Hassan, Gregg Gonsalves and Zackie Achmat. There were many more.

Today, we again face a morally unbearable situation whereby lifesaving vaccines are unfairly distributed globally. Just like when HIV triple therapy became available in affluent countries, the world again seems to lack a sense of urgency to correct the global (Covid vaccine) access gap as soon as possible. There’s a key difference though: compared with the early years of the HIV crisis, there seems to be much less space at decision-making levels for the voices of activists, grassroots organizations, and of those who are denied access to the vaccines. To the best of our knowledge, representatives of the under-vaccinated or unvaccinated communities, and of risk groups in lower-income countries, are seldom or not invited at events where international organizations and political platforms discuss how to resolve the vaccine inequity. While we lack hard evidence for this claim ( here’s a suggestion for social science researchers), it is likely that (almost) all who are attending key (vaccine access) related global events and fora (such as the ones from the WTO, G7, G20 etc. ) have been vaccinated by now, as they are usually middle-aged people or above, and belonging to the economic, political and/or scientific elites in their respective countries.

True, compared to the early days of the HIV crisis, social media are now a powerful tool for activists and can amplify the voices from the field, in principle at least. But so far, the calls for vaccine equity launched via social media do not seem to reach and convince stakeholders beyond the world of global

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health. And yes, there has been a broad-based demand by civil society networks and (former) global leaders and UNAIDS, calling for a People's Vaccine, to be considered a global public good and available to all, everywhere, free of charge. But it’s not like the most forceful People’s Vaccine proponents get a front seat at many of these global fora. And if they do get a seat, they’re often drowned in sessions with a bunch of other, more ‘mainstream’ voices. The same goes for many of the global (Covid related) ‘governance mechanisms’ in place. While efforts are now under way to establish local manufacturing sites for Covid-19 vaccines in countries like Senegal, Rwanda and South-Africa, these policy and cooperation discussions typically include local producers and government representatives, but no (direct) representatives of the affected populations as such, including patients and health care worker organizations.

Against that backdrop, it seems pertinent to ask whether such new partnerships and assemblies have the full moral and democratic legitimacy to design the roadmap for global access to the vaccine, if they lack first-hand experience of how it feels to urgently need a vaccine and not even get close to one. Functionaries, policy-makers, politicians, etc. need to be confronted to the experience of frontline healthcare staff, patients with chronic diseases and other categories at risk in countries with low or virtually no access to the vaccine. Keeping these key witnesses away from high-level platforms, on purpose or not, leads to a(n artificial) lack of sense of urgency, and can even create a dangerous moral alibi for the elites who are taking technical and political decisions on key issues for global health. Vaccine inequity is affecting the world along many dimensions -ethics, politics, economy, health, justice- and those most affected by inequity need to be given voice and visibility, at the highest levels, now.

Highlights of the week

Covid key news

On key trends, WHO messages, …

Let’s start with a global update.

Cidrap News - COVID-19 continues to surge https://www.cidrap.umn.edu/news-perspective/2021/08/who-continues-call-solidarity-around- covid-19

“…Cases have continued to increase around the world, led by 14% and 8% increases in the Western Pacific and Americas, respectively, according to the WHO's weekly epidemiologic update yesterday. While deaths stayed level, the Middle East reported a weekly death toll of 7,034, a 15% increase from last week and the region's highest since the pandemic began. The United States, Iran, and India had the highest number of new cases last week. The United States is also among the countries with the steepest rise in cases (20%), along with the Philippines (28%) and Japan (23%)…”

See also the Telegraph - Red Cross warns of ‘tragic toll’ in Southeast Asia as infections skyrocket and deaths mount

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“The delta variant and low vaccination rates are wreaking havoc across the region, which recorded over 38,500 deaths in the past fortnight…” “…there are mounting fears that, for Southeast Asia, figures are only going to escalate….”

HPW - COVID Infections Decline Sharply in South America

“ COVID cases across most countries of South America are now declining, after months in which the region was the epicenter of the pandemic. But in the seesawing trends that the pandemic continues to see, infections are rising again throughout central and North America – as well as the Caribbean – where earthquake torn Haiti faces special risks….”

Reuters - Delta surging in areas of low COVID-19 vaccine coverage - WHO

Reuters;

“Circulation of the Delta variant in areas of low vaccination is driving transmission of COVID-19 around the world, World Health Organization officials said on Wednesday. "Many of the places around the world where Delta is surging -- even in countries that at a national level have high levels of vaccination coverage -- the virus, the Delta variant itself, is really circulating in areas of low level of vaccine coverage and in the context of very limited and inconsistent use of public health and social measures," WHO epidemiologist Maria Van Kerkhove told an online news briefing. Vaccines are clearly preventing increases in severe illness and death from the Delta variant, WHO Chief Scientist Soumya Swaminathan added.”

Reuters - WHO seeks to take political heat out of virus origins debate Reuters;

From last week on Friday (August 13).

“The World Health Organization said on Friday it was setting up a new group to trace the origins of the coronavirus, seeking to end what it called "political point scoring" that had hampered investigations. … The WHO called for all governments to cooperate to accelerate studies into the origins of the COVID-19 pandemic and "to depoliticise the situation". It specified that a new advisory group called the International Scientific Advisory Group for Origins of Novel Pathogens would support "the rapid undertaking" of further studies….”

See WHO - WHO Statement on advancing the next series of studies to find the origins of SARS- CoV-2

Telegraph - Hunt for the ‘smoking bat’ and how Wuhan lab leak theory shifted from conspiracy to credible Telegraph;

Also from last week: “Efforts are intensifying to identify the origins of the pandemic and a shift in discussions has occurred.”

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“… Now, in the latest twist, the head of the WHO panel charged with investigating the origins of the pandemic has suggested ‘patient zero’ could have been a researcher from a Wuhan lab, "who was infected in the field by taking samples". In an interview with the Danish broadcaster TV 2, Dr Peter Ben Embarek added that it was "interesting" that the Wuhan Centre for Disease Control laboratories had moved location in early December 2019, to a spot just 500 metres from the market linked to an early cluster of cases….”

“… But others maintain that much of the evidence suggesting a laboratory-related incident remains circumstantial. "[Dr Ben Embarek] is just making a speculation on possibilities, and there’s certainly no evidence for this happening," says Professor David Robertson, head of viral genomics at the Centre for Virus Research at the University of Glasgow. While there’s no smoking bat, neither is there a "smoking lab report," says British virologist Professor Jonathan Ball. …”

Bloomberg - Delayed Wuhan Report Adds Crucial Detail to Covid Origin Puzzle https://www.bloomberg.com/news/features/2021-08-17/where-did-covid-come-from-report-on- infected-wuhan-wild-animals-sheds-new-light

“A study documenting the trade in live wild animals at Wuhan wet markets stayed unpublished for more than a year.”

“… a research paper that languished in publishing limbo for a year and a half contains meticulously collected data and photographic evidence supporting scientists’ initial hypothesis—that the outbreak stemmed from infected wild animals—which prevailed until speculation that SARS-CoV-2 escaped from a nearby lab gained traction. According to the report, which was published in June in the online journal Scientific Reports, minks, civets, raccoon dogs, and other mammals known to harbor coronaviruses were sold in plain sight for years in shops across the city, including the now infamous Huanan wet market, to which many of the earliest Covid cases were traced. The data in the report was collected over 30 months by Xiao Xiao, a virologist whose roles straddled epidemiology and animal research at the government-funded Key Laboratory of Southwest China Wildlife Resources Conservation and at Hubei University of Traditional Chinese Medicine. …”

Reuters - No need for COVID booster jabs for now - WHO Reuters; (as of Wednesday’s WHO media briefing, around the time the US administration announced its booster strategy – see below)

“ Current data does not indicate that COVID-19 booster shots are needed, the World Health Organization (WHO) said on Wednesday, adding that the most vulnerable people worldwide should be fully vaccinated before high-income countries deploy a top-up….”

Or in the words of Mike Ryan, as usual not mincing words (on the booster jabs): “ “The fundamental ethical reality is we're handing out second life jackets while leaving millions and millions of people without anything to protect them.”

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HPW - COVID Booster Vaccines Gain Traction with New US Campaign – Despite WHO Appeals for Moratorium https://healthpolicy-watch.news/covid-booster-vaccines-us-who-appeals/

“US Health officials confirmed on Wednesday that the country will begin to offer a third COVID ‘booster’ vaccine, beginning the week of September 20, to Americans who were vaccinated earliest in the vaccination rollout….”

“…In contrast to governments, the WHO appeals for a moratorium have gained greater traction among global health experts concerned with vaccine equity:”

“No, Boosters are NOT good pub health policy now. Not when most of world hasn’t gotten 1st shot & policymakers insist on monopolized production leading to global shortage of doses. If you want to end the pandemic @DrTedros is right, booster moratorium,” said Matthew Kavanagh, a professor of global health at Georgetown University, on his Twitter feed.

Others, however, have observed that the real problem is vaccine scarcity – and the lack of broader access to the most effective vaccine technologies. “I sympathize with the booster moratorium, yet I wonder whether it falls into the scarcity trap. With the right rules & ambition, there are enough vaccines at the right price & the right dose for everyone. Abundance over scarcity. That has been our demand from the beginning. Non?” said Jon Cohen, Director of New York-based Open Society Health.”

“… The US CDC’s most recent authorization for boosters for those vaccinated earliest, which now includes many health care workers, nursing home residents, and other seniors, is now likely to set off an even wider trend of booster shots in other rich countries fearful of a Delta virus onslaught this fall – or already experiencing one this summer….”

Links:

Guardian - WHO condemns rush by wealthy nations to give Covid vaccine booster (recommended read)

Stat - U.S. health officials recommend booster shots against Covid-19

Stat - U.S. officials’ decision on Covid-19 booster shots baffles — and upsets — some scientists

NPR - Why A Push For Boosters Could Make The Pandemic Even Worse

“ By diverting doses away from unvaccinated people, booster shots will help drive the emergence of more dangerous mutants, the WHO doctors said. "I'm afraid that this [booster recommendation] will only lead to more variants. ... And perhaps we're heading into an even more dire situation," WHO chief scientist Dr. Soumya Swaminathan said. The problem with a call for boosters, she said, is that the virus is primarily circulating in unvaccinated people — not in the fully vaccinated….”

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Devex - 1 billion doses: The cost of COVID-19 booster shots https://www.devex.com/news/1-billion-doses-the-cost-of-covid-19-booster-shots-100647

“If all high-income countries decide to give booster doses to people above 50 years old, that would consume close to 1 billion doses, said WHO Chief Scientist Soumya Swaminathan during a news briefing. … The COVAX initiative, which has struggled all year to gain adequate access to vaccines, aims to deliver 1.5 billion doses to low- and middle-income countries by the end of the year, but it has so far only delivered 208 million — falling far short of its midyear goals as high-income countries hoard supplies. "When COVAX says we have enough vaccines, then let's look at boosters. We are a long, long way from that," said Bruce Aylward, senior adviser to WHO Director-General Tedros Adhanom Ghebreyesus….”

