IHP News 618 : Staring Into the Abyss

IHP news 618 : Staring into the abyss

( 23 April 2021)

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

Dear Colleagues,

In line with the ‘variants of concern’, we flag two major ‘points of concern’ this week, and no – in spite of my football addiction, the European Super League (only one step further on football’s neverending Big Business & Big Bucks journey, in my opinion) wasn’t one of them. The first one relates to Earth Day, celebrated on the 22nd of April. UN SG Guterres’ warning, that the world is on the verge of the - climate & biodiversity - abyss ( or ‘on red alert’), set the scene for the virtual Leaders’ Summit, hosted by ‘Joe the busy one’. Every year, Earth Day reminds us that human health depends on the health of the planet that sustains us - so far largely in vain, unfortunately. If we do want to heed that call, though, we better have a very good look at René Loewenson et al’s new BMJ Global Health paper, in which they argue, correctly, that “Today’s threats raise a critical moment of choice on which ideas dominate, not only for health but also for survival.”

Put differently, “We live in a Gramscian moment of old and new ideas”, in their words, which brings me to the second point of concern for the weeks & months ahead. If the ongoing pandemic carnage in Brazil and India, among other countries, doesn’t change ideas about the urgent need for a TRIPS waiver, and revamp of our R&D/ IP systems in general, then I don’t know what will. The divide between a (small) part of the world where the “Covid endgame” seems near, the countries where they hope for their own Covid endgame soon – somewhat mysteriously, all to materialize by their own ‘national holiday’ (in Flanders: 11 July, in France 14 July: etc) -, and the rest of the world, still staring into the abyss, with horror scenes playing out in hospitals, homes and on the streets, has become outrageous and sickening. ( PS: What makes it even more infuriating: 3 three of the leading Covid vaccine manufacturers have paid out $26bn in dividends and stock buyouts to shareholders in the last year – enough to cover the cost of vaccinating the population of Africa)

In a WHO briefing earlier this week, Greta Thunberg urged world leaders to end the ‘tragedy’ of Covid vaccine inequity. But it’s more than a tragedy, it’s a f****** disgrace. It’s long overdue to go all out for a People’s Vaccine, as Mariana Mazzucato, Jayati Ghosh and Els Torreele argued in The Economist. All the other arguments – like the one by IMF’s Georgieva, that vaccine policy is now also economic policy, are valid too. But they are far less important than the moral one to stop the carnage now, all over the world. So do what it takes, Joe, Ngozi et al. Massive tech transfer, Trips Waiver (as Hyo Yoon Kang argued in Geneva Health Files, you really need both); end export bans; stop the hoarding; and support Covax (which exists one year now) with everything you have.

Do the same for oxygen & treatments. Do it all and do it now.

Enough is enough.

Enjoy your reading.

Kristof Decoster

See also this week’s intro.

“The way healthy societies are conceptualised shapes efforts to achieve them. This paper explores the features and drivers of frameworks for healthy societies that had wide or sustained policy influence post-1978 at global level and as purposively selected southern regions, in India, Latin America and East and Southern Africa. … … The trajectories point to a need for ideas and practice on healthy societies to tackle systemic determinants of inequities within and across countries, including to reclaim suppressed cultures; to build transdisciplinary, reflexive and participatory forms of knowledge that are embedded in and learn from action; and to invest in a more equitable circulation of ideas between regions in framing global ideas. Today’s threats raise a critical moment of choice on which ideas dominate, not only for health but also for survival.”

