IHP News 594 : “We Are Family!”

IHP news 594 : “We Are Family!”

( 23 October 2020))

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,

As you probably already know by now, earlier this week WHO announced that one of the great disco era anthems is being refashioned as a “clarion call” for the COVID-19 pandemic, “We Are Family”. Should be fun at the upcoming World Health Assembly, with Kim Sledge et al. Yes, I know, most of the times, mankind rather looks like a dysfunctional family, but it’s a nice gesture and campaign nevertheless. And still way catchier than the Disney-Like Parody Video, ‘Wear A Mask’. Bet dr. Tedros is a better dancer than The Donald too ! ( but granted, that’s a bit like taking ‘Ground Zero’ as a benchmark )

We all can use a bit of diversion these days, certainly in the Northern Hemisphere, where “pandemic fatigue” is palpable and the prospect of a second (or even third) wave in grim autumn/winter days isn’t exactly enticing. Virologists again dominate our screens (never a good sign), and so my wife and I lately have been watching yet another silly Netflix series, ‘Emily in Paris’, as I lack the balls to go to tiny arthouse cinemas these days and it can’t always be Bayern Münich. The series is the ideal antidote for the daily (pandemic/climate emergency) "doomscrolling" on social media and “Zoom and Gloom”. Emily is a young American “influencer” trying to find her way in a Paris-based fashion marketing firm. Although the series is full of dumb clichés, you cannot help but wonder what Emily would suggest to global health and HPSR youngsters/”influencers”, trying to shake up the global health world. I bet that for the Decolonialize Global Health Movement, for example, she might recommend to alumni to ritually burn all their big global health institutes’ t-shirts (Harvard, JH, LSHTM, McGill, ITM …), in one big “bonfire” ( hashtag #DecolonializeGHChallenge ) .

In the era of a Syndemic Pandemic, we all crave to be ‘systemic Pasteurists’ ( a term I learnt about this week in the Covid SSA Googlegroup). It’s a tall order for everybody, including, very much so, the currently beleaguered decision makers. And yet, we must try. The upcoming (virtual) global HSR symposium ( 8-12 November), neatly introduced by Sara Bennett on Youtube, should give us all some inspiration. And before that, the ITM colloquium (27-29 Oct)! Also fully digital, this year.

Enjoy your reading. And keep sane.

Kristof Decoster

Featured Article

Meeting old demands and rising to new challenges: Revisiting the role of Ethiopian health extension workers in the prevention and control of NCDs amid COVID-19

Azeb Gebresilassie Tesema (PhD student, Health Systems Science, The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia. School of Public Health, Mekelle University, Tigray, Ethiopia; EV 2020)

In many parts of the world, COVID-19 has caused sudden disruption in essential health services, including for non-communicable diseases (NCDs). A recent WHO report indicated that, due to the pandemic, as many as 75 % of its member states had experienced acute service interruptions for NCDs. The pandemic has hit hard both ostensibly “strong” and fragile health systems. In the latter, community health workers have been embraced to mitigate health workforce shortages associated with the pandemic and to maintain essential health services. That has also been the case in my country, Ethiopia. Since the first few COVID-19 cases were detected in Ethiopia seven months ago, the country’s health extension workers (HEWs) have been instrumental in responding to the pandemic and keeping up essential health services. Till recently, however, they’ve had a negligible role in the prevention and control of NCDs. With an already substantial NCD burden in Ethiopia, and an anticipated further increase in the coming years, it seems crucial for the country to revisit the “HEW army” gaps, in order to make this relatively abundant health workforce ready for the additional NCD tasks.

Below I offer some thoughts on how to do so.

Needs are evolving, so should models of care

Across the globe, COVID-19 continues to have far-reaching consequences on the way we live our lives. In many parts of the world, the health system is under severe strain, including the capacity to provide NCD services. The health systems “stress test” has to deal with, among others, supply chain stress, diversion of resources and fear of infection among health workers and the public. Moreover, the stay at home policies (during the lockdown), the policies on social distancing and the resulting economic hardship being witnessed across countries have heightened risks of sedentary life, mental health, hypertension, and drug and alcohol abuse. This is even more true for low- and middle-income countries than for affluent nations, putting further pressure on already overstressed systems.

Against this overall backdrop, the health system needs to be re-defined to maintain essential services and restore people’s trust, but also to meet both COVID-19 related requirements and newly emerging NCD service needs. In many resource constrained countries, CHWs are relatively abundant and accessible to the community, but their role and skill set need to be reinforced to meet old demands and address newly emerging challenges.

The missing link

Community-based NCD prevention and control through the involvement of HEWs is relatively new in Ethiopia. The urban health extension program covering NCD services was introduced only a decade ago, in 2010, and the program is even more recent, dating back to 2015/2016, in rural Ethiopia, where over 80 % of the population reside. As a result, coverage of NCD services is low, even by sub-Saharan Africa standards.

This is corroborated by preliminary findings from my own PhD work. HEWs are less involved in delivering NCDs services, and they are ill equipped to provide needed services, and this despite the fact that a significant number of HEWs, particularly those with a diploma level training, had formal training on NCDs in school. These early PhD findings are further supported by a national evaluation study conducted last year, which revealed that HEWs are the least acknowledged source of information on NCDs in the communities where they are supposed to provide such services.

What needs to be in place?

Since Ethiopia reported its first COVID-19 case on March 13, 2020, infections have increased steadily, with over 88 thousand cases as of October 18th, 2020. For many Ethiopians, the economic and social hardship has been enormous too, creating immense pressure on individuals and families, with direct ramifications on health conditions and service need. More specifically, the dire situation also further affects NCD risk factors and exacerbates the already high burden of NCDs in the country. In 2019, before the pandemic struck, 32 % of total deaths and 33 % of disability adjusted life-years in Ethiopia were due to NCDs. Engaging the country’s HEWs is thus more than necessary to expand essential NCD services and to ensure that these are delivered on time and with an acceptable quality of care.

Over the last two decades, Ethiopia’s HEWs have been extensively involved and successfully so, in the promotion, prevention and delivery of essential health services, especially in the provision of maternal and child health, tuberculosis, HIV and malaria related services. The success of HEWs in these areas was primarily linked to political leadership, reasonable resource commitments, effective and supportive supervision, and the existence of a well-defined program of action. As well as their own drive and commitment, of course. Availability of ongoing training opportunities for HEWs also meant that they were able to boost their skill base and readiness to provide needed services.

Success in the prevention and control of NCDs through the HEW program requires building on the success story of the past, but also re-alignment and an updated vision that combines both long- and short-term strategies. Currently, the Ethiopian government has a mobile phone based short-term training program directed towards training HEWs for COVID related response efforts. The training is also meant to boost their skill base to provide needed essential health services. However, on aspects related to NCDs, the training provides limited learning opportunities. Areas of focus need to include: (a) availing adequate and simplified content about the prevention and control of NCDs; (b) sufficiently integrating NCD topics into the existing training modalities; (c) strengthening supportive supervision from the district and primary health care unit; (d) explicitly integrating an NCD component in the supervision process; and (e) collate, report and use NCD data for program implementation and decision making. Furthermore, advocacy and support from high level policy makers will be key, as well as protecting, motivating and providing psycho-social support to the HEWs themselves.

In Ethiopia, HEWs are one of the critical resources of the health system. They are relatively abundant and easily accessible for the poor majority in the country. However, their effectiveness to deliver

needed services is intertwined with their skill set and their (career) opportunities within the health system. As I have argued above, the HEWs need to be empowered, supported, and offered opportunities to boost their knowledge base and skill set on NCDs so that they are ready for action. Only then, the country will be able to meet old demands and rise to emerging challenges within the current resource constraints.

Highlights of the week

Coming up very soon: virtual (61st) ITM colloquium: Implications of COVID-19 for global and local health, and beyond (27-29 October) https://colloq2020.com/

Next week! Full digital, “Covid oblige”. You can register here.

Global Health governance

Geneva Health Files (newsletter issue) - A peek into COVAX machine; The curious case of the prequalification of Remdesivir P Patnaik; Geneva Health Files;

Content of the newsletter this week: “… Our story this week, takes a close look inside Gavi’s COVAX Facility - its governance structures and contracts with countries. Thorny issues of liability provisions and cost-sharing, especially with respect to low-income countries continue to be hashed out. … In addition, we also try to understand why Remdesivir was prequalified a day before WHO announced the results of its Solidarity Trial, declaring its ineffectiveness in treating COVID-19….”

The Covax feature story has two parts: the state of play on the contracts negotiated by the COVAX Facility; and the proposed governance structures. Must-read!!!!

Reuters - Exclusive: In WHO overhaul push, EU urges changes to handling of pandemics Reuters;

“The European Union wants the World Health Organization to become more transparent about how states report emerging health crises, a draft proposal on reforming the U.N. agency says, following criticism of China’s initial handling of the COVID-19 pandemic. The paper, drawn up by the German government after discussions with other member states, is the latest to outline the EU’s months-long plans to address the WHO’s shortcomings on funding, governance and legal powers. The document, dated Oct. 19 and seen by Reuters, urges the WHO to adopt measures that would

increase “transparency on national compliance” with International Health Regulations. These require WHO member states to quickly share information on health emergencies….”

“… The EU draft will be discussed by EU health ministers at a video conference next week and is aimed to be the EU’s common position ahead of the WHO assembly in mid-November, it said. It reiterates EU support for the WHO and stresses the agency’s central role in addressing global health challenges. However, it lists insufficient transparency as the first of many challenges faced by the U.N. agency, as well as a lack of “predictable and sustainable” financing….”

See also Reuters - China wants to take active role in WHO reform process: foreign ministry

“China’s foreign ministry said Beijing wants to take an active role in the World Health Organization reform process. … … Reforms should advance based on consensus among member-states, and the WHO should be better protected from political factors, foreign ministry spokesman Zhao Lijian told a news briefing.”

The Independent Panel Works to Establish Authoritative Chronology of the COVID-19 Pandemic https://mailchi.mp/0d74e9f9edc6/panelists-named-to-independent-panel-for-pandemic- preparedness-and-response-9593670?e=[UNIQID]

(Newsletter) update on the work of the Independent Panel. “The Independent Panel for Pandemic Preparedness and Response is working to establish an authoritative chronology of the emergence, global recommendations, national response, and impacts of SARS-CoV2, the virus which causes COVID-19. The chronology is part of the Independent Panel’s “Program of Work” – the roadmap which describes the themes and research questions the Panel will answer in the months ahead….”

“The Independent Panel is also establishing a framework through which to understand national and subnational responses. … … The Independent Panel published its Program of Work this week. This is the roadmap which guides the Panel’s review. … “ With 4 main themes for enquiry.

Science News - In new strategy, Wellcome Trust will take on global health challenges https://www.sciencemag.org/news/2020/10/new-strategy-wellcome-trust-will-take-global-health- challenges

“One of the world’s largest nongovernmental funders of science, the Wellcome Trust, is enlarging its focus to include goal-oriented, as well as basic research. The London-based philanthropy, which spends more than £1 billion per year, said today it will boost funding for research on infectious diseases, the health effects of global warming, and mental health. The new strategy moves it closer to philanthropies such as the Bill & Melinda Gates Foundation, which focuses on public health challenges around the world. “It’s a big shift,” says Jeremy Farrar, an infectious disease expert who leads the charity. “It’s not just about discovering stuff, it’s also about making sure that changes come to peoples’ lives.” …. …. … Wellcome, which has seen its endowment rise to £28 billion (more than the $22.6 billion of the Howard Hughes Medical Institute and less than the Gates Foundation’s $50 billion),

also plans to spend a bigger share of its money outside of the United Kingdom. The trust wants to foster international cooperation as a counterweight to rising nationalism, Farrar says. ….”

German Global Health Strategy https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Gesundheit/Br oschueren/Global_Health_Strategy.pdf

English version. See also a previous newsletter. Check out Germany’s strategic priorities in global health.

I Kickbusch – Health Politics: Forever changed https://edition.pagesuite.com/html5/reader/production/default.aspx?pubname=&pubid=5a5defd6- 3d6f-4e37-98df-88c6741f157e

2-pager & intro to “Health: A Political Choice – Act Now, Together” (to be launched at the WHS). Kickbusch nails it here, with a helicopter view on the overall implications for health politics of Covid- 19. The landscape will never look the same anymore, she argues. A new more radical health debate is emerging, focusing on structural inequities, social determinants, and beyond. At all levels.

Must-read. For more on the whole report, see below (section ‘Covid-19: key news’).