AP – WHO Africa: COVID-19 booster shots make ‘mockery’ of equity https://apnews.com/article/africa-health-coronavirus-pandemic-united-nations- c5114af130f6b50c768bf6859dd217ba

“Rich countries’ decisions to roll out COVID-19 booster shots while so many people across Africa remain unvaccinated “threaten the promise of a brighter tomorrow” for the continent, the Africa director for the World Health Organization said Thursday, warning that “as some richer countries hoard vaccines, they make a mockery of vaccine equity.” Matshidiso Moeti and other African health officials, including the Africa Centers for Disease Control and Prevention, had warned against booster shots in recent weeks as less than 2% of the population on the continent of 1.3 billion people is fully vaccinated against COVID-19.”

“Moeti noted that the latest resurgence in cases across Africa is leveling off and more vaccine doses are finally arriving on the continent, but “Africa is encountering headwinds” as rich countries like the United States decide to roll out booster shots. The situation in Africa remains “very fragile” as the more infectious delta variant is now dominant in most of the continent’s 54 countries, she said. More than 7.3 million cases, including more than 186,000 deaths, have been confirmed across the continent and health systems are straining to provide medical oxygen and other care….”

Politico - Troubling CDC vaccine data convinced Biden team to back booster shots https://www.politico.com/news/2021/08/17/cdc-data-booster-shots-505637

“The evidence showed a decline in the initial round of protection against Covid-19 infection that's coincided with a resurgence in cases driven by the more contagious Delta variant….”

“… Still, the decision to forge ahead with third shots of Pfizer and Moderna is likely to invite backlash both at home and abroad. The World Health Organization has urged developed countries to hold off on booster shots over fears that a new round of mass vaccinations will make it even more difficult for lower-income countries to get access to initial supplies of the vaccines….”

“… Biden officials are confident they can fulfill their vows to be an “arsenal of vaccines” for the world while sending Americans back for more because of their surplus of shots and expectation that many more are on the way, an administration official said…..”

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Via Politico’s Global Pulse: “The U.S. will be giving about 100 million boosters in the coming months and will send 200 million doses abroad, said Jeff Zients, the White House coronavirus response coordinator. “We can and must do both at the same time because that's what it's going to take to end this pandemic…”

Reuters - Pfizer, Moderna seen reaping billions from COVID-19 vaccine booster market Reuters;

“Drugmakers Pfizer Inc, BioNTech and Moderna Inc are expected to reap billions of dollars from COVID-19 booster shots in a market that could rival the $6 billion in annual sales for flu vaccines for years to come, analysts and healthcare investors say.”

For more on the debate on ‘booster shots’, see also the sections ‘Covid Science’ & ‘Covid vaccine access’, below.

Covid science

Science – New SARS-CoV-2 variants have changed the pandemic. What will the virus do next? https://www.sciencemag.org/news/2021/08/new-sars-cov-2-variants-have-changed-pandemic- what-will-virus-do-next

By K Kupferschmidt. “The pandemic is giving scientists a unique view of viral evolution in action”

“… the most tumultuous period in SARS-CoV-2’s evolution may still be ahead of us, says Aris Katzourakis, an evolutionary biologist at the University of Oxford. There’s now enough immunity in the human population to ratchet up an evolutionary competition, pressuring the virus to adapt further. At the same time, much of the world is still overwhelmed with infections, giving the virus plenty of chances to replicate and throw up new mutations….”

Stat - Scientists unlock clues to determining how safe vaccinated people are from Covid-19 https://www.statnews.com/2021/08/16/scientists-clues-how-safe-vaccinated-people-are-from- covid-19/

“…..researchers are starting to flesh out exactly what these “correlates of protection” look like, a step that could help track the durability of immunity and speed the development of additional vaccines. In a preprint paper last week, a group of researchers from both academia and U.S. health agencies reported their findings of the immune correlates for Moderna’s Covid-19 vaccine. The study demonstrated the link between the level of antibodies in a person’s system and how protected

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they are against Covid-19, validating the hypothesis that antibodies could be used as a measure that signifies overall protection….”

Science News - A grim warning from Israel: Vaccination blunts, but does not defeat Delta https://www.sciencemag.org/news/2021/08/grim-warning-israel-vaccination-blunts-does-not- defeat-delta

“With early vaccination and outstanding data, Israel is the world’s real-life COVID-19 lab.”

See also an FT Editorial - Israel’s worrying fourth wave

“…. Now, one of the world’s most-vaccinated nations is among the first to experience an alarming fourth wave of infections — and hospitalisations — and is rushing to give booster shots. The rest of the world should take notice. New infections in Israel have surged to the highest in six months, with signs that protection against severe disease has fallen significantly for elderly people vaccinated early this year. The data has caveats, but the trend is clear: six to eight months after second jabs, immunity starts to wane….”

“Israel’s case may reflect a particular combination of factors, and may not be exactly replicated elsewhere. … But Israel’s experience still has implications. Until more is known about the durability of protection from different jabs, it suggests even highly-vaccinated countries should retain some preventive measures, such as mask-wearing in public places. It also signals booster programmes, though long expected, may need to be relatively frequent and large-scale, unless the virus burns itself out. In the US, where the Delta variant has also surged in the past month, the Biden administration has decided to recommend booster shots eight months after a second shot — in part after looking at the Israeli data. It is preparing to offer them from next month. This raises difficult questions about whether scarce vaccines should be used to extend immunity for rich populations, rather than directed to developing countries which remain largely unprotected. Yet it would be wrong to undermine all the costly progress made in the developed world, requiring new lockdowns and endangering the global economic recovery — which would have harmful knock-on effects for lower-income countries in other ways. All this does add yet more urgency, however, to the need to step up production — including within the developing world. The biggest lesson of the vaccine rollout in Israel and elsewhere is that the world simply cannot have enough.”

NYT - Vaccines’ protection against virus infection is waning, C.D.C. studies suggest. https://www.nytimes.com/2021/08/18/health/cdc-booster-shots.html

“The Centers for Disease Control and Prevention released three studies on Wednesday that federal officials said provided evidence that booster shots of the Pfizer-BioNTech and Moderna coronavirus vaccines would be needed by all Americans in the coming months. But some experts said the new research did not support the decision to recommend booster shots for all Americans….”

“Taken together, the studies show that although the vaccines remain highly effective against hospitalizations, the bulwark they provide against infection with the virus has weakened in the past

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few months. … …. Together, the new studies indicate overall that vaccines have an effectiveness of roughly 55 percent against infections, 80 percent against symptomatic infection, and 90 percent or higher against hospitalization, noted Ellie Murray, an epidemiologist at Boston University….”. Pretty good, in other words.

Science (Perspective) – The animal origin of SARS-CoV-2 https://science.sciencemag.org/content/early/2021/08/16/science.abh0117

“Trading of animals susceptible to bat coronaviruses is the likely cause of the COVID-19 pandemic.”

See also Cell - The Origins of SARS-CoV-2: A Critical Review (18 Aug)

“ Here, we critically review the current scientific evidence that may help clarify the origin of SARS- CoV-2….”

• Science – COVID-19 vaccines may trigger superimmunity in people who had SARS long ago

See also the Telegraph - Pioneering study could launch ‘dream’ vaccine to halt future pandemics

“ Scientists in Singapore have identified a new strategy to develop a next-generation vaccine effective against variants and emerging viruses. … Scientists from Singapore’s Duke-NUS Medical School and National Centre for Infectious Diseases (NCID) have discovered that survivors of the 2003 Severe Acute Respiratory Syndrome (Sars) outbreak who have been vaccinated with the Pfizer- BioNTech mRNA vaccine produce antibodies that can tackle a range of coronaviruses. These highly potent functional antibodies are capable of neutralising not only all known variants of concerns (VOCs) linked to the current Sars-CoV-2 virus, but also other animal coronaviruses with the potential jump to humans. … The finding, published in the New England Journal of Medicine on Wednesday, is the first time that such cross-neutralising reactivity for coronaviruses has been demonstrated in humans, and experts believe it could be a game changer in the race to develop a universal coronavirus vaccine. …”

• And via Cidrap News: CEPI enters into funding agreement with Gritstone bio to develop COVID-19 variant vaccine

“The Coalition for Epidemic Preparedness Innovations (CEPI) today announced a funding agreement with California-based Gritstone Bio to further the development of its next-generation COVID-19 vaccine, which will target variants. CEPI said the company's vaccine is based on a self- amplifying mRNA platform and that it will provide Gritstone up to $20.6 million to get the product through a phase 1 clinical trial. The award is CEPI's fifth to support next-generation COVID-19 vaccines.”

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Covax & ACT-A

ACT-Accelerator launches urgent US$ 7.7 billion appeal to stem surge of dangerous variants and save lives everywhere https://www.who.int/news/item/16-08-2021-act-accelerator-launches-urgent-appeal-to-stem- surge-of-dangerous-variants-and-save-lives-everywhere

“…. Funding the Rapid ACT-Accelerator Delta Response (RADAR) urgent appeal for US $7.7 billion would enable: significantly increased testing and better surveillance to detect and protect against new variants; more oxygen to treat the seriously ill and save lives; vital personal protective equipment (PPE) to protect health workers; the rolling out of emergency response and delivery support for the effective delivery and deployment of COVID-19 tools, including in humanitarian contexts; and continued research and development (R&D) so that tools remain effective. The US$ 7.7 billion is not an additional funding need but is part of the ACT-Accelerator’s overall 2021 budget, which is needed urgently within the next four months…”

See also Cidrap News – WHO: $7.7 billion needed for COVID variant detection, oxygen

And HPW - WHO Issues Urgent Appeal For US $11.5 Billion For COVID Tests, Treatments, and Vaccines

“ In addition to the US$ 7.7 billion appeal, there is an opportunity to reserve a supply of 760 million doses of vaccines in the fourth quarter of 2021, ensuring a continued supply of doses for delivery by COVAX in 2022. On delivery, these 760 million doses will cost an additional US $3.8 billion, though WHO did not specify which vaccines were to be reserved….”

NYT - The Road to Getting Vaccines to the World Seth Berkley; https://www.nytimes.com/2021/08/13/opinion/letters/headache- treatment.html?referringSource=articleShare

Seth Berkley reacted to last week’s NYT article on Covax. Cfr a tweet by him: “Letter to the Editor “The Road to Getting Vaccines to the World” via @nytopinion responding to the appalling NYT article. It is easy to be critical but it is important to consider the counterfactual of what would have happened without Covax.”

I refrain from commenting.