The authors’ conclusion: “…At this critical moment of choice, the social constructivist analysis suggests that we look not only to ideas advanced by elites and states for what assumes dominance, but also to those promoted by social actors. A key driver of healthy societies may thus be when sufficient people in communities, countries, regions and global institutions converge in seeing an unhealthy status quo as no longer acceptable; when we have generated the space and processes to fairly share and build ideas that benefit, are understood and embraced by the wider public; and when we have the confidence and assert the collective power to produce change.”L

Lancet Comment - Global health and its discontents K Rasanathan; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00713- 3/fulltext

Ex aequo with the previous read : )

“ A year ago, a group of us gathered to reconsider how to build healthy and equitable societies. During that meeting, we rehearsed critiques of the current practice of global health. The COVID-19 pandemic has laid bare the truth in these charges, highlighting deficiencies in the pursuit of equity and in the capacity for multisectoral action… … As a global health community, we should not miss the opportunity from this crisis to reflect upon and remedy our shortcomings to better support global health equity. …” He lists five deficiencies.

And then concludes:” COVID-19 has made the case more persuasively than ever for an effective global health. It is time to use the political oxygen of the current prominence of global health to construct a more participatory, just, and effective practice out of the cruelty and misery of COVID- 19…”

Check out the panel to see what’s needed: Improving the effectiveness and equity of global health practice in the wake of COVID-19.

Inaugural event of a new initiative, Children in All Policies 2030 (CAP-2030) (21 April)

On Wednesday, a new initiative, CAP-2030 was launched,, born out of a WHO-UNICEF- Lancet Commission, A future for the world’s children?

Lancet (Comment) - Children in All Policies 2030: a new initiative to implement the recommendations of the WHO–UNICEF–Lancet Commission

Sarah Dalglish, Anthony Costello, Helen Clark et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00718-2/fulltext

“On April 21, 2021, we launched Children in All Policies 2030 (CAP-2030), with the support of our founding partners WHO, UNICEF, and The Lancet. Our ambition is to join our voices to those of children and young people, activists, civil society institutions, religious groups, UN organisations, politicians, governments, private sector leaders, academics, and others working to centre children's health and wellbeing in the urgent work of sustainable development. We encourage people to join the movement to preserve children's future and contribute to CAP-2030 by getting in touch via our website….”

CAP-2030 has three objectives: “First, we build coalitions for children across sectors … Second, we seek to advance action on the global climate crisis by centring children's perspectives and harnessing their voices to drive action by national and global policy makers. … Our third objective is to address the problems associated with commercial marketing and advance understanding of this key area for improving children's health and wellbeing. We will strengthen a binding international treaty, the UN Convention on the Rights of the Child, to protect children from exploitative marketing of harmful products and services. …”

World Immunization Week (April 24-30)

Lancet Editorial – 2021: the beginning of a new era of immunisations? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00900-4/fulltext

“While the world is firmly focused on the efficacy, adverse events, licensing, and roll-out of COVID-19 vaccines, the disruption of and barriers to routine immunisations during the pandemic have garnered much less attention. World Immunization Week (April 24–30) presents an opportunity to reflect on the state of immunisation efforts for vaccine-preventable diseases, how the COVID-19 pandemic has affected progress, and what lessons can accelerate efforts to prevent diseases through immunisation. The Immunization Agenda 2030 (IA2030) will be officially launched on April 26. This agenda provides a new global vision and strategy for vaccines for the next decade, following on from the Global Vaccine Action Plan (2011–20). …” “…The four overarching principles the IA2030 puts forward are a people-centred, country-owned, partnership-based, and data-guided approach….”

The editorial concludes: “Much has been achieved through vaccination, with many lives saved and disabilities prevented. Science has brought us options for many diseases, with further possibilities on the horizon. A new era of immunisations is much needed and the IA2030 sets out a very good framework. But vaccine hesitancy remains an important issue to tackle. And without addressing the fundamental underlying barriers of inequity, poverty, political posturing, and commercial interest protection, the next decade will not achieve much more than the past.”

Earth Day & Virtual global leaders’ summit on climate change (22-23 April)

(Official) Main objectives of this summit are: “- Get the world's major economies to reduce emission in this decade while also getting the public and private sector involvement. - Show how climate action can have economic and social benefits. Build new businesses and industries. - Using the technology available to adapt to climate change but also reduce emissions. Use nature-based solutions to achieve net-zero emissions by 2050. - Protect lives and livelihoods by finding ways to adapt to climate change.”