Slightly along the same lines: O P Ottersen et al - COVID-19 puts the Sustainable Development Goals center stage (in Nature Medicine)

“… Rather than calling for a revision of the SDGs, COVID-19 should be seen as a catalyst for progress. COVID-19 has effectively unveiled the inequities and governance dysfunctions that the SDGs are poised to rectify. … What is needed is the development of a universal preparedness for health, in the spirit of the SDGs. While universal health coverage addresses present problems and challenges, universal preparedness for health takes the future as its yardstick. This implies an anticipatory approach to health: the root causes of zoonotic transmission must be investigated and vaccine strategies against zoonotic viruses must be developed before their pandemic potential is translated into a pandemic8. This time the world was caught unprepared — the next pandemic virus should be given the shortest head start possible. The SDGs instruct that universal preparedness for health requires a radical systems approach: health must be seen in the broadest of contexts, with due attention to social structures and infrastructure, working and living conditions and with strategies to counteract climate change, loss of biodiversity and human destruction of wild habitat. In line with the overarching goal of leaving no one behind, preparedness means paying particular attention to vulnerable groups such as ethnic minorities, the elderly and people with underlying medical conditions….”

Globalization & Health - Exploring anti-corruption, transparency, and accountability in the World Health Organization, the United Nations Development

Programme, the World Bank Group, and the Global Fund to Fight AIDS, Tuberculosis and Malaria J C Kohler et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020- 00629-5

« Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption. In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals. »

Politico - The HIV fight is growing old https://www.politico.eu/article/the-hiv-fight-is-growing-old/

Getting old myself, I can relate to that . “Fundraising and activism have suffered as HIV treatment improves. But the fight is far from over. … … Donations for the global fight against HIV from wealthy countries were down $200 million in 2019 compared to the previous year, and cash from rich countries other than the U.S. has been slumping ever since it peaked in 2014. … … And it’s not just money, but activism, too. Red ribbons — the symbol of the fight against AIDS — are at risk of becoming passé, as a younger generation devotes itself to green issues and Black Lives Matter. … “Fundamentally, it’s just not as sexy,” said Robin Gorna, a longtime AIDS activist whose career evolved from protesting on the streets of London in the 1980s to running the International AIDS Society in 2010….”

“… … With public health attention focused on the coronavirus, the fight against HIV risks going from being a victim of its own success to simply a victim. Global health organizations warn that a decade of progress could be slashed by service disruptions and budget cuts. AIDS organizations are trying to cope by riding the coattails of the virus in the headlines. UNAIDS, for example, is leading the charge for a "people's vaccine," citing a desire to avoid a repeat of early AIDS treatments that were available in rich countries long before anyone else could afford them. "These are colliding pandemics," said Shannon Hader, a UNAIDS deputy executive director, at the POLITICO event last week.”…”

GFO – Increased domestic financing and efficiency of health expenditure necessary amid Covid-19 in Africa https://www.aidspan.org/en/c/article/5376

“In a virtual meeting convened by the African Union on 8 and 9 October 2020, health and finance ministers from east and southern Africa discussed how to sustain Africa’s earlier health gains in the face of COVID-19. They agreed on the dual importance of raising domestic resources for health and improving the management of available resources. The stance is summarized as “more money for health and more health for money.” Strong leadership and social protection for the most vulnerable are the two other additional levers to “build back” after the COVID-19 crisis. Peter Sands, the Executive Director of the Global Fund and Donald Kaberuka, the Chairman of the Global Fund Board, as well as representatives of multilateral organizations like the World Health Organization (WHO), GAVI (the Vaccine Alliance), and the World Bank addressed the participants and emphasized different aspects of those four levers….”

Finally, a link: Updated list of Canadian Women in Global Health

Planetary Health

Cambridge Review of International Affairs - Beyond continuationism: climate change, economic growth, and the future of world (dis)order M J Albert; https://www.tandfonline.com/doi/full/10.1080/09557571.2020.1825334

One of the papers of the week.

“An apocalyptic zeitgeist infuses global life, yet this is only minimally reflected in International Relations (IR) debates about the future of world order and implications of climate change. Instead, most approaches within these literatures follow what I call a “continuationist” bias, which assumes that past trends of economic growth and inter-capitalist competition will continue indefinitely into the future. I identify three key reasons for this assumption: 1) a lack of engagement with evidence that meeting the Paris Agreement targets is incompatible with continuous economic growth; 2) an underestimation of the possibility that failure to meet these targets will unleash irreversible tipping points in the earth system, and 3) limited consideration of the ways climate change will converge with economic stagnation, financial instability, and food system vulnerabilities to intensify systemic risks to the global economy in the near-term and especially later this century. I argue that IR scholars should therefore explore the potential for ‘post-growth’ world orders to stabilize the climate system, consider how world order may adapt to a three or four degree world if Paris Agreement targets are exceeded, and investigate the possible dynamics of global ‘collapse’ in case runaway climate change overwhelms collective adaptation capacities during this century.”

Guardian - Climate finance driving poor countries deeper into debt, says Oxfam https://www.theguardian.com/global-development/2020/oct/20/climate-finance-driving-poor- countries-deeper-into-debt-says-oxfam

“Billions of dollars are being loaned on high-interest terms to poor countries seeking help to cope with the impacts of climate breakdown, according to an Oxfam report. The loan terms risk storing up debt burdens lasting far into the future, the charity says. Poor countries are reported to have received about $60bn (£45bn) of climate finance from rich governments and publicly funded institutions in 2017-18, the latest year for which reliable data is available. Oxfam estimates that the amount that actually reached them was more like $19bn to $22.5bn when interest, repayments and other costs are subtracted….”

Guardian - Polluted air killing half a million babies a year across globe https://www.theguardian.com/environment/2020/oct/21/polluted-air-killing-half-a-million-babies- a-year-across-globe

“Air pollution last year caused the premature death of nearly half a million babies in their first month of life, with most of the infants being in the developing world, data shows. Exposure to airborne pollutants is harmful also for babies in the womb. It can cause a premature birth or low birth weight. Both of these factors are associated with higher infant mortality. Nearly two-thirds of the 500,000 deaths of infants documented were associated with indoor air pollution, particularly arising from solid fuels such as charcoal, wood, and animal dung for cooking. The discovery is reported in the State of Global Air 2020 report, which examined data on deaths around the world alongside a growing body of research that links air pollution with health problems….”

Interim report of the Special rapporteur on extreme poverty and human rights, Olivier De Schutter - The “just transition” in the economic recovery: eradicating poverty within planetary boundaries https://undocs.org/A/75/181

First thematic report by O De Schutter, presented to the UN General Assembly on the Just Transition. The report provides a human rights vision to both eradicate poverty and transition towards low-carbon economies. Enter the principles of a ‘just transition’.

See also https://www.ohchr.org/EN/Issues/Poverty/Pages/CallforsubmissionsJustTransition.aspx

Climate News - Peru and Switzerland sign ‘world first’ carbon offset deal under Paris Agreement https://www.climatechangenews.com/2020/10/21/peru-switzerland-sign-world-first-carbon-offset- deal-paris-agreement/

“In an agreement that took two years to negotiate, Peru will get finance for sustainable development projects while Switzerland takes credit for the emissions cuts. “ The first deal of its kind under Article 6 of the Paris agreement.

Covid key news – More than 40 million (official) cases now

Focus on key trends, WHO messages, …

Cidrap News - World's COVID-19 cases top 40 million https://www.cidrap.umn.edu/news-perspective/2020/10/worlds-covid-19-cases-top-40-million

As the Northern Hemisphere is heating up ( again).

See also Devex - Latin America no longer region with most COVID-19 cases

“The world region with the highest COVID-19 caseload is no longer Latin America and the Caribbean, Pan American Health Organization Director Carissa Etienne announced Wednesday. A resurgence of the disease in Europe means it has overtaken the Americas, which had led in the number of coronavirus cases for months….”

HPW - WHO: Brace Yourselves For Second Wave – COVID-19 Cases In Northern Hemisphere Accelerating https://healthpolicy-watch.news/who-brace-yourselves-covid-19-cases-in-northern-hemisphere- accelerating-further/

Short report of Tedros’ media briefing of Monday.

“As the northern hemisphere enters winter, “COVID-19 cases are accelerating, particularly in Europe and North America,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus, speaking at a Monday press briefing….”

PS: update on Covax: 184 Countries Committed to WHO Co-Sponsored COVAX Vaccine Facility

“…On another positive note, Dr Tedros said that some 184 countries have now committed to the WHO co-sponsored COVAX vaccine facility, including Ecuador and Uruguay as among the latest to join. …”

See also UN News – Focus on fundamentals as COVID-19 caseloads rise: WHO

Link: Telegraph - India 'over Covid-19 peak' as nation posts lowest death toll for three months

HPW - ‘We Are Family’ – WHO Launches Collaboration With Kim Sledge To Reproduce Global Version Of Unity Anthem https://healthpolicy-watch.news/we-are-family-who-launches-collaboration-with-kim-sledge-to- reproduce-global-version-of-unity-anthem/

“WHO is launching a collaboration with R&B Vocalist Kim Sledge of “We Are Family” fame to reproduce her signature album in a campaign aimed to promote global solidarity for COVID-19, and raise funds to battle COVID-19. The campaign, which will be coordinated by The World We Want Foundation, is to feature a special edition cover of the classic song “We Are Family” in a worldwide viral video that would include versions of the song by people ranging from celebrities to frontline health heroes, political leaders and members of the public – singing together to support global public health needs, including COVID-19. …”

World Leaders Unite in Their Response to COVID-19 https://www.prnewswire.co.uk/news-releases/world-leaders-unite-in-their-response-to-covid-19- 873275439.html

Press release via the Global Governance Project: “The COVID-19 pandemic has wreaked havoc on the global economy and threatened to undo decades of progress made in health care. Health: A Political Choice – Act Now, Together is the latest in a series of titles produced in collaboration with the World Health Organization. It calls on key actors to unite in their response to the pandemic and other imminent and long-term threats. The publication launches during the World Health Summit – this year a fully digital, interactive conference with a free-to-view programme – and coincides with the 75th anniversary of the United Nation General Assembly.”

“Health: A Political Choice – Act Now, Together calls on world leaders to unite in their response to the COVID-19 pandemic and other imminent and long-term threats to population health and the global economy. … The publication focuses on five key areas:

1. Inclusive economics, defined by a new social contract and the pursuit of progress for all 2. The fundamental requirements for a healthy life 3. Equitable investments and making UHC a reality 4. Health in the digital age and how technology can help reshape the human rights agenda 5. The long-term outlook on global health”

Health: A Political Choice – Act Now, Together is an official publication of the Global Governance Project produced in collaboration with the World Health Organization.

Reuters - Europe, North America should learn from Asia on COVID-19: WHO expert https://uk.reuters.com/article/uk-health-coronavirus-who/europe-north-america-should-learn- from-asia-on-covid-19-who-expert-idUKKBN2742J3?il=0

Via WEF blog - “Europe and North America should follow the example of Asian countries, according to Dr. Mike Ryan, Executive Director of the World Health Organization's (WHO) Health Emergencies Programme. They should persevere with measures to tackle the spread, as well as contact tracing and quarantining, he told a media briefing. Countries like China, Japan, Australia and South Korea have reduced the spread of detected cases by isolating patients and their contacts. This has led to people having "higher levels of trust" in their governments. “In other words, they ran through the finish line and beyond and they kept running, because they knew the race wasn’t over, that finish line was false. Too many countries have put an imaginary finishing line and when they cross this may have decelerated some of their activities,” Ryan said. “The countries

in Asia, south Asia, the Western Pacific that have been successful to my mind have really continued to follow-through on those key activities,” he added….”

NYT - WHO and Wikipedia join to combat Covid misinformation https://www.nytimes.com/2020/10/22/health/wikipedia-who-coronavirus- health.html?smtyp=cur&smid=tw-nythealth

“The health agency will license much of its material to the online encyclopedia, allowing the information to be reposted widely into almost 200 languages.”

More Debate re ‘The Great Barrington Declaration’ (in BMJ) • Scientific divisions on covid-19: not what they might seem

“It is not whether we should open up or lock down. Rather, it’s how we can break the chain of transmission, argue Martin McKee and David Stuckler. ”

• Economist – Should covid be left to spread among the young and healthy? (on the two petitions, Great Barrington Declaration & John Snow memorandum)

• BMJ Editorial - The known unknowns (by G D Smith et al)

“The more certain someone is about covid-19, the less you should trust them.”

• R Horton in his Offline: Offline: Science and politics in the era of COVID-19

Concluding: “… Naomi Nathan argued that the public health community must learn to think more about the intersection between politics and health. The complexities we are facing today have been partly caused by us not taking political decision making more seriously as a core part of public health. As the relationship between science and politics continues to break down, we need to concede that evidence alone will never be enough.”

Guardian - Covid-19 has exposed the catastrophic impact of privatising vital services https://www.theguardian.com/society/2020/oct/19/covid-19-exposed-catastrophic-impact- privatising-vital-services

“Global markets have failed to provide people with basic needs like housing and water, say present and former UN special rapporteurs.”

See a related tweet by Fran Baum – “So good to read this - has been evident for years that privatisation doesn't deliver all that is promised - Covid-19 has exposed the catastrophic impact of privatising vital services.”