Lancet World Report – Health leaders criticise limited ACT-A review https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01861-4/fulltext

“A review of the Access to COVID-19 Tools Accelerator will be a “mid-course correction” rather than substantive, drawing criticism from health leaders and civil society. Ann Danaiya Usher reports.” Excerpts:

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“An ongoing review of the Access to COVID-19 Tools Accelerator (ACT-A)—an ad-hoc coalition of global agencies and private foundations that came together to fight the COVID-19 pandemic in April, 2020—is under fire for not looking deeply enough into the causes of global inequity in access to COVID-19 tools. …. The review is expected to deliver a final report in early October, 2021, in time for the G20 summit at the end of that month. The terms of reference state that it will document lessons learned from ACT-A, and examine the results achieved, its strengths and weaknesses, and financing issues. The consultants’ recommendations will guide decision making on the current functioning of ACT-A and its potential role beyond the first quarter of 2022. However, the terms say that “it will not be a full evaluation of ACT Accelerator work and performance; this effort is ongoing, and it is too soon to try to quantify impact”. The WHO Special Envoy for ACT-A, former Swedish Prime Minister Carl Bildt, wants to limit the review's mandate to a “mid-course correction”. He said the “long-term philosophical questions” about how to deal with the next pandemic should be left for later….”

“… Donors have provided US$18 billion to ACT-A over the past year, with 80% earmarked for vaccines. ACT-A still lacks $15 billion for this year's budget to pay for other COVID-19 tools such as tests, medical oxygen, and personal protective equipment for health personnel. Billions more will be needed for 2022….”

“… Two major reports on the global pandemic response—by the Independent Panel for Pandemic Preparedness and Response, published in May, 2021, and the G20 High-Level Independent Panel report, published in June, 2021—have already concluded that ACT-A is seen by countries and civil society as “supply-driven and not inclusive enough”. …. … Adeyi was involved in consultations at the World Bank about the creation of ACT-A until his retirement in June, 2020. He said he does not question the intention of the designers of the mechanism. “However, in the fullness of hindsight, it is now eminently clear that the power structures have favoured the Global North over the Global South. These power structures crippled the functions of [ACT-A], including [COVAX].” …. The civil society representative for the review, Rachael Crockett, said civil society organisations also want the review to be expanded to include the perspectives of people outside of ACT-A who have been following its progress, such as those from think tanks, academia, and research…”

People’s Dispatch - Inequity in COVID-19 testing has far reaching consequences for poor countries http://peoplesdispatch.org/2021/08/13/inequity-in-covid-19-testing-has-far-reaching- consequences-for-poor-countries/

“Testing is crucial to combat the pandemic. But with all the funds and attention going towards vaccines, diagnostics is suffering, impeding key steps to curb the spread of the virus.”

“… The diagnostics pillar of the Access to COVID-19 Tools Accelerator (ACT-A) faces acute shortage of funds, does not have LMIC representatives and has set low targets for itself. The World Health Organization (WHO), on the other hand, has been conservative in promoting and approving rapid diagnostic tests (RDTs) which could boost testing in LMICs. The result — extended mass lockdowns and unchecked spread of COVID-19.”

“… ACT-A’s diagnostic pillar was established in April 2020 with exactly the idea of reducing this, much anticipated, inequality. The pillar is coordinated by FIND, a global alliance for diagnostics, and the Global Fund to fight AIDS, Tuberculosis, and Malaria. The original goal of the diagnostics pillar

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was to distribute 85 million tests in LMICs by the end of 2021. According to a progress report available on FIND’s website, however, for now merely 39 million tests were procured through ACT-A…. the diagnostics pillar, on the other hand, has received USD 1047 million, just 8% of the funds for the vaccines pillar. Discussions at ACT-A also show bias against funding for diagnostics. ;;; here is no LMIC representation in the ACT-A diagnostics pillar. “The working group meets every two weeks,” says Rahman, “but it is only the Global North discussing the way forward.” The absence of LMICs in governance mechanisms such as the ACT-A diagnostics pillar has impacted their approach to local testing. …”

WHO - Joint Statement from Unitaid and the World Health Organization (on behalf of the Access to COVID-19 Tools Accelerator) regarding availability of tocilizumab WHO;

“ WHO and Unitaid are concerned by Roche’s statement yesterday, warning of a global shortage of tocilizumab (brand name Actemra/RoActemra), an IL6 inhibitor WHO recommended in June for use as a treatment for severe COVID-19 cases. Tocilizumab can play a key role in decreasing mortality and reducing need for invasive mechanical ventilation among severely ill patients, when delivered alongside oxygen and corticosteroids. While we welcome and acknowledge that Roche has announced measures to address the shortage, we call on the company to ensure equitable allocation of current stocks of this medicine for all countries, including low- and middle-income countries. We also strongly encourage Roche to facilitate technology transfer and knowledge and data sharing to broaden access to this important treatment. The ACT-A partnership Access to COVID-19 Tools (ACT) Accelerator partners are working with Roche to set up channels for distribution of tocilizumab in places where it is not yet in use, as part of their effort to support roll-out of effective new therapeutic products for COVID-19. In addition, WHO has issued a call for Expression of Interest to its Prequalification programme to expand the number of quality-assured manufacturers of the drug and thus to increase global supplies…..”

Links:

Guardian: Australia’s Pfizer purchase from vaccine-sharing Covax stockpile under fire

Via One’s Aftershocks newsletter:

“It gets worse: Not content just to gobble up African-produced vaccines, some rich nations have also been dipping into the COVAX supply. In late June alone, COVAX sent 530,000 doses to the UK, more than double the amount sent that month to the entire continent of Africa. Other wealthy offenders to receive doses from COVAX include Australia, Canada, New Zealand, and Qatar. In the meantime, COVAX has only been able to deliver 25 million of the 700 million doses the African Union expects this year.”

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Trips waiver negotiations & tech transfer

FT - Vaccine patents battle intensifies as poor nations struggle in war on coronavirus Vaccine patents battle intensifies as poor nations struggle in war on coronavirus | Financial Times (ft.com)

“Pharmaceutical industry and health officials lock horns over intellectual property waivers for Covid-19 jabs.”

Excerpts:

“…. WTO talks over the proposed waiver were suspended without progress at the end of July as delegates dispersed for the European summer holidays. Despite a request from WTO director-general Ngozi Okonjo-Iweala for members to shorten the break given the urgency of the issue, they do not plan to reconvene until September. …. …. Observers said the US move, while symbolic, had so far done little to address the technicalities needed to see it through and accused the EU, UK and other high-income countries of continuing to obstruct progress. … …. Despite encouraging rhetoric, the Biden administration has failed “the most obvious test of leadership” in not directly confronting those pharmaceutical companies “obstructing global access to life-saving vaccines”, said Asia Russell, executive director at Health GAP, an advocacy group….”

“… Top global health officials have become increasingly exasperated with the industry’s inability to boost access and clashed with pharmaceutical executives at a WTO meeting last month, according to two people familiar with what was said….”

“… The current shortage was not a “momentary” problem, said Hyo Yoon Kang, a reader in law at the UK’s University of Kent. “Companies are really trying to see how much they can push for monopoly rights in future pandemics.” Suerie Moon, the co-director of the global health centre at Geneva’s Graduate Institute, added that the current regulatory framework for the global pharmaceutical industry had been found wanting. “We don’t have clear policy frameworks that articulate the social contract,” she said. “If we don’t find a solution, if we don’t demonstrate that the rules can be flexible enough, that they can stretch to take into account the emergency, they become more fragile, they lose their legitimacy and become less acceptable overall.”…”

Geneva Health Files - Understanding Germany’s Trenchant Opposition To the TRIPS Waiver P Patnaik; Geneva Health Files;

Indepth analysis of Germany’s opposition to the Trips waiver by Rithika Sangameshwaran, a visiting researcher with the Heidelberg Institute of Global Health in Germany. Recommended!

Quotes: “…Although it may be difficult to establish with certainty, Germany’s decision to oppose the waiver may well be due to a desire to protect its thriving biotechnology industry. Hyo Yoon Kang, a

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reader in law at Kent Law School, University of Kent, referred to this as a case of economic nationalism coupled with biopolitical nationalism…”

“…A Geneva-based trade source familiar with discussions at the WTO told us that Germany is increasingly isolated, but decisively becoming the only EU country to block the TRIPS waiver. France, Netherlands, Spain, have varyingly made statements suggesting support for the waiver proposal, as individual member states. But since the EU votes as a bloc at WTO, Germany can effectively coerce others to oppose the waiver. As the largest EU economy, Germany has the latitude to do so, in addition to being dictated by domestic political priorities…..”

Links:

Law 360 - Brazil's Senate Passes COVID Vaccines License-Waiver Bill

“The Brazilian Senate has passed a bill that will allow the country's president to temporarily waive patent rights and grant compulsory licenses for COVID-19 vaccines and medicines in light of the public health emergency spurred by the global pandemic….” (August 12)

Other vaccine access news & other bottlenecks

NYT - Covid Vaccines Produced in Africa Are Being Exported to Europe https://www.nytimes.com/2021/08/16/business/johnson-johnson-vaccine-africa-exported- europe.html

This article caused a big stir, rightly so – and including to dr Tedros. “…. South Africa is still waiting to receive the overwhelming majority of the 31 million vaccine doses it ordered from Johnson & Johnson. It has administered only about two million Johnson & Johnson shots. That is a key reason that fewer than 7 percent of South Africans are fully vaccinated — and that the country was devastated by the Delta variant. At the same time, Johnson & Johnson has been exporting millions of doses that were bottled and packaged in South Africa for distribution in Europe, according to executives at Johnson & Johnson and the South African manufacturer, Aspen Pharmacare, as well as South African government export records reviewed by The New York Times….”

“… Many Western countries have kept domestically manufactured doses for themselves. That wasn’t possible in South Africa because of an unusual stipulation in the contract the government signed this year with Johnson & Johnson. The confidential contract, reviewed by The Times, required South Africa to waive its right to impose export restrictions on vaccine doses. …. … Critics say the shortfall in South Africa partly reflects a power imbalance between a giant company and a desperate country. “The disproportionate amount of power that Johnson & Johnson has exercised is really concerning,” said Fatima Hassan, a human rights lawyer in South Africa. “It is harming our efforts to get speedy supplies into the system.”…”

See also Devex – Europe receiving 10M COVID-19 vaccine doses produced in South Africa

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“Ten million COVID-19 vaccines partially produced in South Africa are being exported to Europe in August and September, according to an op-ed published in the Guardian by former U.K. Prime Minister Gordon Brown. … According to Brown’s op-ed, J&J vaccines are only being exported to Europe in the short term. He said South African President Cyril Ramaphosa threatened to ban all vaccine exports from South Africa until “Europe agreed all J&J’s future African-produced vaccines could stay in Africa from October.”…”

And Reuters - EU says import of J&J vaccines from South Africa is temporary

“The European Commission said on Thursday it had reached a temporary agreement with South Africa to use a plant there to bottle Johnson & Johnson (JNJ.N) COVID-19 vaccines that are being imported into the EU….”