Basically, as you know, it’s intended to (1) re-establish some US leadership on climate change (2) a key milestone before the COP 26 in Glasgow.

Guardian - US vows to cut its emissions at least 50% by 2030 ahead of climate summit https://www.theguardian.com/us-news/2021/apr/22/us-emissions-climate-crisis-2030-biden

Main news so far, but the meeting is ongoing. Japan, Canada, EU, (and even Brazil)… have also already announced further cuts. China didn’t (it sticked to what they already announced some months ago, with exception of an opening on coal from 2026 on), but Xi gave a speech. India’s Modi also didn’t make new announcements.

Unfortunately, a (global) carbon tax is still not on the table…

See also CNBC - Here’s what countries pledged on climate change at Biden’s global summit

Devex – Biden announces US will double climate finance by 2024 https://www.devex.com/news/biden-announces-us-will-double-climate-finance-by-2024-99729

“President Joe Biden announced Thursday that the U.S. government will double its public climate finance to lower-income countries by 2024. … doubling by 2024 would amount to roughly $5.7 billion per year… “

PS: a virtual event called Financing the Race to Zero, coincided with Earth Day. … The climate finance event took place in parallel with the first day of U.S. President Joe Biden’s Leaders Summit on Climate. There’s still a long way to go to meet the 100 billion finance goal…

Some analysis ahead of the summit Guardian - Concerns over climate finance for poorer nations as White House summit begins

Devex - Biden's summit a 'crunch moment' for US climate finance leadership

Climate Home News - Biden’s moment: What to expect from Thursday’s climate leaders summit

“Helicopter analysis & prognoses ahead of the summit. “The US is expected to unveil a stronger emissions target and call for higher ambition from big emitters at a leaders’ summit on Thursday.”

HPW - Health & Climate Activists Have High Hopes That US Climate Summit Can Open New Chapter

“Climate activists have high hopes that at this week’s Leaders Summit on Climate, hosted by US President Joe Biden with forty other heads of state, climate change will be framed as a health issue that is exacerbating the risk of future pandemics, as well as causing seven million deaths a year right now as a result of air pollution and reducing already fragile crop yields critical to nutrition and food security. Climate activists are pinning these hopes on the Biden administration’s recent appointment of two well-known advocates of the health card in climate change negotiations – John Kerry, the U.S. Special Presidential Envoy for Climate, and Gina MacCarthy, the White House climate advisor. …”

Remains to be seen, though. See the ‘official objectives’ of the summit.

Guardian - Carbon emissions to soar in 2021 by second highest rate in history https://www.theguardian.com/environment/2021/apr/20/carbon-emissions-to-soar-in-2021-by- second-highest-rate-in-history

One of the many (worrying) reports ahead of the summit.

“Carbon dioxide emissions are forecast to jump this year by the second biggest annual rise in history, as global economies pour stimulus cash into fossil fuels in the recovery from the Covid-19 recession. The leap will be second only to the massive rebound 10 years ago after the financial crisis, and will put climate hopes out of reach unless governments act quickly, the International Energy Agency has warned. Surging use of coal, the dirtiest fossil fuel, for electricity is largely driving the emissions rise, especially across Asia but also in the US. Coal’s rebound causes particular concern because it comes despite plunging prices for renewable energy, which is now cheaper than coal….”

Guardian - ‘Relentless’ climate crisis intensified in 2020, says UN report https://www.theguardian.com/environment/2021/apr/19/relentless-climate-crisis-intensified-in- 2020-says-un-report

“There was a “relentless” intensification of the climate crisis in 2020, according to the UN’s World Meteorological Organization. The coronavirus pandemic made the accelerating impacts of global heating even worse for millions of people. But the temporary dip in carbon emissions due to lockdowns had no discernible impact on atmospheric concentrations of greenhouse gases, the WMO report said. … The WMO’s State of the Climate report comes just before a global leaders’ summit, convened by the US president, Joe Biden, and as the UK prepares to host the crucial Cop26 UN climate summit in November, at which urgent action must be agreed to meet the goals of the 2015 Paris agreement, to keep the global temperature increase to well below 2C and 1.5C if possible. In 2020, the temperature was 1.2C above pre-industrial levels….”