FT - Why the second wave of Covid-19 appears to be less lethal https://www.ft.com/content/b3801b63-fbdb-433b-9a46-217405b1109f

“Shifts in demographics and better hospital treatments help explain rising odds of survival.”

“… While coronavirus infections have been surging again across Europe since late summer, the chances of surviving the respiratory disease seem to have improved from the first phase of the outbreak. The number of Covid-19 patients ill enough to go to hospital has risen less steeply — and mortality more slowly still, according to an FT analysis. Health services are not overwhelmed as they would have been if severe disease had followed infection in the way it did between March and April.”

““In western Europe, pretty much every country including the UK is still seeing a much smaller per capita death rate in this second wave than in the first one during the spring,” said Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh. The falling “case fatality rate” — deaths as a proportion of confirmed cases — can be explained partly by increased testing, which reveals more infections, and by the fact that a higher percentage of people with Covid-19 today are young and less likely to become severely ill than patients in the spring. But even patients admitted to critical care are more likely to survive now than their counterparts earlier in the pandemic….”

“…Paul Hunter, professor of medicine at the University of East Anglia, attributed about half of the improvement to the use of dexamethasone and other steroid medicines to reduce inflammation and dampen down patients’ overactive immune systems. “The rest is probably down to the experience of doctors and nurses learning how to treat patients,” he said….”

“… Scientists also discuss more speculative reasons why Covid-19 may be becoming less lethal. One is that people who become infected today receive lower doses of coronavirus than six months ago, for behavioural reasons including more cautious social interactions and wearing masks…”

UN News - One in six children living in extreme poverty, with figure set to rise during pandemic https://news.un.org/en/story/2020/10/1075722

“An estimated one in six children – or 356 million globally – were living in extreme poverty before the COVID-19 pandemic began, and this is set to worsen significantly, according to a new World Bank Group and UN Children’s Fund (UNICEF) analysis released on Tuesday. Global Estimate of Children in Monetary Poverty: An Update, notes that sub-Saharan Africa, with its limited social safety nets, accounts for two-thirds of children living in households that struggle to survive on an average of $1.90 a day or less per person – the international measure for extreme poverty, while South Asia accounts for nearly a fifth of these children….”

See also the Guardian - Progress in fight against child poverty could be wiped out by Covid, says report

Thomson Reuters - U.N. says pandemic will slow already miniscule progress in women's rights https://news.trust.org/item/20201020193933-qo90y/

“The coronavirus pandemic threatens to grind down progress toward gender equality that already was creeping along at a snail's pace, the United Nations said on Tuesday. Gender-based violence and inequities in the workplace and political leadership are nearly as bad as they were 25 years ago, the global agency said in a report "The World's Women 2020." Only modest gains in education and lowered maternal mortality have taken place since the U.N.'s 189 members made a commitment to women's rights at a landmark conference in Beijing in 1995, Secretary-General António Guterres said….”

Guterres: “"No country has achieved gender equality, and the COVID-19 crisis threatens to erode the limited gains that have been made."”

And some links:

NYT - With Covid-19 Under Control, China’s Economy Surges Ahead

Covid access to vaccines, medicines, …

With updates on the TRIPS waiver proposal and much more.

Meanwhile, there’s quite some momentum behind Ngozi Okonjo-Iweala’s campaign to become the next WTO lead (see this Project Syndicate piece).

But let’s start with a bit of optimistic news:

HPW - Leading US Expert Anthony Fauci: ‘Cautiously Optimistic’ About COVID-19 Vaccine Approval This Month Or Next https://healthpolicy-watch.news/us-anthony-fauci-cautiously-optimistic-about-near-term-prospects- for-sars-cov-2-vaccine/

“America’s most-respected public health guru, Dr Anthony Fauci, said Wednesday that he is “cautiously optimistic’ that at least one COVID-19 vaccine will prove to be safe and effective later this month or next. While cautioning that “one can never guarantee a safe and effective vaccine… we are cautiously optimistic that we will have one based on preliminary encouraging data,” said Fauci, director of the National Institute of Allergy and Infectious Diseases, speaking at a session of the weeklong 51st Union World Conference on Lung Health. “We project that by November and December, we’ll have the answer, and then by the end of the year in the beginning of 2021 will be able to distribute doses of vaccines that have been pre ordered and made – prior to even knowing they would work. Fauci spoke at a panel at the World Conference on “the Hope for a Vaccine”, also

featuring speakers from the World Health Organization, the Geneva Graduate Institute and the Barcelona Institue of Global Health….”

FT - How much will a Covid-19 vaccine cost? https://www.ft.com/content/80f20d71-d7eb-4386-b0f2-0b19e4aed94d

“ The race for a coronavirus vaccine has stoked a debate on how much the jabs will cost and who will pay for them, as prices range from $3 to more than $30 a dose and public health advocates including Bill Gates call for a price cap for poor countries….”

“The pricing of all vaccine deals has been shrouded in secrecy, with companies and public institutions defending their right to confidentiality. But people briefed on talks between drugmakers and the European Commission say that AstraZeneca has sold its jab at about $3 to $4 per dose in deals with the EU, while the Johnson & Johnson shot and the vaccine jointly developed by Sanofi and GSK have come in at about $10 per dose. By contrast, Moderna — a newer and still lossmaking company — has sought to pitch its vaccine at about $50 to $60 per course of two jabs, after initially asking for almost double that amount. Other biotechnology businesses, such as CureVac, have said they would seek an “ethical margin” on their prices. Pressure from civil society and media reports have pushed some companies to disclose projected list prices, with Moderna doing so in August and publishing a maximum price tag of $37 a dose. One of China’s vaccine frontrunners, Sinovac, this week began selling its vaccine in select cities at $60 for two shots as part of an emergency use programme with hundreds of thousands of participants. … … At the heart of the discussion lies a question both ethical and practical: whether pharmaceutical corporations should work with rich countries to ensure charges to poor nations are capped. Mr Gates, for example, told the Financial Times drugs companies should support a system whereby rich countries subsidise vaccines so that poor nations pay $3 or less a dose. “The price needs three tiers where rich countries are paying back a lot of the fixed costs, middle-income countries are paying back some of the fixed costs and the poorer countries are paying a true marginal cost,” Mr Gates, co-chair of the Bill & Melinda Gates Foundation, said in an interview.”

KEI - WTO TRIPS Council (October 2020): South Africa issues clarion call urging support for TRIPS waiver proposal https://www.keionline.org/34235

From informed sources, three blocs emerged from the discussions:

“WTO Members who supported the proposal, the vast majority of which were least developed and developing countries (Tanzania on behalf of the African Group, Chad on behalf of the LDC members, Bangladesh, Sri Lanka, Pakistan, Venezuela, Honduras, Nepal, Nicaragua, Egypt, Indonesia, Argentina, Tunisia, Mali, Mauritius and Mozambique);

WTO Members who expressed their rejection of the text, the vast majority of which were developed countries (European Union, United States of America, Switzerland, Norway, Australia, Canada, Japan and the United Kingdom), joined by Brazil;

WTO members who welcomed the proposal but asked for further clarification on some points, particularly with regards the possible economic impact of the waiver and said they were consulting with capital in order to make a more informed decision (Nigeria, Philippines, Turkey, Ecuador, China, Thailand, Senegal, Jamaica, Colombia, Costa Rica, Chile and El Salvador).”

See also Amnesty International – WTO: A missed opportunity to put people before patents

And KEI - WTO TRIPS Council (October 2020): European Union dismisses concerns that IPRs are a barrier to COVID-19 medicines and technologies

TWN - South Africa, India strongly rebut arguments against TRIPS waiver https://www.twn.my/title2/intellectual_property/info.service/2020/ip201010.htm

In-depth report of the WTO discussion last week, with respective stances of countries and blocs. Very much recommended.

Independent - WHO backs Indian proposal to ensure universal access to Covid vaccine https://www.independent.co.uk/news/world/asia/coronavirus-vaccine-india-south-africa-world- health-organisation-covid-b1152239.html

“The World Health Organisation has backed a proposal by India and South Africa to waive international property rights on health advances against Covid-19, amid fears that countries’ competing efforts on this front could give rise to “vaccine nationalism”. The proposal, first tabled by the two nations at the World Trade Organisation, has met with resistance from a number of developed countries. “[The] WHO welcomes South Africa’s and India’s recent proposal to WTO to ease international and intellectual property agreements on Covid-19 vaccines, treatments and tests in order to make the tools available to all who need them at an affordable cost," WHO director-general Tedros Adhanom Ghebreyesus wrote on Twitter. “Ending the pandemic starts with collaboration. [The] WHO launched the Covid-19 Technology Access Pool (CTAP) in May, inviting countries to share data, knowledge and intellectual property on vital, life-saving health products in the fight against the coronavirus," Ghebreyesus added….”

PS: check out also this press statement by The Elders : The Elders call for urgent action to address multilateral failings exposed by Covid-19

“As Elders, we call today on world leaders to urgently strengthen, defend, and realise the potential of the multilateral system. This is the fundamental requirement to end the current disarray in the global order, and tackle existential threats such as COVID-19, the climate crisis and nuclear conflict. We also call for their clear commitment to erase the moral stain of economic and social inequality, both within and between nations, that has been exacerbated by the pandemic. The collective failure of leaders to articulate the benefits of effective multilateralism, which serves the self-interest of all countries, has further damageed the effectiveness and reputation of the wider rules-based multilateral system.”

“In this regard, we support the campaign by South Africa and India for the World Trade Organization to waive certain provisions of the TRIPS (Trade-Related Aspects of Intellectual Property Rights) agreement.”

Lancet Healthy Longevity - COVID-19 Vaccines A Global Common Good M Yunus et al; https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(20)30003-9/fulltext

“To date, over 3000 people, including 115 international personalities and 19 Nobel Laureates, have issued a joint appeal to global leaders, international organisations, pharmaceutical companies, and governments to adopt legal measures ensuring the availability of 2019 novel coronavirus disease (COVID-19) vaccines for all and free of charge. We present the case behind not only the declaration of COVID-19 Vaccine a Global Common Good, but also how this can be operationalised….”

“Three key pillars would be required to make COVID-19 vaccines a global common good…” A set of clear principles, an operator to establish and enforce allocation and pricing rules; an industrial force.

Devex - The World Bank approves $12B for vaccine finance. Will other financial institutions follow? https://www.devex.com/news/the-world-bank-approves-12b-for-vaccine-finance-will-other- financial-institutions-follow-98323

“The World Bank board’s approval of a $12 billion financial package this week is a welcome boost to financing for COVID-19 vaccines. Some international financial institutions are expected to follow, although it’s unclear when and how exactly financing from these institutions will support global efforts….” With some info on related plans from the African Development Bank, Asian Development Bank, and other banks.

And also how the WB funding should be used (according to A Glassman and others).

Devex - Africa needs to go beyond COVAX to secure vaccine doses, experts say https://www.devex.com/news/africa-needs-to-go-beyond-covax-to-secure-vaccine-doses-experts- say-98331

“Health experts in Africa have praised the COVAX Facility as a solution for ensuring that the continent has prompt access to an affordable vaccine for COVID-19 — but concerns surrounding gaps in funding and the continent’s immunization needs have experts looking at alternative ways of securing vaccine doses. While African countries should be able to access at least 220 million doses of vaccine through COVAX, Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, pointed out that this allocation is not nearly enough for a continent with a population of more than 1.3 billion….”

Reuters - Sinovac coronavirus vaccine offered by Chinese city for emergency use costs $60 Reuters;

“A Chinese city is offering Sinovac Biotech’s experimental COVID-19 vaccine to essential workers and other high-risk groups as part of a national programme for about $60….”

“The city’s center for disease control and prevention said in a statement on WeChat that it would make the vaccine, called CoronaVac, available to the general public, prioritizing essential workers and other high-risk groups. The vaccine is in phase III trials in Brazil, Indonesia and Turkey, and interim results are expected in late November….”

AP – Brazil’s Bolsonaro rejects coronavirus vaccine from China https://apnews.com/article/virus-outbreak-brazil-state-governments-health-sao-paulo- b7b5b620ba54f402dbf803e26fe6b842

“Brazilian President Jair Bolsonaro on Wednesday rejected the announced purchase of 46 million doses of a potential vaccine against the coronavirus being developed by a Chinese company and tested in a state governed by a political rival, prompting some to question if he was allowing politics to steer public health decisions….”

Telegraph - Unicef unveils plan to stockpile half a billion vaccine syringes by Christmas https://www.telegraph.co.uk/global-health/science-and-disease/unicef-unveils-plan-stockpile-half- billion-vaccine-syringes/

“There are concerns that shortages could disrupt vaccination efforts as jabs could arrive in some countries before injection kits.”

AP - Vaccine storage demands could leave 3B people in virus cold https://apnews.com/article/virus-outbreak-burkina-faso-immunizations-united-nations- 7f5526f46ce5e15ba8bb51fe62569ee6

On the “cold chain” obstacle.