“…A spokesperson for the European Commission told reporters on Thursday the agreement with South Africa was reached after J&J faced problems in producing vaccines in the United States at a factory belonging to its partner Emergent Biosolutions (EBS.N). Under the deal, Aspen Pharmacare bottles the vaccine substance produced elsewhere, and then transfers the finished doses to South Africa and the EU. A J&J factory in Leiden, in the Netherlands, is a major producer of its vaccine substance for COVID-19 shots worldwide. From September, J&J will transfer all bottling operations for vaccines directed to the EU to Leiden, the EU spokesperson said….”

Guardian - Gordon Brown hits out at EU’s ‘neocolonial approach’ to Covid vaccine supplies https://www.theguardian.com/world/2021/aug/16/gordon-brown-hits-out-at-eu-neocolonial- approach-to-covid-vaccine-supplies

With more detail on this op-ed by Gordon Brown. “Former UK prime minister calls on western leaders to convene summit to address Africa’s vaccine deficit.”

Brown called on Joe Biden, Boris Johnson and Mario Draghi to convene a special summit to coincide with next month’s UN general assembly in New York to address Africa’s vaccine deficit.

BMJ Editorial - Profiteering from vaccine inequity: a crime against humanity? F Hassan, G Yamey et al; https://www.bmj.com/content/374/bmj.n2027

Hard-hitting piece. “Companies and rich nations are creating a deadly covid-19 vaccine “protection racket”.”

“Pandemic profiteering is, in our view, a human rights violation that demands investigation and scrutiny. …”

“… Covid-19 global vaccine allocation is based on power, first mover advantage, and the ability to pay. This moral scandal, enabled by corporate and political permission of mass death, is tantamount to a crime against humanity. Yet we too are complicit by our silence. Why are workers and

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shareholders at vaccine companies not speaking out? Where are the academics clamouring to make the “fruits of the scientific enterprise” available to all? Where are the lawyers demanding global justice and corporate accountability? Which leaders of rich nations are pressuring vaccine companies to make their people safe by making the world safe? Where is the grassroots mobilisation of scientists and health workers to fight for fair access to vaccines?....”

Nature Editorial - The WHO is right to call a temporary halt to COVID vaccine boosters https://www.nature.com/articles/d41586-021-02219-w

“Richer countries should focus on ramping up vaccine supply to the billions who are still waiting for their first dose.”

Nature is on the right side of history – including in terms of its suggestions on how supply can be boosted.

See also a few links:

NYT – The prospect of booster shots is igniting a global health debate.

“As the Delta variant rages around the world, a heated debate has arisen over whether public health officials should recommend booster shots. On one side are global health officials who contend that available vaccines would be better used to inoculate high-risk people in poor nations where few have gotten the shots. On the other are leaders and health officials in wealthier countries, who are setting aside doses for more vulnerable people who may need additional doses to protect them from the virus….”

Guardian - Booster jabs for rich countries will cause more deaths worldwide, say experts

“Oxford Vaccine Group and Gavi say western leaders must not ‘reject their responsibility to the rest of humanity’.”

Devex - Elusive herd immunity comes at the cost of equity, vaccine expert says https://www.devex.com/news/elusive-herd-immunity-comes-at-the-cost-of-equity-vaccine-expert- says-100606

“Reaching the elusive goal of herd immunity to COVID-19 is unrealistic and instead governments should focus on equitable distribution of vaccines, said Dr. Shabir Madhi, director at the vaccines and infectious diseases analytics research unit at the University of the Witwatersrand in Johannesburg, and co-director at the African Leadership in Vaccinology Expertise….”

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WB (‘Investing in Health’ blog) - New Data Illuminates Acute Vaccine Supply & Delivery Gaps for Developing Countries https://blogs.worldbank.org/health/new-data-illuminates-acute-vaccine-supply-delivery-gaps- developing-countries

“The Multilateral Leaders Taskforce (MLT) on COVID-19 is working to accelerate access and delivery of COVID-19 vaccines and other essential health tools to developing countries. To enhance transparency, and facilitate targeted solutions, the Taskforce is compiling data on dose requests, contracts, deliveries, and deployment of COVID-19 vaccines to developing countries.”

See https://data.covid19taskforce.com/data (for the interactive data)

“…Huge gaps exist between the number of vaccine doses pre-purchased by low-income countries and the number of doses needed to vaccinate 40% of the population in low-income countries. The gaps between doses delivered and the number needed to reach the targets of vaccinating 40% of the population in these countries by end-2021, and 60% by mid-2022, are enormous. The expected vaccination rate for developing countries at end-2021 based on current delivery schedules of AVAT/COVAX/bilateral deals & donations is around 20% of the population, on average. …”

Can This Houston-Born COVID Vaccine Save the Developing World? https://www.texasmonthly.com/news-politics/covid-vaccine-corbevax-india/ “For low-income countries, the less-expensive, easier-to-make Corbevax could prove a godsend.”

“A pair of dedicated Texas researchers are poised to play a significant part in making that happen. Dr. Peter Hotez and Maria Elena Bottazzi, co-directors of the Texas Children’s Hospital Center for Vaccine Development, in Houston, have helped develop a COVID-19 vaccine that’s likely to become one of the cheapest and most accessible vaccines throughout the world. It’s just entered phase three clinical trials in India, and it could prove vital to low-income countries that can’t afford to purchase or manufacture the sort of vaccines that are widely available in the United States.” “… What makes their vaccine, Corbevax, so special is that, well, it’s not that special. Instead of relying on newer—and more expensive—technology, such as mRNA (as in the Pfizer and Moderna vaccines) or adenovirus vectors (the Johnson & Johnson and AstraZeneca vaccines), Corbevax is a more conventional recombinant protein vaccine. It’s designed the same way as the hepatitis B vaccine and others that have been in use for decades. Yet testing so far suggests that Corbevax is about as effective as its newer, fancier counterparts, with an efficacy over 85 percent.” “… Perhaps most important, however, is that any country with existing vaccine-manufacturing facilities can easily make, transport, and store Corbevax. There’s no need to build new factories, since this vaccine type is so similar to others that countries across the world already produce. The vaccine also needs only basic refrigeration—no ultra-freezing storage requirements—so there’s less risk of it spoiling in areas without reliable electricity or infrastructure….”

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WB (Research & Policy Brief) - Policy Actions to Increase the Supply of COVID-19 Vaccines in the Short Term

World Bank;

“This Research & Policy Brief identifies and quantifies the impact of six policy and regulatory actions that could increase vaccine supply to developing countries before the end of 2021. The actions focus on measures to accelerate regulatory approvals, optimize production capacity across firms, reconfigure prioritization of low-risk groups, and adjust generous dosage thresholds. Together these actions could yield enough supply to reach the interim target to vaccinate at least 40 percent of the population of every country by the end of 2021, as a means to vaccinate 60 percent of global population by mid-2022, thereby helping to end the pandemic earlier, reducing uncertainty and raising growth.”

And some links:

HPW - Kenya Mandates COVID-19 Vaccines for Civil Servants as Africa’s Vaccine Rollout Gathers Speed

Covid analysis

All Plagues Are Political C Kilian; https://thetyee.ca/Culture/2021/07/09/All-Plagues-Are- Political/?utm_source=daily&utm_medium=email&utm_campaign=090721

“Alex de Waal’s myth-shattering new book deconstructs COVID-19 and two centuries of epidemics. Five deadly misconceptions.”

Conclusion: “Alex de Waal’s extraordinary book deserves to be read, debated and acted upon. He refuses to offer a solution, just a new word: “pandemy.” Pandemic is just a noun and adjective for the disease. Pandemy is the state of the diseased society. “In using the word ‘pandemy,’ we can reclaim the concept of a holistic disruption, reaching backwards into the ecological, social and health pathologies.... The pandemic needs biomedicine and NPIs [non-pharmaceutical interventions]; the pandemy needs much more.” Alex de Waal concludes with a modest suggestion: “Emancipatory public health begins with a conversation on this whole-of-society, whole planet, ‘One Health,’ democratic, and participatory agenda. The starting point is not the content of the policies but the process for getting to them. Those who are most vulnerable and most excluded will have some of the most important things to say. This means dismantling the ‘war on disease’ mindset and its politics, assembled over the last two centuries. If we do this, COVID-19 may yet be the emancipatory catastrophe that we need.

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CGD - Three Key Gaps in the Health Economics Research on COVID-19, and Why It Matters

S Ghosh et al; https://www.cgdev.org/blog/three-key-gaps-health-economics-research-covid-19- and-why-it-matters#.YRpBUdexHtA.twitter

“The online platform C19economics was created to support researchers and decision makers by collating the health economic literature published on the COVID-19 pandemic into an easily searchable repository. To do so, we screened over 13,000 resources (see our methods) and the site now includes over 665 papers covering a wide geographic base and a broad range of subject areas. After reviewing the literature, we found three notable gaps in coverage in terms of geographical focus and topic areas….”

Nature - Has COVID taught us anything about pandemic preparedness? A Maxmen; https://www.nature.com/articles/d41586-021-02217-y

“Researchers warn that plans to prevent the next global outbreak don’t consider the failures that have fuelled our current predicament.”

Guardian - An economic calamity’: Africa faces years of post-Covid instability https://www.theguardian.com/world/2021/aug/13/an-economic-calamity-africa-faces-years-of- post-covid-instability

“Analysts and experts are warning of many years of instability across Africa, possibly leading to wars and political upheavals, as the economic impact of the Covid-19 pandemic deepens across the continent.”

“Though many of the likely consequences are yet to become evident, recent unrest in southern Africa, increased extremist violence in the Sahel and growing instability in parts of west Africa can all be attributed in part to the outbreak, observers say. …. …. However, there has also been strong leadership and effective action by large organisations that provide hope that the worst effects of the pandemic may be avoided. … The economic damage inflicted by the outbreak will make it harder for governments to fulfil the aspirations of increasingly globalised youthful populations, will exacerbate tensions in places where competition for scarce resources already causes conflict, and could force some authoritarian regimes to reinforce repression to head off widespread dissent….”

Plos Speaking of Medicine and Health (blog) - COVID-19 Vaccine Equity- The Neglected Pandemic Stepchild B Titanji; https://speakingofmedicine.plos.org/2021/08/18/covid-19-vaccine-equity-the-neglected- pandemic-stepchild/#.YRzy0vJKZcc.twitter Quote: “…To attain the goal of immunizing 70% of the population against COVID-19, HICs have to increase their healthcare spending by an estimated 0.8%. In staggering contrast LICs will on

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average have to increase healthcare spending by 56.6% to reach this same goal. This cost is likely to increase over time as pharmaceutical companies increase the cost of COVID-19 vaccines and rollout of booster doses in wealthy countries further drive-up vaccine demand and squeezes the market…”

Global health governance & financing

CGD (blog) - Retooling UNICEF - New Leadership Needs to Couple Humanitarian Imperatives with Systems Reform

A Glassman et al; https://www.cgdev.org/blog/retooling-unicef-new-leadership-needs-couple- humanitarian-imperatives-systems-reform

“UNICEF’s Executive Director, Henrietta Fore, recently announced that she will step down from her position. The role has traditionally been held by an American, and while the issue of merit-based and competitive global appointments has been raised before, we can expect that the Biden Administration’s nominee will be appointed. The choice will matter. With a change in leadership imminent, we consider the organization’s dual imperative: to protect children during humanitarian crises - including the current COVID-19 crisis-, and to shift from direct service delivery towards support for systems and policies that will drive sustainable improvements in child well-being today and tomorrow, ending with a call to prioritize technical leadership for a new era…..”