Save the Children (report) – Climate crisis: 710 million children live in countries at high risk https://www.savethechildren.net/news/climate-crisis-710-million-children-live-countries-high-risk

Another report ahead of the Leaders summit. “An estimated 710 million children live in the 45 countries that are at the highest risk of suffering the impact of climate change, Save the Children warned today. Floods, droughts, hurricanes and other extreme weather events will have an especially deep impact on vulnerable children and their families. .. … 70 percent of countries facing a high risk of climate impact are in Africa…”

…Ahead of the Climate Summit on Earth Day, Save the Children urges all governments to take immediate and drastic action to address climate injustice head on, and avoid further catastrophic impacts on children and their families. …” Read what they suggest.

Other Planetary Health news

Guardian - 101 Nobel laureates call for global fossil fuel non-proliferation treaty https://www.theguardian.com/environment/2021/apr/21/101-nobel-laureates-call-for-global-fossil- fuel-non-proliferation-treaty?CMP=Share_AndroidApp_Other

“A hundred and one Nobel laureates, including the Dalai Lama, are calling for governments around the world to sign up to a fossil fuel non-proliferation treaty to help tackle the climate crisis. In an open letter to world leaders published on Wednesday former presidents, scientists, novelists and religious leaders are urging governments to commit to a rapid and just transition away from fossil fuels, and a “transformational plan” to ensure everyone around the world has access to renewable energy….”

Lancet Planetary Health (Comment) – From pandemic to Paris: the inclusion of COVID-19 response in national climate commitments A Wyns et al ; https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00111-X/fulltext

“… A successful response to both crises can only succeed when tackled concurrently. NDCs offer a crucial policy platform to connect near-term national climate strategies and COVID-19 recovery efforts. Arguably, therefore, the next 6 months could be the most important decision-making window for both climate change and public health policy in the foreseeable future. Here, we examined 48 new or updated NDCs (as of Dec 31, 2020) for their inclusion of COVID-19, representing 75 (40%) of the 191 parties to the Paris Agreement and accounting for about 30% of global greenhouse gas emissions. COVID-19 was referenced in 42% NDCs. Based on content analysis, various recurring themes and entry points were discussed in relation to COVID-19 recovery and climate commitments, including altered ambitions, gendered impacts, and human wellbeing (table). However, most governments did not meaningfully reflect the impacts of the pandemic and worsening climate crisis on their level of commitment….”

“…There are several key political windows for countries to step forward with enhanced commitments that address the COVID-19 and climate crisis in tandem (eg, the Leaders' Climate Summit, G7, and G20 summits). The recommendations highlighted in this article can help governments create pandemic-primed NDCs, potentially offering a triple win for safeguarding wellbeing, sustainable economic development, and climate goals.”

WHO - Director-General's opening remarks at the media briefing – 19 April 2021 https://www.who.int/director-general/speeches/detail/director-generals-opening-remarks-at-the- media-briefing-on-covid-19-19-april-2021

“…. At the COP26 climate conference in Glasgow this year, WHO will deliver a special report with recommendations on how to maximize the health benefits of tackling climate change, while avoiding the worst health impacts of the climate crisis. WHO is also spearheading an initiative on promoting climate-resilient health systems, in collaboration with the government of the United Kingdom…..”