“From factory to syringe, the world’s most promising coronavirus vaccine candidates need nonstop sterile refrigeration to work. But despite great strides in equipping developing countries to maintain the vaccine “cold chain,” nearly 3 billion of the world’s 7.8 billion people live in places with insufficient temperature-controlled storage for an immunization campaign to bring COVID-19 under control….”

FT - China’s Covid-19 vaccine diplomacy steals a march on US https://www.ft.com/content/ce9a4c98-49b5-4c24-9ff2-ed1c6a3f3412

“Beijing has promised to help developing world but regulatory and logistical hurdles loom.”

“China is promising preferential access to its Covid-19 vaccines to countries across Asia, Africa and Latin America, as Beijing uses inoculations as a new tool to bolster its ties with nations neglected by the US. Wang Yi, China’s foreign minister, has spearheaded the effort, pledging that Malaysia, Thailand, Cambodia and Laos will be among the “priority” recipients of Chinese vaccines. China aspires to be a global vaccine supplier with four Chinese products now in phase 3 trials, the final stage intended to ensure safety and effectiveness before approval for public use.”

“… “The United States has ceded the field to China in terms of bilateral vaccine deals in south-east Asia,” said Aaron Connelly from the International Institute for Strategic Studies, a think-tank. .. … China is determined that “vaccine diplomacy” succeeds where “mask diplomacy” failed, said Huang Yanzhong from the Council on Foreign Relations, a think-tank….”

… China’s promises of preferential access have extended beyond Asia. Beijing has pledged to help most developing countries, including the entire African continent. It has also pledged a $1bn loan to Latin American and Caribbean nations to fund procurement.”

“… Experts debate whether China will be able to overcome logistical and regulatory hurdles to fulfil its grand promises. China is not alone in offering vaccines to the developing world. Indonesia also secured 100m doses of vaccines from AstraZeneca, the Anglo-Swedish pharmaceutical company, that will be delivered next year. But strong state support and a lack of pressing demand within China, where the virus’s spread has been almost entirely halted, gives Chinese vaccine makers an advantage, according to analysts.”

PS: China lies ahead in the global vaccine race with at least four candidates in phase three clinical trials.

Guardian - India at heart of global efforts to produce Covid vaccine https://www.theguardian.com/world/2020/oct/20/india-at-heart-of-global-efforts-to-produce- covid-vaccine

“Country plays central role in development, manufacture – and possible distribution – of potential vaccines.”

Devex - What do people in BRICS countries think about a COVID-19 vaccine? https://www.devex.com/news/what-do-people-in-brics-countries-think-about-a-covid-19-vaccine- 98356

“… About 28% of 13,400 individuals from 19 countries would hesitate to get, or completely refuse, a COVID-19 vaccine, according to a study published Tuesday on the opening day of the 51st Union

World Conference on Lung Health. The study surveyed respondents from some of the countries hit hardest by the COVID-19 pandemic, including those that make up the BRICS countries: Brazil, Russia, India, China, and South Africa. Respondents from China had the most favorable response when asked if they will take a COVID-19 vaccine that is proved safe and effective when available…”

In Russia, vaccine hesitancy was the highest.

HPW – Resistance To COVID-19 Vaccine Running So High It Would Twart Efforts To Reach Community Immunity – New Study https://healthpolicy-watch.news/77968-2/

“Current levels of public willingness to be immunized with a forthcoming COVID-19 vaccine are so high that they would block many countries from reaching community immunity, found a new study of vaccine hesitancy among people in 19 of the most COVID-impacted countries around the world. The study of 13,436 people, published in Nature Medicine on Tuesday, also reveals that “vaccine hesitancy” is growing worldwide, although are also significant variations in vaccine acceptance between countries and regions. On average, only 71.5 percent of respondents would definitely take a safe and effective COVID-19 vaccine, below the bar of near universal acceptance that is normally needed to build ‘herd immunity’, and meaning that there are tens of millions of potential vaccine avoiders globally. …”

See also Cidrap News - Who will accept a COVID-19 vaccine?

TWN – COVID-19 Medical supplies largely benefited high income countries, says UNCTAD https://www.twn.my/title2/health.info/2020/hi201014.htm

“The latest quarterly report of the UN Conference on Trade and Development (UNCTAD) drew attention to the COVID-19 medical supplies such as personal protective equipment (PPE), disinfectants, diagnostic kits, oxygen respirators and other related hospital equipment. It said that international trade has played a substantial role in responding to the COVID-19 pandemic. "Despite the very early stages of the pandemic, characterized by several nations imposing restrictive trade policies to safeguard potentially scarce medical supplies, international markets have contributed to meet the surge in overall demand for products necessary to combat the diffusion of COVID-19." Between January and May of this year, exports of COVID-19 medical supplies (personal protective equipment, disinfectants, diagnostic kits, oxygen respirators and other related hospital equipment) from China, the European Union and the United States rose from about US$25 billion to US$45 billion per month. On a year-on-year basis, the trade of these products has increased by an average of more than 50 per cent since April 2020. "Nevertheless, the increase in supply of COVID- 19 related products has been largely to the benefit of wealthier countries," said UNCTAD. "There is substantial evidence that middle- and low-income countries have been largely priced out from access to COVID-19 related products," it added….”

And a few links:

• Via The Guardian :

“A state-owned drugmaker in China is setting up production lines to supply a billion doses of two possible vaccines that are being tested on 50,000 people in 10 countries, the company chairman said on Tuesday. Testing by SinoPharm Group is “in the last kilometre of a long march”, chairman Liu Jingzhen said. He gave no indication when results were expected.”

• WHO Afro - New COVID-19 rapid tests a game changer for Africa

“the roll-out of new, World Health Organization (WHO) approved antigen-based rapid diagnostic tests for the novel coronavirus in Africa will significantly boost testing capacity and marks a game changer in the continent’s fight against COVID-19. …”

Covid funding, debt relief, social protection & wrap-up annual meetings WB/IMF

Bretton Woods – Annual Meetings 2020 Wrap Up: Bank and Fund struggle to implement sustainable recovery as private sector dashes hopes of debt relief progress https://www.brettonwoodsproject.org/2020/10/annual-meetings-2020-wrap-up-bank-and-fund- struggle-to-implement-sustainable-recovery-as-private-sector-dashes-hopes-of-debt-relief-progress/

Must-read wrap-up analysis of the IMF/WB annual meetings (& related G20). “Predictions of slow economic recovery in developing countries; Private sector undermines debt negotiations; No agreement on SDR issuance or IMF gold sales; Austerity and private finance central to BWIs' recovery plans.”

Quote: “…in her opening speech, IMF Managing Director Kristalina Georgieva said the WBG and IMF faced a, “new Bretton Woods moment,” harking back to the role the institutions played facing crises at their founding.” “But with private lenders disrupting debt suspension so forcefully, the state-led multilateral decision-making of the post-war era seems more remote than ever. The rising power of private creditors since the 2008 global financial crisis has meant that even the hands of the world’s wealthiest nations are tied when it comes to disciplining the financial markets that they have so readily touted as essential to achieving the Sustainable Development Goals (SDGs)….”

And: “Despite rhetoric on the sustainable recovery, Bank and Fund’s neoliberal orthodoxy continues to constrain action on climate change.”

Eurodad - 2020 IMF and World Bank Annual Meetings: Disappointing response to Coronavirus crisis J Saldanha; https://www.eurodad.org/2020_imf_and_world_bank_annual_meetings_disappointing_response_t

o_coronavirus_crisis?utm_campaign=newsletter_22_10&utm_medium=email&utm_source=euroda d

Also a neat wrap-up analysis. “Last week was a crucial week for the citizens of developing countries, who are being hit hard by the Coronavirus crisis. They are facing increasing poverty, growing inequality and uncertain futures – and were looking to the world's leaders for decisive action. Yet despite a week of stirring rhetoric from G20, International Monetary Fund and World Bank leaders, who claim they are determined to tackle the crisis, the results are deeply disappointing. What is clear is that world leaders and the Bretton Woods institutions need to take much more ambitious steps to deliver in the public interest.”

More links:

BW: G20 communiqué analysis – Annual Meetings 2020

Global Development Policy Center - All Talk, Little Action: Between the Lines of ‘Whatever it Takes’ at the IMF and World Bank Annual Meetings Scathing analysis of the IMF/WB response so far, failing to tackle the structural problems.

Devex - As World Bank pushes others on debt relief, it doesn't participate https://www.devex.com/news/as-world-bank-pushes-others-on-debt-relief-it-doesn-t-participate- 98320

“While the World Bank has been vocal about pushing bilateral and private creditors to take stronger action to provide debt relief, it maintains that it shouldn’t be part of existing debt suspension initiatives. The world’s lowest-income countries owe the World Bank about $4 billion in debt service payments this year, and some advocates argue that since funding is critical, the World Bank should at least consider suspending those payments to provide additional liquidity. This comes amid concerns that the World Bank’s COVID-19 response is too slow and may not be reaching the most vulnerable.”

Excerpt on the Bank’s defense: “The World Bank has argued that it is providing net positive flows to these countries by offering additional COVID-19 funding, and a debt service suspension could jeopardize its AAA credit rating and limit or make its financing more expensive in the future, according to an explanatory note it released in July. “Debt service suspension by MDBs would likely reduce net funding to IDA countries by undermining the attractiveness of MDB debt, including IDA debt, and increasing IDA and IBRD’s funding costs significantly. Given that IDA and IBRD have slim margins to cover their administrative costs,” the note says. It goes on to explain that the long term costs of the debt service suspension would outweigh the short term benefits. The bank is concerned that if it offers debt suspension while private creditors continue not to participate in the G-20 DSSI, the bank would jeopardize its preferred creditor treatment, which means it gets paid back first — a key factor in maintaining its AAA rating, the note said.”

China's 'secret loans' throw wrench into G-20 debt relief plans https://asia.nikkei.com/Politics/International-relations/China-s-secret-loans-throw-wrench-into-G- 20-debt-relief-plans

“Concerns mount that debtor nations will use money to pay back Beijing lenders.”

“…According to a team, which includes World Bank chief economist Carmen Reinhart, China has lent $385 billion to developing countries, including $200 billion in hidden debt. Although much of this lending technically came from private-sector actors, they are believed to be a piece of national policy….”

Devex - Is the COVID-19 pandemic a cash transfer tipping point? https://www.devex.com/news/is-the-covid-19-pandemic-a-cash-transfer-tipping-point-98346µ

(gated) “Cash transfers have been a key tool in the response to social and economic fallout from the COVID-19 pandemic. Will the crisis give rise to a new era that puts cash at the center of global development?”

And some links:

• CGD - The World Bank’s Response to Our Analysis of its COVID Relief Efforts

• CGD - Six Takeaways from the New Growth Forecasts from the IMF and the World Bank

One of them being: “This year was worse for low- and middle-income countries than predicted. Repeatedly.”

Covid science

BMJ Editorial - Covid-19 vaccine trial protocols released

P Doshi; https://www.bmj.com/content/371/bmj.m4058?utm_source=twitter&utm_medium=social&utm_te rm=hootsuite&utm_content=sme&utm_campaign=usage

“The world has bet the farm on vaccines as the solution to the pandemic, but the trials are not focused on answering the questions many might assume they are.”

« The ongoing phase III trials for covid-19 vaccines are some of the most consequential randomised trials ever done. In September, following months of campaigning for greater openness, four manufacturers made their full study protocols publicly available. The publications create a rare opportunity for “real time transparency” in which the conduct of clinical trials is opened to public scrutiny while the studies are still under way. Whatever the results ultimately show, public release of these protocols—each over 110 pages containing far greater detail than was previously available—enables a more scientific, deliberative, and inclusive trial process. While protocol transparency is not new—and is already common for high impact trials—transparency in real time is an important development and a great win for public trust. We may not like what we read, but

with real time sharing of full protocols comes an unprecedented space for translating critique into action to improve trial design mid-stream. And there is much to critique….”

Read what exactly.

Atlantic - The Vaccine News That Really Matters https://www.theatlantic.com/health/archive/2020/10/what-successful-vaccine-trial-looks- like/616775/

It’s “money time” for a number of vaccines now, between mid-November and mid-December.

“Soon COVID-19 vaccine makers will release early data from large clinical trials, and the results could be ambiguous.” What do you need to look at (in terms of efficacy & safety) in the results?

NYT – Corona virus vaccine tracker https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine- tracker.html?referringSource=articleShare

(updated as of 16 Oct)

NBC - Massive WHO remdesivir study suggests no Covid-19 benefit. Doctors aren't so sure. https://www.nbcnews.com/health/health-news/massive-who-remdesivir-study-suggests-no-covid- 19-benefit-doctors-n1243730

“Remdesivir, an antiviral drug, may be more beneficial when given earlier in the course of an infection.”