CGD (blog) - Beyond Aid: Sources of Finance for Global Health Security

A Glassman https://www.cgdev.org/blog/beyond-aid-sources-finance-global-health-security

“Twenty months into the COVID-19 pandemic, there is broad agreement that more and smarter international financing is needed to respond to the current pandemic and to prepare for the next global health threat. The G20 independent panel report and this blog, among others, highlight the priorities for the uses and needed characteristics of the funding, but now to the next hard question – how to raise the money? What are the sources of revenue beyond ODA that could contribute to the proposed Global Health Threats Fund?...”

“…To raise the estimated $10 billion a year required, there are several, complementary strategies needed to build a sustainable base for preparedness and response going forward…”

With a number of suggestions. My favourite one: the “Pandemic super-profits levy”. Though I’d make it a tad more ‘ambitious’.

Policy Brief (Pandemic Action Network/CGD/Nuclear Threat initiative)- Calling for a New Multilateral Financing Mechanism for Global Health Security and Pandemic Preparedness https://pandemicactionnetwork.org/calling-for-a-new-multilateral-financing-mechanism-for-global- health-security-and-pandemic-preparedness/

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More or less along the same lines: “At the 2021 United Nations General Assembly, world leaders should launch a 100-day action plan to establish and resource a new financing mechanism, or Fund, that can mobilize at least US$10 billion annually over the next five years to bolster global health security and pandemic preparedness. …. An expedited timeline for establishing the Fund will provide a critical new tool for the ongoing COVID-19 response efforts and create continuity between the pandemic response and recovery activities while bridging to escalated and sustained efforts on pandemic preparedness. This policy brief, prepared by contributors from the Center for Global Development, Pandemic Action Network, and Nuclear Threat Initiative, is intended to inform and guide ongoing conversations among governments and non-governmental stakeholders on the parameters and design of the new Fund and action plan….”

Among others, on the timeline, key characteristics of this new Fund, …

Devex - Even African philanthropists underfund African NGOs, report says https://www.devex.com/news/even-african-philanthropists-underfund-african-ngos-report-says- 100584

“The research finds that both African and non-African philanthropies underfunded nonprofits based in Africa for a variety of reasons, including a "pervasive" bias against local organizations.”

“… African NGOs are being underfunded by African and non-African philanthropists alike in comparison to organizations headquartered outside the continent, according to a recent report from the African Philanthropy Forum and The Bridgespan Group. …. The research, which delves into the driving factors behind funding disparities for African NGOs, found that African funders directed just 9% of large gifts to NGOs based on the continent between 2010 and 2019, while non-African funders provided just 14% to these groups. Those numbers remained virtually unchanged despite a “massive” response from African funders to the COVID-19 pandemic in 2020, according to the report….”

WP – How Chinese pressure on coronavirus origins probe shocked the WHO – and led its director to push back https://s2.washingtonpost.com/camp- rw/?trackId=5ea6028cae7e8a4360eb83b4&s=611dd65c9d2fda2f47fd6109&linknum=4&linktot=61

“…. a new book that details the relationship between the United States, China and the WHO during the pandemic offers a more nuanced and revealing story. It shows how WHO Director General Tedros Adhanom Ghebreyesus cautiously praised China in public while pressuring it in private. And it shows how the Trump administration undermined this tactic with open hostility toward China and the WHO.

“Aftershocks: Pandemic Politics and the End of the Old International Order,” written by Thomas Wright and Colin Kahl, reveals how Tedros lost patience with China: When a WHO scientist on a coronavirus origins probe announced in February that the idea that the virus leaked from a lab was “extremely unlikely” and unworthy of further investigation, senior WHO staff in Geneva were shocked. “We fell off our chairs,” one member told the authors.

… Since then, relations between the WHO and China have nosedived. …”

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Think Global Health - Health Security and the COVID-19 Pandemic: Health and Security for Whom?

C Almeida; https://www.thinkglobalhealth.org/article/health-security-and-covid-19-pandemic- health-and-security-whom

“The pandemic proves “health security” should no longer drive global health policy.” Nice one.

And a link:

• Tim Schwab - The conflict over conflicts of interest (in Columbia Journalism Review)

Cfr tweet by the author: “As journalists take on financial ties to the subjects of their reporting (like the @gatesfoundation ), where is the editorial oversight? My new investigation in @CJR reveals serial probs w/ unmanaged conflicts of interest @nytimes and beyond.”

AMR

Cidrap News - At 5 years, CARB-X celebrates progress on antibiotic development https://www.cidrap.umn.edu/news-perspective/2021/08/5-years-carb-x-celebrates-progress- antibiotic-development

“Since its founding in July 2016, the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, better known as CARB-X, has poured more than $361 million into the early-stage development of innovative new therapeutics, diagnostics, and vaccines to tackle the world's most dangerous drug-resistant pathogens….”

Interview with Executive Director Kevin Outterson. CIDRAP News spoke recently with Outterson about what CARB-X has achieved in the past 5 years, the challenges posed by the broken market for new antibiotics, and what lies ahead.

A few excerpts:

“…. what Outterson and others can tell you is that the antibiotic development pipeline, which has been battered in recent years by the broken financial model for new antibiotics, is in better shape because of CARB-X's efforts. Through its 5 years of existence, CARB-X has provided early-stage funding for 92 projects, 10 of which have advanced into phase 1 trials—far exceeding the goals set by the US National Action Plan for Combating Antibiotic-Resistant Bacteria.

…. After us is where there has been the most exciting development, what happens after they graduate from CARB-X. The most exciting entrant is the AMR Action Fund, [which provides] a billion dollars from a lot of the companies that gave up on antibiotics decades ago. Together with the European Investment Bank and the World Health Organization [WHO] and the Wellcome Trust, [they are] collectively committing to invest in 10 to 12 companies around the stage where one would graduate from CARB-X [phase 2 and phase 3 trials], to try to get two to four antibiotics to market.

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… You were one of the authors on a recent paper that found that patients in several high-income countries have limited access to most of the new antibiotics approved since 2010. What is the significance of that study? What does it tell us about the economic challenges that antibiotic developers face? Outterson: There have been 18 antibiotics and antibacterials approved by either FDA, Health Canada, the European Medicines Agency, or Japan since 2010. That looks like success, right? But there are only 3 high-income countries in which a majority of those drugs are available…The United States, England, and Sweden. So if the bulk of the innovative new antibiotics that have come out in the past decade aren't even commercially launched in the G7 and 7 other high- income countries in Europe, then what is the prospect of these drugs being available in the rest of the world that desperately needs new antibiotics?

Ebola

HPW - Cote d’Ivoire Declares First Ebola Outbreak After More Than 25 Years https://healthpolicy-watch.news/cote-divoire-first-ebola-outbreak-25-years/

“The Ivory Coast is the third country to experience an Ebola outbreak in 2021, following on from Guinea and the Democratic Republic of the Congo (DRC), whose outbreak in the eastern province of North Kivu also was quickly squashed with a vaccine drive and declared over in May. But this is the first time an outbreak has occurred in a large capital city such as Abidjan since the 2014-2016 West African Ebola outbreak. That, WHO has said, is a big concern because of the potential for just one individual to infect others in close proximity. “It is of immense concern that this outbreak has been declared in Abidjan, a metropolis of more than 4 million people,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. ….”

Links:

Telegraph - Hundreds vaccinated against Ebola as Ivory Coast races to curb first outbreak in 25 years

UN News - Côte d’Ivoire: Ebola vaccination of high-risk populations begins three days after outbreak declared

“The vaccination against Ebola of high-risk populations began on Monday in Côte d’Ivoire following the discovery of an outbreak in the country three days ago. The swift response came after vaccines manufactured by Merck, which the World Health Organization (WHO) helped to secure to fight a four-month long outbreak in neighbouring Guinea, were quickly sent to the country. … The deployment from Guinea included 2,000 doses that are being used under the “ring strategy,” where people who have come into contact with a confirmed Ebola patient are given the vaccine, as well as first responders and health workers. … Guinea also sent around 3000 vaccine doses manufactured by Johnson & Johnson. These are being used as booster jabs in areas not experiencing active transmission….”

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Planetary health

HPW - Can Greater Health Focus at Glasgow Climate Conference Motivate Tougher Action on Global Warming? https://healthpolicy-watch.news/can-greater-health-focus-at-glasgow-climate-conference-motivate- more-climate-commitments/

Recommended analysis (ahead of the Glasgow COP 26 in November). Excerpts:

“This year’s 26th UN Climate Change Conference of the Parties (COP26), will be a critical moment of decision on climate policies, as the clock runs down before the more severe ravages of global warming become irreversible. Against the panoply of issues under debate, health is getting more attention from this year’s COP26 organisers as a potentially powerful motivating factor for action – although it remains to be seen if that can also translate into more concrete climate commitments from countries. ….” “The COP26 presidency has for the first time ever in the history of climate negotiations put a special emphasis on health – and developed a dedicated Climate Health Programme specifically for COP,” Marina Maiero, a Technical Officer in Partnership and Advocacy as part of WHO’s Climate Change and Health team, told Health Policy Watch. …. “

But it’s still not a central theme.

“… That reflects the long road yet ahead to convince most countries to take up health-related climate commitments, says Sir Andrew Haines, professor of environmental change and public health at the London School of Hygiene and Tropical Medicine. “There is a belated recognition of the importance of health in the climate change agenda – although it’s not one of the official themes,” Haines told Health Policy Watch. … In fact, environmental health experts in WHO, academia and the NGO world, have spent years promoting the health and climate nexus as integral to the climate narrative. The fruits of those efforts are evident in the recent Intergovernmental Panel on Climate Change (IPCC) report, which refer in more detail than ever to the impacts of climate change on human health and well-being. …” …. However, so far, responses fall far short of the mark in most countries … “There are major gaps in considering the health effects of climate change and health in adaptation policies or the co-benefits of GHG mitigation [in countries’ NDCs],” said Haines. He points to a recent analysis of the Nationally Determined Commitments (NDCs) of 40 nations – that looked at how governments’ national climate commitments recognise and respond to the linkages between climate change and health. The “climate and health scorecards” point to gaps in all three policy domains: assessing the health effects of climate change; integrating plans for more climate resilient health systems into climate adaptation strategies, and choosing climate mitigation strategies that also optimise “health co-benefits.”