Guardian - Environment protest being criminalised around world, say experts https://www.theguardian.com/environment/2021/apr/19/environment-protest-being-criminalised- around-world-say-experts

“Peaceful environmental protesters are being threatened, silenced and criminalised in countries around the world including the UK and the US, according to some of the world’s leading climate scientists and academics. More than 400 leading experts – including 14 authors from the UN Intergovernmental Panel on Climate Change (IPCC) – say that non-violent civil disobedience from groups like the school strikers, Extinction Rebellion and the Sunrise Movement have transformed the debate around the climate crisis in recent years. But in an open letter published on Monday they warn governments around the world are criminalising them at a pivotal time in the fight to tackle the escalating climate emergency…..”

“Dr Oscar Berglund, from the Cabot Institute for the Environment at the University of Bristol, helped coordinate the letter. He said the attempt to “criminalise climate protest” was central to the fossil fuel industry’s new strategy of delaying action on climate change…. …. The experts warn that just months before a crucial global climate conference due to be held in Glasgow later this year, it is more important than ever that these groups are able to put pressure on politicians and highlight the role polluting corporations are playing in the escalating ecological crisis….”

Link:

• Lancet Planetary Health - A framework to guide planetary health education

“…a taskforce of thought leaders in planetary health and education was convened by the Planetary Health Alliance to create the Planetary Health Education Framework… … The Planetary Health Education Framework considers five foundational domains that we believe comprise the essence of planetary health knowledge, values, and practice …”

WHO - Informal meeting for Non-State Actors in advance of the Seventy-fourth World Health Assembly (20-22 April) https://www.who.int/news-room/events/detail/2021/04/20/default-calendar/informal-meeting- for-non-state-actors-in-advance-of-the-seventy-fourth-world-health-assembly

“This virtual informal meeting [aimed] to improve the involvement of non-state actors in WHO’s governing bodies, giving them the opportunity to engage with WHO technical units and Member States. The agenda for the meeting [is] organized along the 74th Health Assembly agenda and the 13th GPW 3 pillars to allow discussions on selected items from the Assembly agenda….”

HPW - WHO Holds First Ever Pre- World Health Assembly Session With Civil Society https://healthpolicy-watch.news/who-holds-first-ever-pre-world-health-assembly-session/

Coverage of the first day of this meeting.

“The World Health Organization (WHO) and member states have an obligation to listen to stakeholders in a “sympathetic and respectful manner” as non-state actors (NSAs) play critical roles in supporting global health work generally – and more immediately addressing COVID-19 and its impacts on communities. That call was made by Mara Burr, director of multilateral relations at the United States Department of Health and Human Services/Global Affairs, during a first- ever informal meeting between civil society groups, WHO officials and WHO member states ahead of the formal 74th World Health Assembly, 24 May-1 June. …”

“… While civil society groups have expressed fears that novel format of a separate forum for more detailed discussions between NGOs and member states could also undermine their standing at the formal WHA – the presence of some leading WHO donors and member states, such as the United States, Germany and France – in at least some of the sessions – seemed to indicate that countries are taking the new model seriously. …” (not everybody agreed, though)

WHO Reforms, Finance And Other Key Issues were raised on this first day.

PS: on the ‘pandemic treaty’ - “There is currently a group of countries, including the United Kingdom, Germany, France, Indonesia, Kenya, Rwanda, and South Africa, co-sponsoring a draft decision on the treaty at the WHA. The decision would mandate WHO to create an intergovernmental working group to start working through the treaty specifics. Mahjour stated that civil society’s role in supporting such a treaty would be “most important”…”

“While Tuesday’s sessions were focused on COVID-19 response and health emergencies more generally, Wednesday and Thursday sessions [will] trace the steps of the wider range of issues that will also be addressed in May’s formal World Health Assembly. Those will include sessions on the other two “pillars” of the WHO’s current strategic plan, including: one billion more people getting access to universal health coverage and one billion more people enjoying better health and well being. …”

Tweet Maik Dünnbier :

“After day, I’m encouraged. Solid Member States participation & good exchange w/ @WHO colleagues from different parts of the organization. But I’m also concerned: civil society interaction remains limited to “ask questions” - to MS & WHO. But we need policy debate not Q&A #WHA74.”