Reuters - Gloomy COVID drug data shows why big, randomised trials matter https://uk.reuters.com/article/us-health-coronavirus-remdesivir-trials/gloomy-covid-drug-data- shows-why-big-randomised-trials-matter-idUKKBN2712FS

“When it comes to trials of any drug, size matters, potentially giving the World Health Organization’s (WHO) gloomy verdict on Gilead Sciences’ COVID-19 treatment remdesivir an edge over the company’s more positive data, leading scientists say….”

Science News – Remdesivir and interferon fall flat in WHO’s megastudy of COVID- 19 treatments https://www.sciencemag.org/news/2020/10/remdesivir-and-interferon-fall-flat-who-s-megastudy- covid-19-treatments

Kai Kupferschmidt’s take on the results of the Solidarity trial. Recommended.

Including this excerpt: “Gilead received the manuscript about Solidarity on 28 September, according to WHO. On 8 October, before the results became public, the company signed a $1 billion deal with the European Commission for a 6-month supply of the drug. Solidarity’s “most disappointing results,” however, are those for interferon-beta …”

See also the FT - EU medicine regulator seeks full results of WHO’s remdesivir trial

“Drugmaker Gilead was briefed on poor results of study before signing European deal, officials say.”

“… According to WHO officials, the organisation told Gilead of the findings of the Solidarity trial in September, as long as two weeks before the European Commission announced its deal to procure the drug.“[The WHO] made a presentation to Gilead and other companies [on the results of the trial] on September 23,” Ana Maria Henao-Restrepo, a medical officer at the WHO, said at a briefing on Friday. “On the following Monday, September 28, [the WHO] forwarded [to Gilead] not only the graph, figures and tables, but the first draft of the manuscript”.

Stat - Blood plasma showed no benefit in Covid-19 patients in trial — a finding that could re-energize debate Stat News;

“Infusing hospitalized Covid-19 patients with blood plasma from people who recovered from the disease had no effect on whether patients got sicker or died, according to the first completed randomized trial of the treatments. The study, published Thursday in BMJ, could re-energize the debate over whether blood plasma is an effective treatment for the disease. …”

HPW - China’s Inactivated COVID-19 Vaccine Candidate Is Safe and Provokes Immune Response, Say Preliminary Clinical Trial Results https://healthpolicy-watch.news/77828-2/

“A new study published in The Lancet on Thursday found that an inactivated vaccine candidate, called BBIBP-CorV, was safe and provoked an immune response in healthy individuals. This is the first study of an inactivated COVID-19 vaccine to include participants over 60 years of age. The BBIBP-CorV vaccine is being developed by the Beijing Institute of Biological Products and Sinopharm in China….”

Science (news) - Could certain COVID-19 vaccines leave people more vulnerable to the AIDS virus? https://www.sciencemag.org/news/2020/10/could-certain-covid-19-vaccines-leave-people-more- vulnerable-aids-virus

“Cold-causing adenovirus used in four experimental COVID-19 vaccines increased risk of HIV infection when used in AIDS vaccine trials.”

Lancet Letter - GeneXpert for the diagnosis of COVID-19 in LMICs https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30428-9/fulltext

“…The example of Madagascar shows that optimising the use of the GeneXpert MTB/RIF platform for the surveillance of SARS-CoV-2 in low-income and middle-income countries is relevant and achievable and should be considered in settings with difficult access to laboratories and an already existing GeneXpert MTB/RIF network….”

Reuters - Hospitalised COVID-19 patients can have ongoing symptoms for months -study Reuters;

“More than half of COVID-19 patients discharged from hospital still experienced symptoms of breathlessness, fatigue, anxiety and depression for two to three months after their initial infection, according to the findings of a small UK study. The research, led by scientists at Britain’s Oxford University, looked at the long-term impact of COVID-19 in 58 patients hospitalised with the pandemic disease.”

Guardian – Women aged 50-60 at greatest risk of ‘long Covid’, experts suggest https://www.theguardian.com/world/2020/oct/21/women-aged-50-60-at-greatest-risk-of-long- covid-experts-suggest

“Women aged 50-60 are at greatest risk of developing “long Covid”, analysis suggests. Older age and experiencing five or more symptoms within the first week of illness were also associated with a heightened risk of lasting health problems….”

Stat - Covid-19’s wintry mix: As we move indoors, dry air will help the coronavirus spread Stat;

Recommended read for the Northern Hemisphere (duh). “…Cold, dry air facilitates the spread of the coronavirus, and the social distancing that helped outside won’t be as effective indoors, scientists said….”

Guardian - If you're pinning your hopes on a Covid vaccine, here's a dose of realism D Salisbury; https://www.theguardian.com/commentisfree/2020/oct/21/covid-vaccine- immunisation-protection

Focus on the UK here, but true for other countries as well.

“A targeted immunisation programme may offer some protection, but it will not deliver ‘life as normal’.” And “… Even if countries do decide to switch from a personal-protection policy to a transmission-interruption strategy, obstacles remain….”

Guardian - 'Killer' cells in Ebola immunity study could help Covid research Guardian;

“Immunity from the deadly Ebola virus could last years after the infection, the world’s longest study of survivors by British and Guinean scientists has concluded in findings that could have implications for Covid immunity research. The findings are the result of the world’s longest and most comprehensive study of survivors from the devastating west African outbreak between 2013 and 2016. They could help the understanding of the body’s immune response to Covid and other zoonotic diseases. A recent study suggested antibodies for Covid may only last two months, leading to speculation that immunity to the virus may not be long-lived and those who have recovered would be at risk of reinfection. The team of scientists in Guinea found that some Ebola survivors there showed no antibodies three months after the infection even though they would have to mount a strong response to fight such a lethal virus. But they did have the capacity to fight a possible reinfection with backup “killer” T cells, a type of white blood cell that triggers the immune response and B cells that memorises the specific battle plan for a pathogen and rapidly secrete antibodies when reactivated, according to the findings published in the Lancet Infectious Diseases journal….”

Cidrap News - Experts: Don't count on mild flu season amid COVID-19 https://www.cidrap.umn.edu/news-perspective/2020/10/experts-dont-count-mild-flu-season-amid- covid-19

“The Southern Hemisphere had a very light flu season in 2020, with Australia seeing only 315 cases over its winter, down 99.8% from the 130,000 cases seen in most years. But flu experts say that, while the low numbers could portend a similar scenario in the Northern Hemisphere, it would be a foolhardy not to prepare for high caseloads this winter….”

BMJ Feature - Will covid-19 vaccines save lives? Current trials aren’t designed to tell us https://www.bmj.com/content/371/bmj.m4037

“The world has bet the farm on vaccines as the solution to the pandemic, but the trials are not focused on answering the questions many might assume they are. Peter Doshi reports.”

Telegraph - Experts reveal how to optimise heat and humidity to reduce Covid transmission inside the home

Telegraph;

“A new study shows that both temperature and humidity play a key role in the survival of Sars-Cov-2 and therefore the risk of transmission.”

Quick links:

• Telegraph - Coronavirus can survive on skin for nine hours, researchers find

• NYT - Some Signs of Recovery From Severe Covid Lung Damage

“In two early studies, researchers said some patients showed signs of healing just weeks after leaving the hospital.” Especially with intensive aftercare and exercise, it seems.

• FT - World’s first Covid human challenge trials to start in London

• FT - Schools play limited role in spread of Covid-19, studies signal

• Reuters - AstraZeneca COVID-19 vaccine trial Brazil volunteer dies, trial to continue

“Brazilian health authority Anvisa said on Wednesday that a volunteer in a clinical trial of the COVID- 19 vaccine developed by AstraZeneca AZN.L and Oxford University had died but added that the trial would continue.” Apparently he was part of the control group.

Covid analysis

Lancet Letter - The COVID-19 syndemic is not global: context matters

E Mendenhall; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32218- 2/fulltext

“Richard Horton recently called COVID-19 a syndemic. He aptly used this concept to describe how COVID-19 clusters with pre-existing conditions, interacts with them, and is driven by larger political, economic, and social factors. Calling COVID-19 a global syndemic is misguided. Syndemics matter because they focus on what drives diseases to cluster and interact. What is driving coronavirus to move through the population in the USA and interact with biological and social factors, however, differs from other contexts. US political failures have driven COVID-19 morbidity and mortality, and this cannot be divorced from our historical legacy of systemic racism4 or our crisis of political leadership. This matters because in other contexts COVID-19 is not syndemic. New Zealand's political leadership in response to the crisis has been exemplary. COVID-19 is not syndemic there. In

this sense, syndemics allow us to recognise how political and social factors drive, perpetuate, or worsen the emergence and clustering of diseases….”

“Recognising political determinants of health is central to the syndemic construct. By calling the COVID-19 syndemic global, we miss the point of the concept entirely.”

COVID-19: Europeans Can Learn from Developing Countries M Mormina et al ; https://www.indepthnews.net/index.php/sustainability/health-well-being/3923- covid-19-europeans-can-learn-from-developing-countries#.X40iu8JvIqo.Twitter

With a range of examples. And ending with this killer quote: “A healthy start would be for developed countries to get rid of their “world-beating” mindset, cultivate the humility to engage with countries they do not normally look towards, and learn from them.”

NYT - As the Coronavirus Surges, a New Culprit Emerges: Pandemic Fatigue https://www.nytimes.com/2020/10/17/us/coronavirus-pandemic-fatigue.html

“Exhaustion and impatience are creating new risks as cases soar in parts of the world. “They have had enough,” one U.S. mayor said of her residents. … Shared, though, is a public weariness and a growing tendency to risk the dangers of the coronavirus, out of desire or necessity: With no end in sight, many people are flocking to bars, family parties, bowling alleys and sporting events much as they did before the virus hit, and others must return to school or work as communities seek to resuscitate economies. And in sharp contrast to the spring, the rituals of hope and unity that helped people endure the first surge of the virus have given way to exhaustion and frustration.

… In parts of the world where the virus is resurging, the outbreaks and a rising sense of apathy are colliding, making for a dangerous combination. Health officials say the growing impatience is a new challenge as they try to slow the latest outbreaks, and it threatens to exacerbate what they fear is turning into a devastating autumn.”

FT - Covid-19: The global crisis — in data https://ig.ft.com/coronavirus-global-data/

“Charts and maps show paradoxes of a pandemic that has claimed a million lives.” Worth checking out.

Open Democracy - How to break the COVID doom loop https://www.opendemocracy.net/en/oureconomy/how-break-covid-doom-loop/

Since a few weeks, the term ‘circuit breakers’ has gone global. “Introducing a system of planned, intermittent ‘circuit breakers’ would save lives and protect the economy.”

BBC News - Coronavirus in Africa: Five reasons why Covid-19 has been less deadly than elsewhere https://www.bbc.com/news/world-africa-54418613

Quick action; public support; young population & few old age homes; favourable climate; good community health systems.

World Development - Why is the Number of COVID-19 Cases Lower Than Expected in Sub-Saharan Africa? A Cross-Sectional Analysis of the Role of Demographic and Geographic Factors

P Nguimkeu et al ; https://www.sciencedirect.com/science/article/pii/S0305750X20303788?dgcid=raven_sd_aip_email

“Unlike initially predicted by WHO, the severity of the novel coronavirus pandemic has remained relatively low in Sub-Saharan Africa, more than two months after the first confirmed cases were identified. In this paper, we analyze the extent to which demographic and geographic factors associated to the disease explain this phenomenon….”

“…We found that proportion of population aged 65+, population density, and urbanization are significantly positively associated with high numbers of active infected cases, while mean temperature around the first quarter (January-March) is negatively associated to this COVID-19 outcome. These factors are those for which Africa has a comparative advantage. In contrast, factors for which Africa has a relative disadvantage, such as income and quality of health care infrastructure, are found to be insignificant predictors of the spread of the pandemic.”

FT – How Africa fought the pandemic — and what coronavirus has taught the world D Pilling; https://www.ft.com/content/c0badd91-a395-4644-a734-316e71d60bf7

“African countries mounted a powerful response, using their experience of previous infectious disease.”

IDS - Shielding the vulnerable – a strategy for long-term pandemic response https://www.ids.ac.uk/opinions/shielding-the-vulnerable-a-strategy-for-long-term-pandemic- response/

“As the Covid-19 pandemic enters a protracted phase, governments and pandemic response teams face difficult decisions about mitigating its spread while also protecting economic security. While any response must be proportionate and tailored to a local context, there is a menu of options from which policy makers can draw. One option is to implement shielding, an approach that isolates, or “shields” the most vulnerable without a generalised lockdown. Early evidence shows that it can be effective if it is appropriately designed with community input, socioeconomic support, and trust….”

NYT - A Viral Theory Cited by Health Officials Draws Fire From Scientists https://www.nytimes.com/2020/10/19/health/coronavirus-great-barrington.html

More on the Great Barrington Declaration. “A manifesto urging reliance on “herd immunity” without lockdowns was warmly received by administration officials. But the strategy cannot stem the pandemic, many experts say.”