“The COP26 Health Programme is one of the three COP26 flagship science projects, alongside work on the Climate Risk Assessment and Vision for Net Zero,” said Maiero. “It is not yet visible on the COP26 agenda, but there will be special health events within the science and innovation day.” In terms of the COP26 Health Programme, which bears the logo of the COP26 Presidency, the key priorities are focused more narrowly on health systems, including calling upon countries to invest in building greener and climate resilient health systems. …”

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Lancet series on Heat and Health https://www.thelancet.com/doi/story/10.1016/series.2021.08.16.108853

“…In this two-paper series, the physiological, social, and environmental factors that contribute to individual heat vulnerability, and the megatrends affecting future heat-related morbidity and mortality at the population level, are comprehensively reviewed. Solutions to address the physiological heat strain that underlies the negative health effects of heat extremes and hot weather, which can be employed across a range of settings at individual, building, and landscape scales, are presented.”

Cfr Lancet Press release:

“Extreme heat is a clear and growing health issue, with evidence-based adaptation plans urgently needed to prevent unnecessary deaths

• Health impacts and deaths from extreme heat are increasing and these effects are expected to grow as global temperatures continue to rise. • Climate change mitigation is necessary to help prevent further warming. • Even with strategies in place to slow climate change, global temperatures will continue to rise and environmentally sustainable changes in individual behaviour and to the built environment are urgently needed to adapt to an ever-hotter world.

Extreme heat is an increasingly common occurrence worldwide, with heat-related deaths and illnesses also expected to rise. The authors of a new two-paper Series on Heat and Health, published in The Lancet, recommend immediate and urgent globally coordinated efforts to mitigate climate change and increase resilience to extreme heat to limit additional warming, avoid permanent and substantial extreme heat worldwide, and save lives by protecting the most vulnerable people. In alignment with the Paris Agreement, the Series authors call for global warming to be limited to 1.5°C to avoid substantial heat-related mortality in the future. Reducing the health impacts of extreme heat is an urgent priority and should include immediate changes to infrastructure, urban environment, and individual behaviour to prevent heat-related deaths. The Series is published ahead of this year’s COP26 UN Climate Change Conference in Glasgow, UK….”

“… Health risks of extreme heat: According to a new Global Burden of Disease modelling study, also published in The Lancet, more than 356,000 deaths in 2019 were related to heat and that number is expected to grow as temperatures rise worldwide. However, Series authors note, many heat-related deaths are preventable by mitigating climate change and reducing exposure to extreme heat. …”

Check out also the related Editorial: Health in a world of extreme heat .

Guardian - Humans ‘pushing Earth close to tipping point’, say most in G20 https://www.theguardian.com/environment/2021/aug/16/three-quarters-g20-earth-close-to- tipping-point-global-survey-climate-crisis

“Three-quarters of people in the world’s wealthiest nations believe humanity is pushing the planet towards a dangerous tipping point and support a shift of priorities away from economic profit,

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according to a global survey. The Ipsos Mori survey for the Global Commons Alliance (GCA) also found a majority (58%) were very concerned or extremely concerned about the state of the planet….”

Guardian - A billion children at ‘extreme risk’ from climate impacts – Unicef https://www.theguardian.com/environment/2021/aug/20/a-billion-children-at-extreme-risk-from- climate-impacts-unicef

“Almost half the world’s 2.2 billion children are already at “extremely high risk” from the impacts of the climate crisis and pollution, according to a report from Unicef. The UN agency’s head called the situation “unimaginably dire”. Nearly every child around the world was at risk from at least one of these impacts today, including heatwaves, floods, cyclones, disease, drought, and air pollution, the report said. But 1 billion children live in 33 countries facing three or four impacts simultaneously. The countries include India, Nigeria and the Philippines, and much of sub-Saharan Africa. The report is the first to combine high-resolution maps of climate and environmental impacts with maps of child vulnerability, such as poverty and access to clean water, healthcare and education….”

“…The report was launched with youth climate activists on the third anniversary of Greta Thunberg’s first school strike, which sparked a global movement. After a pause in public demonstrations during the coronavirus pandemic, a global climate strike is planned for 24 September….”

Harvard - Protecting forests and changing agricultural practices are essential, cost-effective actions to prevent pandemics https://www.hsph.harvard.edu/c-change/news/PreventingPandemicsResearch/

“A new report from Harvard and international experts outlines the strong scientific foundations for taking actions to stop the next pandemic by preventing the spillover of pathogens from animals to people. The report provides recommendations for research and actions to forestall new pandemics that have largely been absent from high-level discussions about prevention, including a novel call to integrate conservation actions with strengthening healthcare systems globally. The report from the Scientific Task Force to Prevent Pandemics at the Source, a collaborative convened by Harvard Chan C-CHANGE and the Harvard Global Health Initiative, was led by our Director, Dr. Aaron Bernstein….”

Afghanistan

Devex –Afghanistan: Aid organizations face uncertain future under Taliban https://www.devex.com/news/afghanistan-aid-organizations-face-uncertain-future-under-taliban- 100619

“Afghan aid workers have vowed to continue working but access, freedom of movement, and funding will be some of the biggest challenges.”

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• See also The Telegraph - 'Stay and deliver': what is the future for aid in the Taliban's Afghanistan?

“While emergency aid is likely to continue, the outlook could be bleak for development and girls' education projects”

“… aid agencies in Afghanistan are also confronting a difficult question: how to help those left behind. For the vast majority contacted by The Telegraph on Monday - including Médecins Sans Frontières, Mercy Corps, the International Committee of the Red Cross (ICRC), and several United Nations agencies - that means entering talks with the newly triumphant Taliban to ensure their work can continue. “Stay and deliver” is the mantra, echoed last week by new UN humanitarian chief Martin Griffiths. …”

• Devex - Afghan aid workers targeted by Taliban but excluded from UK evacuation

“Development organizations are urgently calling for the United Kingdom’s Afghan relocation policy to be expanded amid fears that aid workers who supported U.K.-funded programs are being “hunted down” by the Taliban. … …. With the Taliban now in control of the country, thousands of Afghans who worked with development organizations funded by international donors are believed to be at severe risk because of their perceived association with Western countries.”

• Devex: https://www.devex.com/news/devex-newswire-the-threat-to-aid-workers-under- the-taliban-100637

« While dwarfed by military spending, incredible amounts of official development assistance were spent in Afghanistan over the past decade. A total of $50 billion made its way to the country between 2010 and 2019. Devex’s data team analyzed its top donors — and focused more specifically on gender equality funding, given ongoing questions about how those projects may be affected by the Taliban takeover….”

Devex - Devex Newswire: Should a Taliban-led Afghanistan get development funds?

Update as of 19 August.

HPW – WHO Rolling Out Emergency Aid in Afghanistan – Stresses Importance of Retaining Women Health Workers https://healthpolicy-watch.news/who-emergency-aid-afghanistan/

“WHO has affirmed that it is staying in Afghanistan and providing emergency aid to the tens of thousands of recent victims of conflict and displacement – even as staff in some NGOs go into hiding or desperately seek to leave the country for fear of their lives. “

… Supplies and support for mass casualty response, trauma care, cholera and diarrhoeal disease prevention and management, are among the top priorities, WHO has said. Addressing the needs of displaced populations – including malnutrition, high-blood pressure, COVID and reproductive health, are also critical priorities, Al Mandhari stressed in his statement, also emphasizing the need to ensure women access to female health workers. …“

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“… WHO also pointed out an “immediate need” for sustained humanitarian access and health services in Afghanistan, placing special emphasis on women’s health and displaced populations.”

“… Along with WHO, the International Rescue Committee, and UN humanitarian staff say that they’re committed to staying in the country to assist displaced and vulnerable populations – while further operations for other organizations seem more uncertain. …”

See also Devex - Amid Afghanistan’s political crisis, a health system at ‘breaking point’

And Devex - WHO regional polio director expects Taliban to support polio program

Lancet Commission on cancer and health systems

Lancet Comment - The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions F M Knaul et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01895- X/fulltext

“…The new Lancet Commission on cancer and health systems (panel) proposes a diagonal approach to harness linkages and forge a synergistic and mutually symbiotic relationship to improve outcomes. …” Do check what the Commission has in mind.

Decolonize Global Health

A few new reads well worth checking out:

• Lancet Global Health – Voices in the wilderness: how exclusionist article processing charge policies of academic journals underscore what is wrong with global health (by B Edem et al)

“… In response to The Lancet Global Health's call for articles on what is wrong with global health, we reviewed the conditions for an APC waiver or discount in 13 major global health journals….”

• Lancet Global Health (Essay) - Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship (by T Naidu)

Quote: “…. Northern ventriloquism occurs when LMIC scholars enunciate HIC ideas to access globally competitive grants and publish in high-impact journals. HIC scholarship uses its position to dictate structures and set priorities for the content, relevance, and timing of publications. Academic English is a key marker of academic authorship, so LMIC researchers might collaborate with HIC-based colleagues to “westernise the voice and the arguments” in their manuscripts to ensure publication in HIC journals …. …. Northern ventriloquism results in researchers mimicking foreign poses for foreign

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ratification, thus strengthening HIC dominance while extinguishing the LMIC episteme, a process that decolonial scholar de Sousa Santos calls epistemicide….”

• BMJ Global Health - The absurdity of research registration for community-oriented knowledge coproduction (by Kaaren Mathias et al)

World Humanitarian Day (19 August)

Lancet (Comment) - More than honour, humanitarian health-care workers need life-saving protection E Langlois et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01892- 4/fulltext

« Honouring all humanitarian workers, including health-care professionals, Aug 19, 2021, marks the second World Humanitarian Day since the start of the COVID-19 pandemic. Many humanitarian workers have given their lives to support and protect the communities they serve, including millions of the world's most vulnerable women, children, and adolescents. But humanitarian workers need more than honour: they need support and protection themselves. Settings for humanitarian health care have become increasingly complex: at the crossroads of conflict, social and economic fragility, a global pandemic, and a growing climate crisis. The climate emergency, and its impact on humanitarian contexts, is the central theme of the World Humanitarian Day 2021, calling on greater action to address the needs of the people most vulnerable to the effects of climate change and the essential workers caring for them….”

Other news of the week

World Bank - World Bank and Partners Announce New Global Fund for Cybersecurity

World Bank

“The World Bank announced …. the launch of a new Cybersecurity Multi-Donor Trust Fund under the broader Digital Development Partnership (DDP) umbrella program. …”

Devex - Zenysis aims to be government 'operating system' in low-income nations https://www.devex.com/news/zenysis-aims-to-be-government-operating-system-in-low-income- nations-100438

“A Silicon Valley startup that has developed a data interoperability platform to improve the delivery of health care and other public services is expanding its work in Mozambique. Zenysis Technologies, with financial support from Gavi, the Vaccine Alliance, will work with Mozambique’s government “to strengthen national childhood vaccination programs and outbreak response

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capabilities.” … Zenysis works in low- and middle-income countries where data is often fragmented, due in part to projects that are developed according to outcomes that donors want to see and then phased out when grants end…. In addition to Mozambique, Zenysis works in Brazil, Pakistan, South Africa, Zambia, Benin, Ethiopia, and Rwanda, as well as for the RBM Partnership to End Malaria, which operates globally….”