CGD - From Overall Fiscal Space to Budgetary Space for Health: Connecting Public Financial Management to Resource Mobilization in the Era of COVID-19 H Barroy & S Guptae; https://www.cgdev.org/publication/overall-fiscal-space-budgetary-space- health-connecting-public-financial-management

“This paper advances the concept of budgetary space for health, which explores resources available for health that are generated through higher public expenditure, better budget allocations, and through improved public financial management (PFM). The budget decomposition approach presented in the paper provides insight into the extent to which each factor drives expansion in budgetary space for health. The approach is applied to 133 low- and middle-income countries (LMICs) between 2000–2017 and finds that around 70% of budgetary space for health is driven by changes in overall public expenditure, while about 30% is directly attributable to the share of the budget allocated to health. Further, PFM improvements can maximize or even enlarge budgetary space for health. A key implication of the analysis is that health policymakers should systematically link PFM reforms to budgetary space for health by supporting comprehensive country assessments and by enhancing the effectiveness of budget dialogue between finance and health authorities.”

CGD - Lives vs. Livelihoods Revisited: Should Poorer Countries with Younger Populations Have Equally Strict Lockdowns? https://www.cgdev.org/blog/lives-vs-livelihoods-revisited-should-poorer-countries-younger- populations-have-equally-strict#disqus_thread

“Governments around the world have taken drastic measures to control the spread of coronavirus. Public debate has understandably focused on the differences across countries; however, there has been surprising uniformity in the severity of lockdowns and other containment measures between rich and poor countries. This fairly homogenous lockdown strategy has spanned much of South Asia and Latin America, which have been ravaged by the pandemic, and many countries in Africa, which appear to have contained it quite effectively.”

Blog linked to a new working paper. “In a new working paper, we explore two factors that may lead economists to produce very different conclusions about the wisdom of lockdowns for rich and poor countries: the infection fatality rate (IFR), which incorporates the effects of demography, comorbidities, and health system capacity; and poverty, which affects people’s ability to trade-off consumption today for reduced infection risk. Building these economic considerations into a textbook epidemiological “Susceptible-Infectious-Removed” or SIR model, we suggest that the rather uniform lockdowns across the global spectrum of per capita GDP are hard to rationalize given different contexts and constraints across countries….”

Lancet Comment - Evidence synthesis communities in low-income and middle- income countries and the COVID-19 response R Stewart et al (on behalf of the LMIC members of COVID-END ) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32141-3/fulltext

“Evidence synthesis specialists have responded to the COVID-19 pandemic. In line with WHO's global roadmap for COVID-19 research, we are working to summarise the available research to support evidence-informed decision making across all sectors for immediate and anticipated challenges, within the COVID-19 Evidence Network to support Decision-making (COVID-END). COVID-END is an umbrella organisation involving 50 evidence synthesis or evidence support organisations that are working together to promote collaboration and reduce duplication of effort in the conduct and translation of COVID-19-related evidence syntheses. As a network we have accelerated investment to enable infrastructure for evidence synthesis and to promote evidence use….”

F2P blog - Voices from the pandemic frontlines: Health worker protests and proposals from 84 countries https://oxfamblogs.org/fp2p/voices-from-the-pandemic-frontlines-health-worker-protests-and- proposals-from-84-countries/

Guest post by Jennifer Johnson for the Accountability Research Center

“The COVID-19 pandemic has put unprecedented strain on health care systems around the world. Frontline health workers have faced great risks, from lack of personal protective equipment (PPE) to discrimination and harassment. Some face repercussions for whistleblowing or walkouts. This evolving situation has given rise to a new wave of hundreds of innovative protests and proposals from health workers on the frontlines. The Health Worker Protest Project seeks to understand more about the relationship between health rights and the rights of health workers, as they risk their own lives to protect the lives of others. This pilot learning project is an open-source initiative to share and store reports of health worker protests around the world, launched in May 2020 by the Accountability Research Center (ARC). The project aims to learn from patterns that emerge when we see the international diversity of health worker protests and proposals. Five months in, we have received and collected over 600 reports from 84 countries, which we share on our twitter account @HealthWorkerPro. Reports of health worker protests and proposals are as diverse as the regions they come from, but common themes emerge:…”

Plos Biology - The COVID-19 response illustrates that traditional academic reward structures and metrics do not reflect crucial contributions to modern science A Kucharsky et al; https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000913

« The COVID-19 pandemic has motivated many open and collaborative analytical research projects with real-world impact. However, despite their value, such activities are generally overlooked by traditional academic metrics. Science is ultimately improved by analytical work, whether ensuring reproducible and well-documented code to accompany papers, developing and maintaining flexible tools, sharing and curating data, or disseminating analysis to wider audiences. To increase the

impact and sustainability of modern science, it will be crucial to ensure these analytical activities— and the people who do them—are valued in academia. »

HS Governance Collaborative - The COVID19 pandemic and the private sector M Hellowell et al; https://hsgovcollab.org/en/blog/covid19-pandemic-and-private-sector

“…in the midst of the COVID-19 pandemic, the private sector in most countries has been subject to major financial and operational disruption, reducing its ability to address local healthcare needs. … the World Health Organization has conducted research, included a rapid survey of private health care providers in eight African countries, alongside a document and media analysis covering a range of countries in Africa, Asia and South America, to assess the scale of “the problem”, its causes and consequences, and the range of policies currently being used by LMIC governments in support of the private health sector….”

Check out the findings.

Amongst them: “…our results indicate that countries with more ‘inclusive’ [governance] regimes have greater capacity to provide more systemic and sustainable solutions to the financial crisis facing the private sector.”

PS: “countries that operate a more ‘inclusive’ governance regime – in which there is a high degree of collaboration between the public and private sectors in the health system…”

Brookings (blog) - The impact of COVID-19 on global extreme poverty https://www.brookings.edu/blog/future-development/2020/10/21/the-impact-of-covid-19-on- global-extreme-poverty/

Sobering blog by H Kharas. Using estimates from World Poverty Clock.

Lancet Infectious Diseases – new (modelling) study https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30785-4/fulltext

Via the press release:

“Study provides estimates of the effect of introducing and lifting physical distancing measures on COVID-19 reproduction (R) number”

“Modelling analysis of measures in 131 countries confirms that combined measures are likely to reduce the R more than individual measures. Authors looked at four possible combinations of measures, with the least comprehensive package of measures (ban on public events and gatherings of more than ten people) reducing R by 29% on day 28, increasing to a 52% reduction for the most comprehensive package similar to a lockdown. The study estimated that there was a 1 to 3 week delay in the effect of imposing or lifting measures on the R number. Authors caution that their study

was not able to account for other potentially influential factors, like mask wearing, and non- compliance with measures.”

“Analysis suggests that individual measures (including school closure, workplace closure, public events ban, ban on gatherings of more than ten people, requirements to stay at home, and internal movement limits) are associated with a reduction in transmission of SARS-CoV-2 but combined measures are more effective at reducing transmission, according to a modelling study published in The Lancet Infectious Diseases journal. …”

Alan Whiteside – Covid-19 Watch: shocks https://alan-whiteside.com/?blogsub=confirming#blog_subscription-2

Alan’s regular update on Covid-19, globally. This week with a guest contribution from my colleague Willem van de Put. Don’t agree with his ‘Focused Protection’ stance, but he says a lot of other valid things in his piece.

Eurodad (report) – Never let a pandemic go to waste: How the World Bank’s Covid-19 response is prioritising the private sector https://www.eurodad.org/never_let_a_pandemic_go_to_waste?utm_campaign=newsletter_22_10 &utm_medium=email&utm_source=eurodad

“This briefing paper analyses the response of the World Bank Group (WBG) to the Covid-19 pandemic and reveals a persistent prioritisation of private over public interests, both in the immediate pandemic response and beyond….”

Covid resources

OECD - policy tracker https://www.oecd.org/coronavirus/country-policy-tracker/

Pretty neat resource. “What are countries doing to contain the spread of the coronavirus? How are countries helping people, small businesses and the economy to weather the crisis and beyond? This Country Policy Tracker helps you to navigate the global response.” Not just with info on OECD countries, but broader.

Covid impact on other global health programs & causes

Open Democracy - Aid donors ‘disturbed’ by reports of childbirth violations https://www.opendemocracy.net/en/5050/aid-donors-disturbed-by-reports-of-childbirth- violations/

“Following openDemocracy revelations of WHO childbirth guidelines being flouted around the world, major donors express concern.”

“Major aid donors that spend hundreds of millions of dollars on maternal health each year have denounced “disturbing” evidence collected by openDemocracy of women’s rights being violated in childbirth during the pandemic.”

Guardian - Tuberculosis breakthrough as scientists develop risk prediction tool https://www.theguardian.com/global-development/2020/oct/20/tuberculosis-breakthrough-as- scientists-develop-risk-prediction-tool?CMP=twt_a-global-development_b-gdndevelopment

“Scientists have developed a new tool to predict the chances of a person developing tuberculosis, which could help limit the spread of the disease and improve the life chances of millions of people . Researchers at University College London (UCL) said they believe they have produced an algorithm that could help eliminate the disease in some countries. Country surveys gathered data from tens of thousands of people, including information on age, exposure to TB, whether an individual’s immune system is compromised and whether they are a migrant. Scientists at the Institute of Global Health say this is the first time that patient histories have been used to predict risk of developing active TB, which should help doctors determine what treatment to offer….”

CDC - Landmark TB Trial Identifies Shorter-Course Treatment Regimen https://www.cdc.gov/nchhstp/newsroom/2020/landmark-tb-trial-media-statement.html?s_cid=tw- cdctb_202010210001

“Results from an international, randomized, controlled clinical trial indicate that a four-month daily treatment regimen containing high-dose, or “optimized,” rifapentine with moxifloxacin is as safe and effective as the existing standard six-month daily regimen at curing drug-susceptible tuberculosis (TB) disease. This regimen is the first successful short-course treatment regimen for drug-susceptible TB disease in almost 40 years….”

Coverage via Devex - After almost 40 years, there's now a shorter treatment for TB

(gated) “The trial for a four-month treatment still needs the World Health Organization's review and recommendations to be adopted for wider use.”

SRHR

Guardian - US signs anti-abortion declaration with group of largely authoritarian governments https://amp.theguardian.com/world/2020/oct/22/us-trump-administration-signs-anti-abortion- declaration

“The US has today signed an anti-abortion declaration with a group of about 30 largely illiberal or authoritarian governments, after the failure of an effort to expand the conservative coalition. The “Geneva Consensus Declaration” calls on states to promote women’s rights and health – but without access to abortion – and is part of a campaign by Trump administration, led by secretary of state, Mike Pompeo, to reorient US foreign policy in a more socially conservative direction, even at the expense of alienating traditional western allies. …”

Access to Medicines

HPW - Ratification of Africa Medicines Agency Treaty Inches Forward – Africa CDC Head Calls It ‘Much-Needed’ https://healthpolicy-watch.news/ratification-of-africa-medicines-agency-treaty-inches-forward- africa-cdc-head-calls-it-much-needed/

“Nearly two years after the Assembly of the African Union, adopted a milestone treaty establishing an African Medicines Agency (AMA) that could provide a more unified approach to regulatory approval of new medicines and vaccines, the AMA treaty is yet to enter into force – because it has not been ratified by 15 countries. So far only 18 of Africa’s 55 countries have even signed the framework agreement establishing the agency, including the Republic of Congo, which signed in Addis Ababa just yesterday. But only 5 countries have actually ratified the agreement – including Rwanda, Mali, Burkina Faso, Ghana and Seychelles. Major holdouts include almost all of the largest countries in southern and eastern Africa, along with Nigeria, the Democratic Republic of Congo, and Egypt….”

The Fourth Symposium on Global Health Policy Research

Tuesdays from 20 October to 1 December 2020 https://globalhpr.org/2020-symposium

The Opening plenary: Covid-19 and the future of global health policy analysis, took place on Tuesday. Recording will be made available.

Stay tuned for the coming Tuesdays.

Decolonize Global Health

BMJ GH - Thinking differently: lessons learned by international public health specialists while supporting the Integrated Disease Surveillance and Response system in Pakistan A Wilson et al ; https://gh.bmj.com/content/5/10/e003593

“Internationally supported activities to build public health capacity and improve compliance with International Health Regulations (2005) so that countries are better able to ‘prevent, protect against, control and provide a public health response to the international spread of disease’ have had a positive impact in recent years. However, despite the proliferation of technical guidance, tools and roadmaps, as the recent COVID-19 emergency demonstrates, a significant challenge still remains. The unique and complex environment within countries is increasingly being recognised as a factor which needs greater consideration if system strengthening activities are to be successful. This paper reflects on the learning from and charts out the journey of the authors’ in their efforts to support the Pakistan government to improve compliance with International Health Regulations, specifically through strengthening its Integrated Disease Surveillance and Response (IDSR) system….” “To effect change, public health technical specialists bring their grounded technical and scientific expertise along with their softer public health skills of, among other things, relationship building and multisector working. In the authors’ experience, the importance of taking time throughout to build and maintain strong trusted relationships and peer-to-peer support has been the key to the successes experienced. The nature of this relationship and ongoing reflexive dialogue enabled the co-construction of the reality of the background environment, which, in turn, led to more realistic visioning of the desired system for IDSR, and therefore more appropriate bespoke technical support to be given, leading to the design and initial implementation of a country owned system developed with sustainability in mind.”

Foreign Policy - The U.N. Has a Diversity Problem https://foreignpolicy.com/2020/10/16/un-diversity-problem-workforce-western-ocha/

“Westerners are overrepresented in senior positions across the world body.”

Working paper - The Corporate Tax Haven Index: A New Geography of Profit Shifting P Jansky, A Cobham et al ; https://ideas.repec.org/p/fau/wpaper/wp2020_38.html

“The geography of corporate profit shifting is often presented in public discourse in simplistic and inaccurate terms. Not only can this easily mislead audiences, but it shapes political responses to the problem in such a way as to undermine the prospects for genuine progress. In this paper, we set out a new approach to the geography of profit shifting, based on a range of objectively verifiable criteria. These are combined in the Corporate Tax Haven Index, published for the first time in 2019. We present the technical argument for the index as a meaningful representation of the global distribution of the risks of corporate tax abuse and explore the new geography that emerges. The key findings show the UK™s dominant responsibility for corporate tax avoidance risks and the colonial roots of many exploitative double tax treaties. We end by considering the index’s political

implications for the immediate process of international tax reform, and for the longer-term prospects for global governance in this area. We conclude that greater clarity about the geography of profit shifting is likely to support growing demands for redistribution not only of taxing rights but also of decision-making power in the global architecture for tax governance.”

WHO Data principles

WHO - WHO Data principles

“The data principles of the World Health Organization (WHO) provide a foundation for continually reaffirming trust in WHO’s information and evidence on public health. The five principles are designed to provide a framework for data governance for WHO. The principles are intended primarily for use by WHO staff across all parts of the Organization in order to help define the values and standards that govern how data that flows into, across and out of WHO is collected, processed, shared and used. These principles are made publicly available so that they may be used and referred to by Member States and non-state actors collaborating with WHO….”

See also WHO - WHO Data sharing policy - Implementation suggestions.

HIV

Telegraph - Funding for HIV prevention within the world's most marginalised communities 'woefully inadequate' Telegraph;

“ Funding to help prevent new HIV infections within the world’s most marginalised communities is “way off track”, a landmark study has found. Key populations – which include gay and bisexual men, transgender people, sex workers and people who inject drugs – represented more than half of all new HIV infections in 2018 alone. However only two per cent of the total amount spent on the global HIV response went towards supporting these groups and their partners, according to an analysis by Aidsfonds and Communities of Change. Just 11 per cent of all prevention funding between 2016 and 2018 was spent on these marginalised communities. The study … is the first of its kind to look at support for these groups in lower and middle income countries …”

Global tax justice

UNCTAD/UNODC – Conceptual framework for the statistical measurement of illicit financial flows http://www.unodc.org/documents/data-and- analysis/statistics/IFF/IFF_Conceptual_Framework_for_publication_FINAL_16Oct_print.pdf

#Progress (re an SDG indicator)

“The 2030 Agenda for Sustainable Development identifies the reduction of illicit financial flows (IFFs) as a priority area to build peaceful societies around the world. Combatting IFFs is a crucial component of global efforts to promote peace, justice and strong institutions, as reflected in target 16.4 of the Sustainable Development Goals: “By 2030, significantly reduce illicit financial and arms flows, strengthen the recovery and return of stolen assets and combat all forms of organized crime”….”

On the relevance of this new framework, see a few tweets by Alex Cobham:

“The big point here is that the report ends once and for all the attempt to subvert SDG 16.4 by retrospectively taking multinational tax abuse out of scope: "aggressive tax avoidance is included as an illicit financial flow, while noting that such activities are generally legal."”

“In addition, the report is explicit that this 'aggressive tax avoidance' is the same as the 'base erosion and profit shifting' activity that the OECD BEPS process. That is: the UN now has a target which requires progress on what has thus far been an (unmet) OECD responsibility.”

Launch of The Lancet Healthy Longevity https://www.thelancet.com/journals/lanhl/issue/vol1no1/PIIS2666-7568(20)X0002-X

1st issue just out.

• Start with the Editorial - The Lancet Healthy Longevity: Health For All, For Longer

“… This new open-access journal will address these issues head-on by publishing the best clinical research into ageing and age-related diseases (their aetiology, epidemiology, and treatment). We will also publish research relating directly to preventive medicine, examining lifestyle factors that ameliorate ageing and age-related disease, and will be keeping a watchful—and critical—eye on early clinical developments coming from the labs of basic biogerontological research. … we will also publish Comment, Health Policy and Review papers from across the basic, clinical, psychological, and social sciences that seek to challenge the status quo for the better. Ageing is undeniably universal. The Lancet Healthy Longevity is here to argue that having one's later years synonymous with ill health and poor quality of life need not be.”

• Do check out also COVID-19 and health care inaccessibility in sub-Saharan Africa

“… based on previous research showing gaps in health facility accessibility in sub-Saharan Africa, populations without access to health care are probably not receiving COVID-19 testing, resulting in under-reporting of the true toll of the pandemic in this region. In an Article in The Lancet Healthy Longevity, Pascal Geldsetzer and colleagues mapped health facility (in)accessibility among people aged 60 years or older across sub-Saharan Africa…”

• COVID ageism as a public mental health concern

• A life-course model for healthier ageing: lessons learned during the COVID-19 pandemic

On The Stanford Center on Longevity’s New Map of Life (NMOL) initiative.”… The NMOL should be integrated into societies' responses to address COVID-19 and carried forward into communities' rebuilding….”

Lancet Editorial – Reimagining long-term care https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32202-9/fulltext

This week’s Lancet Editorial. Concluding: “The dehumanising way that COVID-19 has been managed in people in care homes makes a mockery of the purpose of medicine to extend life and allow people to live life in the fullest sense. The long-term care system in many countries is broken and must be reimagined.”

Some papers & reports of the week

WHO Bulletin - Primary health care, the Declaration of Astana and COVID19 K Rasanathan & T Evans ; https://www.who.int/bulletin/online_first/BLT.20.252932.pdf?ua=1

“…Here we aim to evaluate the current status of primary health care as a vehicle towards health for all in the era of the Astana Declaration, the sustainable development goals (SDGs), universal health coverage (UHC) and COVID-19. We propose that the Alma Ata Declaration may be seen as the palimpsest of global health. A palimpsest is a manuscript, papyrus or other form of writing material which has been used repeatedly with the latest writing superimposed on earlier attempts. At each anniversary of the Alma-Ata Declaration, the global health community has reinterpreted and rewritten the concept of primary health, in an attempt to address the lack of progress towards the vision of health for all. Earlier versions have been only partially erased. The palimpsest therefore bears visible traces of its earlier text underneath the latest version – a record of the repeated efforts of expression. We consider how the most recent interpretation of primary health care at the Astana conference can best guide greater application of the primary health-care strategy. We examine tensions, remaining since the Alma-Ata conference, between the broad political vision of primary health care and its implementation in countries, which has mostly focused on primary care. We also consider what support countries need to apply primary health care more effectively to accomplish health for all.”

Three must-reads on WHO in Global Social Policy

WHO under fire: The need to elevate the quality of politics in global health https://journals.sagepub.com/eprint/GKJGZTHY7XHBTXNET5GI/full#articleShareContainer

By Kelley Lee. Concluding: “In sum, the COVID-19 pandemic is foremost a public health emergency. However, the urgent need for collective action within and across countries also makes it a political crisis. Just as scientists worldwide are tasked with coming together, and bringing their best to fight a novel pathogen, political leaders of WHO member states are facing the same challenge. As the work of the Independent Panel for Pandemic Preparedness and Response (IPPR) gets underway, to evaluate the world’s response to the COVID-19 pandemic, this assessment will include close scrutiny of the WHO (WHO 2020c). However, it would be misguided to conclude that all shortcomings in the global response to COVID-19 are due to WHO’s taint by politics. WHO will not be fixed by pretending that politics does not, or should not, exist. Rather, deeper consideration should be given to the quality of national- and global-level politics and political leadership on display during the pandemic. Much will be found wanting.”

The World Health Organization between the United States and China https://journals.sagepub.com/doi/full/10.1177/1468018120966660

By N Chorev.

Beyond pandemic management: How WHO can address post-COVID- 19 futures V Lin; https://journals.sagepub.com/doi/full/10.1177/1468018120963325

“… WHO needs to become more of a learning organisation, and become more flexible and agile in responding to the needs of the stakeholders…”

The Milbank Quarterly – Power and Purchasing: why Strategic Purchasing fails Scott Greer et al; https://onlinelibrary.wiley.com/doi/abs/10.1111/1468-0009.12471

“Strategically purchasing health care has been and continues to be a popular policy idea around the world. Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing. Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness.”

Based on case studies in the Netherlands, US and England.

FT special report – Communicable diseases https://www.ft.com/reports/communicable-diseases

“As the world grapples with coronavirus, this report looks at how scientists and policymakers are rising to the challenge of a pandemic — from new drugs and diagnostics, to efforts to secure poor countries’ access to treatments. Plus: the WHO chief’s view of the crisis.”

With among others, How to spread the word about antibiotic resistance “The FT is working with the Wellcome Trust to raise awareness of a growing threat.” Among others, by trying to reframe the AMR debate.

AJPH - Global Policy Surveillance: Creating and Using Comparative National Data on Health Law and Policy M Kavanagh et al ; https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305892

“Throughout the world, laws play an important role in shaping population health. Law making is an intervention with measurable effects yet often unfolds without evaluation or monitoring. Policy surveillance—the systematic, scientific collection and analysis of laws of public health significance—can help bridge this gap by capturing important features of law in numeric form in structured longitudinal data sets. Currently deployed primarily in high-income countries, methods for cross-national policy surveillance hold significant promise, particularly given the growing quality and accessibility of global health data. Global policy surveillance can enable comparative research on the implementation and health impact of laws, their spread, and their political determinants. Greater transparency of status and trends in law supports health policy advocacy and promotes public accountability. Collecting, coding, and analyzing laws across countries presents numerous challenges—especially in low-resource settings. With insights from comparative politics and law, we suggest methods to address those challenges. We describe how longitudinal legal data have been used in limited, but important, ways for cross-national analysis and propose incorporating global policy surveillance into core global public health practice.”

BMJ Global Health – Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries

J Ochalek et al; https://gh.bmj.com/content/5/10/e003006 “We assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO’s proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices. …” Results & conclusion: “ At Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries. Estimates of the net health impact of providing a healthcare intervention can be used to assess the

benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions.”

Some blogs and other mainstream news of the week

Devex - $1.7B raised for 'toxic brew' of crises in Sahel https://www.devex.com/news/1-7b-raised-for-toxic-brew-of-crises-in-sahel-98365

“A pledging conference hosted by Germany, Denmark, the European Union, and the United Nations raised $1.7 billion Tuesday for the Central Sahelian countries of Burkina Faso, Mali, and Niger. In announcing that total, U.N. Undersecretary-General for Humanitarian Affairs Mark Lowcock called the conference “a successful event” with a “really good outcome.” Of the pledged funds, $997 million is for the rest of 2020, while the remaining $725 million is for 2021 and beyond. The Sahel has faced widespread humanitarian crises in recent years. According to U.N. Secretary-General António Guterres, displacement has increased twentyfold in just two years and the number of families facing hunger has tripled. He appealed for $2.4 billion from the international community to address the regional crisis over the next several years….”

K Bertram - Why sharing power and cooperating well go hand in hand https://katribertram.wordpress.com/2020/10/20/why-sharing-power-and-cooperating-well-go- hand-in-hand/ “There’s a lot of cooperation in our global health and development sector, but very little redistribution of power. … … “

In this great blog, Katri Bertram makes the case that “there’s no point in speaking about collaborating well if there’s no willingness to share power.” Ultimately, a lot will come down to how we organise governance, she says.

PS: clearly, on a (blogging) roll, Katri also wrote another (Partners for Impact) blog, on Exit strategies for partnerships – why they are important for impact in international development

“In this blog we explain why partners need to agree on exit strategies before partnerships are formed, and outline how different exit strategies work in practice for different types of partnerships in international development. Key lessons are summarised at the end of this blog.”

Evelyne de Leeuw (blog) - Interplanetary health https://chetre.org/2020/10/interplanetary-health/

Excerpts below of this poignant blog, pointing out that it’s high time to assess and deal with the looming privatisation and colonisation of space.