Reuters – Ebola, other outbreaks, atop COVID-19, risk straining West Africa health systems -WHO https://www.reuters.com/world/africa/ebola-other-outbreaks-atop-covid-19-risk-straining-west- africa-health-systems-2021-08-19/

“The World Health Organisation warned on Thursday that on top of the COVID-19 pandemic, West Africa is facing new outbreaks of the viral haemorrhagic fevers Marburg and Ebola, risking huge strains on ill-equipped health systems.”

Some papers of the week

Health Systems & Reform - Equity and Health Systems: Special Issue in Honor of Adam Wagstaff https://www.tandfonline.com/toc/khsr20/7/2?nav=tocList

Issue in progress. Quite some papers are already online.

Check out, for example: Will the Quest for UHC be Derailed? (by Susan Sparkes et al)

“COVID-19 has shocked all countries’ economic and health systems. The combined direct health impact and the current macro-fiscal picture present real and present risks to health financing that facilitate progress toward universal health coverage (UHC). This paper lays out the health financing mechanisms through which the UHC objectives of service coverage and financial protection may be impacted. Macroeconomic, fiscal capacity, and poverty indicators and trends are analyzed in conjunction with health financing indicators to present spending scenarios. The analysis shows that falling or reduced economic growth, combined with rising poverty, is likely to lead to a fall in service use and coverage, while any observed reductions in out-of-pocket spending have to be analyzed carefully to make sure they reflect improved financial protection and not just decreased utilization of services. Potential decreases in out-of-pocket spending will likely be driven by households’ financial constraints that lead to less service use. In this way, it is critical to measure and monitor both the service coverage and financial protection indicators of UHC to have a complete picture of downstream effects. The analysis of historical data, including available evidence since the start of the COVID-19 pandemic, lay the foundation for health financing-related policy options that can effectively safeguard UHC progress particularly for the poor and most vulnerable. These targeted policy options are based on documented evidence of effective country responses to previous crises as well as the overall evidence base around health financing for UHC.”

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SS&M - The anthropology of health systems: A history and review S Closser et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953621006468

“Ethnographies of health systems are a rapidly growing area in medical anthropology. Anthropologists have much to offer Health Policy & Systems Research. There is a long history of such work within anthropology. Ethnographies provide nuanced understandings of the systems that shape health. Anthropological work could benefit from engagement beyond the discipline.”

International Journal of African Renaissance studies - Decolonising the Discourse on Resilience

C Amo-Agyemang; https://www.tandfonline.com/doi/abs/10.1080/18186874.2021.1962725

“This article presents a discursive critique of the Eurocentric paradigms of knowledge production that characterise much of the underlying logics in the age of neoliberal discourses on resilience, pointing out important areas not given sufficient attention. In particular, it highlights the limits of the modernist ontology of resilience, whereby extremely “vulnerable” African communities are encouraged “to become resilient” to climatic disruption and environmental catastrophe and to “bounce back” as rapidly as possible. The article moves the discussion forward, drawing from critical decolonial approaches, in alignment with Indigenous knowledges, to question and rethink meaningful alternative ontologies, ways of knowing and being, in adaptive governance. I argue that the recognition of the plurality of many worlds, rather than one world, highlighted through critical decolonial understandings of epistemic forms with Indigenous knowledges, can be counterposed to Western universality as an innovative ontology to decentre the world order in the problematic dominant development of resilience thinking.”

BMJ Global Health - Research within international non-governmental organisation programmes in low and middle-income countries: challenges amid opportunities S M Ishaku et al; https://gh.bmj.com/content/6/8/e006210

“Despite the increasing number of health programme activities implemented by the international non-governmental organisations (INGO) in low and middle-income countries (LMICs), there has not been commensurate rise in research outputs in these settings. Lack of quality research that addresses pertinent health challenges in this population is retarding our progress to answering relevant health questions. Weak health systems with poor quality routine data, lack of objective outcome measures and conflict of interest between donors, implementers and researchers are some of the challenges militating against research outcomes in LMICs. Promoting INGO–academia collaboration could enhance generation of quality research outputs from LMICs as the two partners complement their strengths and shortcomings. While academia is better placed to provide sound theoretical, methodological, technical expertise, NGOs align research efforts with local needs and political realities and communicate research findings to policymakers.”

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Annals of Global Health - Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe D Rodriguez et al ; https://www.annalsofglobalhealth.org/articles/10.5334/aogh.3194/

“The changing global landscape of disease and public health crises, such as the current COVID-19 pandemic, call for a new generation of global health leaders. As global health leadership programs evolve, many have incorporated experiential learning and mentoring (ELM) components into their structure. However, there has been incomplete consideration on how ELM activities are deployed, what challenges they face and how programs adapt to meet those challenges. This paper builds on the co-authors’ experiences as trainees, trainers, organizers and evaluators of six global health leadership programs to reflect on lessons learned regarding ELM. We also consider ethics, technology, gender, age and framing that influence how ELM activities are developed and implemented. »

Among the six: EV4GH, CHEPSAA, … Check out the findings.

Part of a Special Collection - Capacity Building for Global Health Leadership Training

“….In this supplement, we reflect on the experience of several established Global Health Leadership programs across a range of professional domains and discuss several key features of successful training programs….”

Some tweets of the week

Adam Kamradt-Scott “An idea for @antonioguterres & @DrTedros : is it time for a permanent Independent Panel on Pandemic Preparedness equivalent to @IPCC_CH that brings together 200+ multidisciplinary experts from across to inform evidence-based policies & monitor progress? #COVID19 #BuildBackBetter.”

Seye Abimbola Comments on: Underrepresentation of developing country researchers in development research

“…and this won’t change until we acknowledge that 1. academic global health/development is of, for, & by the ‘North’ 2. bringing ‘Southern’ voices into a ‘Northern’ conversation is not progress 3. academic global health/development has to be reimagined as a ‘Southern’ space. 4 Let’s not limit our imagination to the margins of the North - e.g., how can the Northern academy accommodate Southern voices; or how should Northern funders change their practices 5. Here are more thoughts:

“The uses of knowledge in global health” https://gh.bmj.com/content/6/4/e005802…”

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Dr Tedros https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at- the-media-briefing-on-covid-19---18-august-2021

“Vaccine injustice is a shame on all humanity and if we don’t tackle it together, we will prolong the “acute stage of this pandemic for years when it could be over in a matter of months. When G20 health ministers meet on the 5th and 6th of September in Rome, I will call on them to consider the fragility of this historic moment and make a clear defining commitment to solidarity. “

“In this context, I was stunned by the news that J&J vaccines fill and finished in South Africa are leaving the continent and going to Europe, where virtually all adults have been offered vaccines at this point…..”

Aju Mathew “All the famous global/public health schools in the US that failed to speak up against booster- shots-for-all-Americans while the rest of the world is awaiting their first shot has failed in their pre-eminent mission. #Covid19 #publichealth #medtwitter #globalhealth”

Clare Wenham “Perhaps a controversial opinion, but this “origins of covid” witch hunt is a smoke screen by global health community / western governments. Yes, we need to know so we can prevent in future But can we not focus on the abysmal pandemic management globally instead?”

Global governance of health

IPS - UN Preaches Transparency to the Outside World but Fails to Practice it in its Own Backyard http://www.ipsnews.net/2021/08/un-preaches-transparency-outside-world-fails-practice-backyard/

“A coalition of 380 civil society organizations, along with 746 individuals, have expressed their “concerns with the process to recruit a new UN Women Executive Director”

Devex - Is Samantha Power taking on the aid establishment? https://www.devex.com/news/is-samantha-power-taking-on-the-aid-establishment-100481

“Power has signaled she wants to shift the agency’s funding away from the usual suspects. ...in the background, Power has repeatedly suggested she is not satisfied with the agency’s current mix of implementing partners and signaled to potential allies that she is interested in making changes. Power has kept up a steady and familiar drumbeat for the need to shift USAID’s funding to local partners. ….… Power would not be the first USAID administrator to take on a procurement reform agenda aimed at broadening the agency’s partner base. …”

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China aid blog - “Seven Decades of Foreign Aid. Braving Wind and Rain on Five Continents” http://china-aid-blog.com/2021/08/18/new-head-of-cidca-luo-jianbos-article-in-the-peoples-daily- to-commemorate-the-70th-anniversary-of-chinese-aid/

“Along with the centenary of the CCP in 2021, #China is also officially celebrating the 70th anniversary of #ChineseAid. The RMRB published an essay by #CIDCA's head Luo Zhaohui: “Seven Decades of Foreign Aid. Braving Wind and Rain on Five Continents”.”

With 5 key takeaways.

Think Global Health – Here We Go Again: U.S. Policy and Health Security

D Fidler; https://www.thinkglobalhealth.org/article/here-we-go-again-us-policy-and-health-security

“Framing pandemics as security threats failed to prepare the United States for COVID-19.” “…Why, then, is health security again at the forefront of U.S. policymaking?”…. Good question.

Quote: “The perennial claim that a harmony of interests exists between low-income and high- income countries on health security was threadbare before COVID-19. The behavior of the United States and other high-income countries during the pandemic has thoroughly shredded that proposition. In a common health security crisis, “no one is safe until everyone is safe” has not been a principle identifiable in the responses of high-income countries, especially concerning vaccine access. In health security, as with all security issues, there is a hierarchy, not a harmony, of interests.”

UHC

Links:

Global Health Action - Research for universal health coverage: setting priorities for policy and systems research in Uganda (by F Ssengooba et al)

BMJ Global Health - Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives (by D O Afriyie et al)

Planetary health

Guardian - Global water crisis will intensify with climate breakdown, says report https://www.theguardian.com/environment/2021/aug/17/global-water-crisis-will-intensify-with- climate-breakdown-says-report

“Flooding, droughts and wildfires will worsen as global heating disrupts the planet’s water cycle.”

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“Water problems – drought, with its accompanying wildfires, and flooding – are likely to become much worse around the world as climate breakdown takes hold, according to the biggest assessment of climate science to date. Global heating of at least 1.5C is likely to happen within the next two decades, according to the Intergovernmental Panel on Climate Change. Temperature rises will be accompanied by big changes in the planet’s water cycle, with areas that are already wet becoming much wetter, and already arid areas becoming prone to greater drought. Extreme rainfall intensifies by 7% for each additional 1C of global heating, the report found…..”