“There is a class of government actors and entrepreneurs that is beyond hubris. Without any hesitation or limitation, they believe that by flying to the stars we can fix our own tiny blue speck that floats in orbit in Sol’s circumstellar habitable zone. … … These are good and hopeful arguments. However, in current deliberations around outer space three groups dominate: entrepreneurs, bureaucrats, and politicians. Like so often in discussions around well-being, communities and citizens are absent. … The motivation of space travel is not, or only remotely, to save our planet. It is exploration and resource extraction. Not for humanity or balance or preservation, but for money and continuing relentless growth. The forces that have brought Terra to the brink (rampant capitalism, inexorable unbalanced expansion, ecological, human and cultural exploitation and destruction) will simply be taken to galaxies far, far away. … … In 1967 the Treaty on Principles Governing the Activities of States in the Exploration and Use of Outer Space, including the Moon and Other Celestial Bodies came into force. Essentially, the Treaty commits nation-states and the peoples of planet Terra to be exploring space for the benefit of all. … … The Americans have effectively privatised space, its exploration, and its exploitation. Space-faring nations and businesses have already made outings to our neighbours. …. … The Americans realised that there was an opportunity to set capitalist and neo-liberal standards for our presence in space. The Artemis Accords, superficially, can be seen as an American proposal to manage the Moon in line with the Outer Space Treaty. But the Accords also suggest a platform for government and non-government bodies to agree on arrangements for the exclusive ownership of very precious commodities in space – oxygen and water not the least. And yes – in space no-one can hear you scream, so why would entrepreneurs, bureaucrats and politicians bother to listen?

Some tweets of the week

R Silverman “It's the COVID equivalent of the Peter Principle: as long as COVID remains under control, leaders are under political pressure to reopen more stuff. This continues until too much stuff is open to keep COVID under control.”

Exemplars in Global Health

(as you know, linked to the Gates Foundation)

“#GlobalHealth requires global collaboration, which is why we’re grateful to work with the new #Exemplars Senior Advisory Board: Margaret Chan of @Tsinghua_Uni, @ChrisJElias, @DrSenait, @julio_frenk, @DonaldKaberuka, @MamtaMurthi and Peter Piot of @LSHTM.”

Renzo Guinto “Health policy & systems research for the future? “LMIC-led research on LMICs!” - @Lucy_Gilson Time for activist #HPSR research in the time of #COVID19 and beyond”

Gabby Stern “Speaking of press conferences, @WHO leaders including @DrTedros @mvankerkhove @DrMikeRyan have done more than 110 #COVID19 pressers so far this year, with close-captions & live interpretation in 8 languages. Just sayin’ ...”

Global health events

There’s a flurry of webinars and other online (and/or hybrid) events ongoing and coming up. We won’t try to flag them all here. Just a few, perhaps:

PMAC 2021 : Covid-19 – Advancing towards an equitable and healthy world https://pmac2021.com/

Webinars have already started. Check out the full (virtual) program in the weeks and months ahead.

Coming up – World Health Summit (Berlin) (25-27 Oct) And of course, stay tuned for the hybrid World Health Summit (Berlin) starting on Sunday! https://www.worldhealthsummit.org/

No registration needed, fully online!

CGD/OECD event - Multilateral Development Finance in the Era of COVID-19: A New Report from the OECD (28 Oct) https://www.cgdev.org/event/multilateral-development-finance-era-covid-19-new-report- oecdmultilateral-development-finance

“This year’s edition of the OECD’s Multilateral Development Finance Report (MDFR) makes the case that “building back better” also means improving the existing multilateral aid architecture. …”

Coming up - Series of Graduate institute webinars led by URGE - Independent Resource Group for Global Health Justice https://www.graduateinstitute.ch/GHC-justice-covid19?fbclid=IwAR2ykAL0w- DOrdYLKRmOh1Mk8UpN-PcViA4wAWHnld4WCwQ7gpEFe1SOvd8

Started with this webinar on 22 October.

“The global response to the Covid-19 pandemic raises a number of ethical dilemmas and choices spanning from allocating limited goods such as beds in ICUs and fairly allocating covid-19 vaccines,

how nations should prioritise the health of their citizens versus people elsewhere, to the role and values of international organisations. The Global Health Centre is hosting a new event series on global health justice to facilitate discussions on complex global justice issues and explore the ethical decisions that global Covid-19 responders are and will be facing around the world. This series of conversations is led by the Independent Resource Group for Global Health Justice (IRG-GHJ “URGE”), an international group of leading philosophers.”

Global governance of health

Lancet Infectious Diseases (Profile) – Matshidiso Moeti, first female WHO Regional Director https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30805-7/fulltext

Well worth a read. Mrs Moeti is WHO Regional Director since 2015.

CGD (blog) - The Problem Isn’t that Chinese Lending Is Too Big, It’s that the US and Europe’s Is Too Small

C Kenny et al; https://www.cgdev.org/blog/problem-isnt-chinese-lending-too-big-its-us-and- europes-too-small

“As the possibility of a new Cold War between the US and China gains traction in some foreign policy circles, the scale of Chinese development finance has taken center stage. A closer examination suggests the cost to China of this lending is distinctly underwhelming. It would be cheap for the US and Europe to match China’s lending numbers –and in the interest of global development if it was done right.”

IISD - UN Releases Baseline Report on Disability Inclusion IISD;

“The UN's Disability Inclusion Strategy was launched in June 2019 in the context of the 2030 Agenda’s principle of leaving no one behind. The first report on implementation of the Strategy establishes a baseline on the status of disability inclusion in the UN system. The report identifies challenges in achieving disability inclusion associated with the COVID-19 pandemic and disability- inclusive response and recovery efforts.”

Guardian - Trump could label Oxfam and Amnesty antisemitic over criticism of Israel https://www.theguardian.com/us-news/2020/oct/22/donald-trump-considers-labelling-rights- groups-antisemitic-criticism-israel

“The Trump administration is reportedly considering labelling a number of leading international humanitarian organisations as antisemitic after they documented Israeli rights abuses against

Palestinians, including settlement building in the occupied territories. The groups include the UK- based Amnesty International and Oxfam as well as the US organisation Human Rights Watch. Amnesty International accused the Trump administration, and the secretary of state, Mike Pompeo, of attempting “to silence and intimidate international human rights organisations”….”

Infectious diseases & NTDs

HPW - WHO Releases a Position Statement on Genetically Modified Mosquitoes for the Control of Vector-Borne Diseases https://healthpolicy-watch.news/77919-2/

“Genetically modified mosquitoes could be an innovative tool to combat vector-borne diseases and eliminate malaria, says a new WHO position statement. Genetically modified mosquitoes are designed to suppress mosquito populations and reduce their susceptibility to infection and their ability to transmit disease-carrying pathogens. WHO announced their support for the continued investigation into genetically modified mosquitoes as an alternative to existing interventions to reduce or prevent vector-borne diseases…..”

Lancet GH (Comment) – Back to school for malaria prevention: a new tool in the era of malaria elimination? https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30347-8/fulltext

Comment linked to a new Lancet GH study - Preventive malaria treatment among school-aged children in sub-Saharan Africa: a systematic review and meta-analyses.

The authors aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission.

And a link:

Forbes - Time To Tap Covid-19 Innovations & Systems To Reimagine TB Care (by M Pai)

NCDs

IJHPM - Expanding Public Health Policy Analysis for Transformative Change: The Importance of Power and Ideas P Milsom, R Smith et al ; http://www.ijhpm.com/article_3928_ed9c0a4c0dc6702b468d641a8f185e62.pdf

“It is increasingly recognised within public health scholarship that policy change depends on the nature of the power relations surrounding and embedded within decision-making spaces. It is only through sustained shifts in power in all its forms (visible, hidden and invisible) that previously excluded perspectives have influence in policy decisions. Further, consideration of the underlying neoliberal paradigm is essential for understanding how existing power dynamics and relations have emerged and are sustained. In their analysis of political and governance factors, Townsend et al have provided critical insight into future potential strategies for increasing attention to health concerns in trade policy. In this commentary we explore how incorporating theories of power more rigorously into similar political analyses, as well as more explicit critical consideration of the neoliberal political paradigm, can assist in analysing if and how strategies can effectively challenge existing power relations in ways that are necessary for transformative policy change.”

Globalization & Health - The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts T Oni et al (on behalf of the GDAR network) https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00630-y

“…The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages….”

And a link:

Lancet Global Health - Burden of non-communicable diseases from infectious causes in 2017: a modelling study

Sexual & Reproductive / maternal, neonatal & child health

Devex – The pandemic takes its toll on women and girls' mental health https://www.devex.com/news/the-pandemic-takes-its-toll-on-women-and-girls-mental-health- 98314

(gated) “More women and girls' are experiencing stress, anxiety, and other mental health impacts as a result of the pandemic. Experts warn this could have devastating long-term impacts.”

Guardian - Bottle-fed babies swallow millions of microplastics a day, study finds https://www.theguardian.com/environment/2020/oct/19/bottle-fed-babies-swallow-millions- microplastics-day-study

“Bottle-fed babies are swallowing millions of microplastic particles a day, according to research described as a “milestone” in the understanding of human exposure to tiny plastics. Scientists found that the recommended high-temperature process for sterilising plastic bottles and preparing formula milk caused bottles to shed millions of microplastics and trillions of even smaller nanoplastics….”

Lancet GH - Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30354-5/fulltext

Some of the findings: “Although son preference is evident in some settings—as shown by higher than expected male-to-female sex ratios at birth in India, Vietnam, and China (all >1·10 compared with an expected ratio of 1·05) and excess mortality of girl children in some South Asian and Pacific nations—it is during early adolescence where marked gender inequalities consistently emerged. Adolescent girls face considerable disadvantage in relation to sexual and reproductive health (notably in South Asia and the Pacific), with high rates of child marriage (≥30% of women aged 20–24 years married before 18 years in Bangladesh, Nepal, and Afghanistan), fertility (≥65 livebirths per 1000 girls in Nauru, Laos, Afghanistan, Nepal, Marshall Islands, Bangladesh, Vanuatu, and Papua New Guinea), and intimate partner violence (>20% in Timor Leste, Afghanistan, Pakistan, and Myanmar). Despite educational parity in many countries, females aged 15–24 years were less likely than males to be in education, employment, or training in 17 of 19 countries for which data were available. Compared with girls, adolescent boys experienced excess all-cause mortality and substantially higher mortality due to unintentional injury, interpersonal violence, alcohol and other drugs, and suicide, and higher prevalence of harmful drinking and tobacco smoking.”

JAMA - Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle- Income Countries https://jamanetwork.com/journals/jama/article-abstract/2771901

“This cancer epidemiology study characterizes lifetime cervical cancer screening prevalence in low- and middle-income countries overall and by region; per capita gross domestic product; and patient rurality, education, and household wealth.”

Link:

Guardian - Kenyan efforts to end FGM suffer blow with victims paraded in 'open defiance'

Miscellaneous

Telegraph - Sweden considers 'local lockdowns' in shift in coronavirus strategy https://www.telegraph.co.uk/news/2020/10/17/sweden-considers-local-lockdowns-shift- coronavirus-strategy/

“Sweden quietly shifting strategy in the face of the pandemic and will empower regional authorities to take action.”

Foreign Policy - The Rise of the COVID Dictatorships https://foreignpolicy.com/2020/10/16/the-rise-of-the-covid-dictatorships/

“Around the world, emergency powers are chipping away at democracy—sometimes with public support.”

WHO - A systematic approach for undertaking a research priority-setting exercise: guidance for WHO staff https://apps.who.int/iris/bitstream/handle/10665/334408/9789240009622- eng.pdf?sequence=1&isAllowed=y

For WHO staff. But perhaps also relevant for others?

WSJ - Oxford Developed Covid Vaccine, Then Scholars Clashed Over Money https://www.wsj.com/articles/oxford-developed-covid-vaccine-then-scholars-clashed-over-money- 11603300412?mod=mhp

In-depth story. “Early deal with Merck was scotched for fear poor countries would be left out; now university could make over $100 million with AstraZeneca if technology succeeds.”

HPW - COVID-19 Human Challenge Trials: Frivolous Risk Or Practical Solution? https://healthpolicy-watch.news/78037-2/

Analysis. Including WHO’s take: “Like many other thorny pandemic issues it has faced, WHO doesn’t exactly endorse challenge trials. But it’s fairly obvious that the organisation sees them as a potentially legitimate mode of research – even in the COVID-19 context – having drawn up two weighty volumes of guidance about the issue. In a press briefing this week, WHO Spokesperson Margaret Harris said that the organisation’s guidance includes a report by a WHO working group on the key criteria for the ethical acceptability of COVID-19 human challenge studies and another draft document by a WHO Advisory group on the feasibility, potential value and limitations of challenge studies….”

In sum: “Not an unqualified ‘yes’. But not a ‘no’ either. “