Guardian - Major UN biodiversity summit delayed for third time due to pandemic https://www.theguardian.com/environment/2021/aug/18/cop15-un-biodiversity-summit-hit-by- third-delay-due-to-pandemic-aoe

“A key United Nations biodiversity summit has been delayed for a third time due to the pandemic, the Chinese environment ministry has announced, as environmentalists pledged the delay would “not mean taking our foot off the pedal”. In a statement, the Chinese ministry of ecology and environment confirmed that Cop15, the biggest biodiversity summit in a decade, would be delayed, and that negotiations for this decade’s targets will be split into two phases so that governments can meet face-to-face in Kunming, China, in the first half of 2022. The talks had been scheduled for October this year after two previous delays due to the coronavirus pandemic. …” “The first phase of the meeting, which will be largely procedural, will be held in the Chinese city between 11 and 15 October, with most people attending virtually. Countries will then negotiate the targets for the global biodiversity framework that governments will aim to meet by the end of the decade in Kunming from 25 April to 8 May 2022….”

Infectious diseases & NTDs

Lancet Infectious Diseases (Editorial) - An eventful 20 years https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00408-4/fulltext

This (August) issue marks 20 years of publication of The Lancet Infectious Diseases.

“… Over two decades, seldom a year has passed without news of an emerging infectious disease outbreak with global ramifications, from SARS in 2003 to influenza A H5N1 from 2004, pandemic influenza A H1N1 in 2009, Ebola virus disease in west Africa in 2013–16, Zika virus disease in the Americas in 2015–16, and now the COVID-19 pandemic. Yet, as the Editorial in our first issue of August, 2001, discussed, the greatest infectious diseases threat of all might be the emergence of organisms resistant to antimicrobial drugs….”

Lancet Infectious Diseases (Editorial) - COVID-19 vaccine equity and booster doses https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00486-2/fulltext

The Lancet Infectious diseases’ take on this very controversial issue.

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“The debate on COVID-19 vaccine equity has been long-running, and we have previously weighed in on the topic. However, the facts that (1) by Aug 9, only 12·6 million of the 4·46 billion doses administered globally were in low-income countries, (2) 3·65 billion have been administered in high- income (HICs) and upper-middle-income countries, and (3) WHO Director-General Tedros Adhanom Ghebreyesus actually had to issue a plea for a moratorium on third-dose boosters in HICs on Aug 4, mean that we, again, need to add our voice to the demand for equitable access to vaccines….”

Telegraph - World's largest catalogue of tuberculosis samples identifies 17,000 mutations Telegraph;

“The database is crucial, experts say, to better understand both how TB is evolving to evade drugs and which treatment a given patient needs…”

Uganda Confirms Polio Outbreak https://www.africanews.com/2021/08/17/uganda-confirms-polio-outbreak/

“The Ministry of Health has declared Polio a Public Health Emergency in Uganda following confirmation of positive laboratory tests from environmental samples in Kampala. The samples were collected from the sewage plants in Bugolobi and Lbigi which are two of the sentinel environmental surveillance sites in Kampala….”

And a link:

BMJ GH - 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation

Results: “Pursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.”

NCDs

BMJ Editorial - Corporate ventriloquism undermines action on alcohol harms M Van Schalkwyk et al; https://www.bmj.com/content/374/bmj.n1879?utm_source=twitter&utm_medium=social&utm_ter m=hootsuite&utm_content=sme&utm_campaign=usage

“Industry, women’s rights, and WHO’s draft alcohol strategy.”

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“Alcohol remains a serious global health concern, with a pressing need to reduce consumption among specific population segments, particularly youth, people who are pregnant or planning a pregnancy, and those drinking heavily. These considerations are reflected in the World Health Organization’s draft 2022-2030 global alcohol strategy, which is intended to facilitate consultations with member states, civil society, economic operators, and individuals. The draft attracted criticism for one sentence in the areas for action, which included the statement that “appropriate attention” should be given to “prevention of drinking among pregnant women and women of childbearing age,” as well as drinking among young people and protecting people from pressures to drink. The Portman Group—the UK alcohol industry’s “social responsibility body”—responded with a press release describing this passage as “sexist and paternalistic” and accusing WHO of overstepping its remit. This was picked up by UK newspapers and followed by a Twitter storm that provoked further media coverage focused on perceived paternalism…..”

Lancet Global Health - Vision impairment and traffic safety outcomes in low- income and middle-income countries: a systematic review and meta-analysis P Pyasena et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00303- X/fulltext

The authors aimed to systematically analyse the current evidence to establish whether any aspects of vision, and particularly interventions to improve vision function, are associated with traffic safety outcomes in LMICs.

Links:

• WHO - Bucharest, Cairo, Córdoba, Dublin, Greater Manchester, and Warsaw Join Bloomberg Philanthropies’ Partnership for Healthy Cities

“ With $31 million investment, Bloomberg Philanthropies expands initiative to 70 cities creating healthier urban environments.”

• BMJ GH - Food and beverage industry interference in science and policy: efforts to block soda tax implementation in Mexico and prevent international diffusion

Sexual & Reproductive / maternal, neonatal & child health

UN News - Childhood cancer care in Africa hit hard by COVID-19 pandemic https://news.un.org/en/story/2021/08/1097752

“Nearly 30,000 children in sub-Saharan Africa are believed to have died from cancer during the COVID-19 pandemic, according to the Regional Office of the World Health Organization (WHO). Drastic measures to prevent coronavirus spread, and heightened focus by health systems on response, led to disruptions in other essential health services on the continent. Cancer screening and treatment, including for childhood cancers, were hit especially hard. ….”

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“A WHO survey found screening was affected in 46 per cent of countries, while 13 per cent reported a more than 50 per cent disruption. ….”

Lancet - Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019 GBD 2019 under-5 mortality collaborators https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01207-1/fulltext;

“…Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress….”

Related Lancet Comment - In-country data will illuminate under-5 mortality disparities

Lancet Letter - 40th anniversary of the WHO International Code of Marketing of Breastmilk Substitutes S Forsyth; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01604-4/fulltext

“The WHO International Code of Marketing of Breastmilk Substitutes is a seminal document, but to maintain this status it needs to be relevant to contemporary society; if not, there is the risk that it presents as a problem rather than a solution. A joint statement in 2021 by UNICEF and WHO on the 40th anniversary of the Code noted that, with regards to implementation during the 40-year period, only 25 countries (12·7% of the 197 countries worldwide) have implemented measures that are substantially, but not necessarily fully, aligned with the Code. The 40th anniversary was an opportunity to revisit the original concept, reflect on progress, and invite new thinking on how this document might be more effective for nations in the 21st century. The reluctance to independently review the Code after 40 years raises the suspicion that WHO is concerned that in its current form, under close examination, it would be found wanting….”

PS: “SF reports a consultancy contract with DSM Nutritional Products; consultancy fees from Danone, DSM Nutritional Products, and SciOpinion; received funding to attend scientific meetings from DSM Nutritional Products; and is a member of the Early Life Nutrition and Health Task Force at the International Life Sciences Institute.”

Links:

Plos Med - Investigating barriers to the protective efficacy provided by rotavirus vaccines in African infants

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International Health - Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries

International Journal for Equity in Health – Family planning for urban slums in low- and middle- income countries: a scoping review of interventions/service delivery models and their impact

Cidrap News - Study casts doubt on WHO guidance on antibiotics for neonatal sepsis

“New research by an international team of scientists raises questions about the recommended treatment for neonatal sepsis in low- and middle-income countries (LMICs). Published last week in The Lancet Infectious Diseases, the analysis of newborns diagnosed with sepsis in seven LMICs across Africa and South Asia found extremely high rates of resistance to ampicillin and gentamicin, the combination therapy recommended by the World Health Organization (WHO) for empiric treatment of neonatal sepsis. The study also found that children treated with a different combination therapy—ceftazidime and amikacin—had lower death rates….”

Access to medicines

Global Public Health - Mapping buyer’s clubs; what role do they play in achieving equitable access to medicines?

N Rhodes & R van de Pas; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1959940

“Buyer’s clubs were first recognised during the HIV/AIDS pandemic in the 1980s and focussed on knowledge curation and distribution of treatments. In the past decade, there has been a resurgence of buyer’s clubs, mostly focussed on hepatitis C treatment and PrEP. This paper aims to increase understanding of buyer’s clubs and stimulate discussion on their role in achieving equitable access to medicines…..”

Human resources for health

Links:

HHR - Charting the Rights of Community Health Workers in India: The Next Frontier of Universal Health Coverage (J Shanthosh et al)

HHR - The impact of colonial-era policies on health workforce regulation in India: lessons for contemporary reform (by V Sriram et al)

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Extra Covid section

SS&M - Emergence of knowledge communities and information centralization during the COVID-19 pandemic P L Sacco et al ; https://www.sciencedirect.com/science/article/abs/pii/S0277953621005475

The authors studied “200 million interactions captured from Twitter during the early stage of the pandemic, from January to April 2020, to understand its socio-informational structure on a global scale.” Findings: “The COVID-19 global communication network is characterized by knowledge groups, hierarchically organized in sub-groups with well-defined geo-political and ideological characteristics. Communication is mostly segregated within groups and driven by a small number of subjects: 0.1% of users account for up to 45% and 10% of activities and news shared, respectively, centralizing the information flow.” Interpretation: “Contradicting the idea that digital social media favor active participation and co-creation of online content, our results imply that public health policy strategies to counter the effects of the infodemic must not only focus on information content, but also on the social articulation of its diffusion mechanisms, as a given community tends to be relatively impermeable to news generated by non-aligned sources.”

BMJ GH - Time for action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind S Heidari et al ; https://gh.bmj.com/content/6/8/e006854

“…. It is … imperative that an intersectional gender lens be systematically applied to development and deployment of COVID-19 vaccines. Integral to this approach is meaningful engagement of women at all levels to ensure that scientific, policymaking and programmatic decision-making processes benefit from their leadership, expertise and perspectives. This article presents a rationale and recommended actions for incorporating sex and gender dimensions in current and future COVID-19 vaccine development and deployment efforts to fast-track an end to the pandemic in an equitable way.”

Nature – Iran hopes to defeat COVID with home-grown crop of vaccines Nature ;

“ Nature talks to vaccine developer Kayhan Azadmanesh about efforts in Iran to develop ten or more COVID jabs, two of which have been approved for use.”

Reuters - COVID-19 risks in young adult males may be under-recognized -study Reuters;

“Young men could be at higher risk of contracting COVID-19 than is currently recognized, researchers have suggested, citing computer models. … Coronavirus infections in younger age groups are going undetected and young men in particular may be silent drivers of infections in older adults, a Canadian research team wrote in Annals of Internal Medicine on Tuesday….”

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NEJM (Perspective) – The Covid-19 Infodemic — Applying the Epidemiologic Model to Counter Misinformation https://www.nejm.org/doi/full/10.1056/NEJMp2103798?query=featured_secondary

Read all about ‘infodemiologists’ and the like .

Links:

BMJ - Covid-19: How many variants are there, and what do we know about them?

“Eight notable variants of SARS-CoV-2 have been found since September 2020. Elisabeth Mahase reviews the line-up so far.”

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