Global Governance & Financing

Virtual event this afternoon (23 April 3 pm CET) – One-year anniversary of the Access to COVID-19 Tools Accelerator https://www.who.int/news-room/events/detail/2021/04/23/default-calendar/one-year- anniversary-of-the-access-to-covid-19-tools-accelerator

Will be live-streamed. “…a virtual event to mark the one-year anniversary of the Access to COVID-19 Tools Accelerator, bringing together ACT Accelerator co-founders, Facilitation Council co-chairs and Principals from the partner agencies to reflect on progress, challenges and the path forward….”

CGD (blog) – Financing Global Health Security Fairly J-A Röttingen, B Aylward et al; https://www.cgdev.org/blog/financing-global-health-security- fairly#disqus_thread

Starting from an ACT-A (financial) update. “…Thanks to financial contributions to ACT-A of US$14 billion, the vast majority of WHO member states have now been able to start COVID-19 vaccine roll out, reduce transmission by testing, and save lives by treating the disease. More than 110 countries have already received vaccines through the COVAX Facility, the vaccine pillar of ACT-A. However, ACT-A faces a remaining financing gap of US$19 billion, and if the world is to win the fight against COVID-19, this gap must be filled in 2021…”

“…To address the funding shortfall, the co-chairs of the ACT-A Facilitation Council—the finance ministries of South Africa and Norway—together with Facilitation Council members, have developed a financing framework for fair-share contributions to ACT-A. This “how to split the bill” approach, a financial burden-sharing model, is now being used as a starting point for outreach to all 89 high- income and upper-middle-income countries to contribute to ACT-A. This will be crucial to secure a fair share of financing for ACT-A as a global public good. It is too early to reflect on the experiences at this stage, but there will be a progress report at the Global Health Summit on 21 May 2021….

“…Global health security is a global public good. We need predictable and sustainable models for financing such global public goods fairly and collectively among states. To that effect, we have used the ACT-A experience and approach in addressing this problem and generalized the model for other needs. This simple mathematical approach is based on three consensual macroeconomic indicators to determine the “fair share by country.”…”

“…with a fair-share financing approach such as the one illustrated here, around 90 percent of the total investments will be borne by 30 countries. …”

Reuters - Britain launches expert group to prepare for future pandemics Reuters;

“Britain on Tuesday said it would launch a new international expert group to help bolster the world’s preparedness for the next pandemic and expedite the development of vaccines against future diseases when they emerge. Launched under Britain's Presidency of the Group of Seven (G7) rich nations, the Pandemic Preparedness Partnership (PPP) will report to the G7 leaders summit in June, and will advise on how to achieve Prime Minister Boris Johnson's target of developing vaccines against future diseases within 100 days. …”

C20 Global Health Working Group Statement to the Civil Society Consultation on Sustainable Health Security Preparedness and Response ahead of the Global Health Summit, 20th April 2021 http://civil-20.org/2021/wp-content/uploads/2021/04/GHS-CS-Consultation-GWHG-Statement.pdf

Preparations (and advocacy) for the G20 Global Health Summit in Rome ( 21 May) are in full swing. By way of example, this statement.

Wemos/Cordaid report – Health Systems Strengthening - An analysis of coordination among the Global Fund, the Global Financing Facility and Gavi (3Gs) https://www.wemos.nl/wp-content/uploads/2021/04/Cordaid-and-Wemos_Strengthening-Health- Systems-Strengthening_March-2021.pdf

“In this research paper, Cordaid and Wemos recommend ways for the 3Gs to reinforce their approach to strengthen health systems. These identified areas of attention aim to support their efforts to contribute to country-led, sufficiently funded and staffed, gender-transformative and equitable health systems, together with the communities involved. Only harmonised efforts can truly improve the accessibility, coverage, quality and efficiency of health systems. Our recommendations for the 3Gs focus on six key components of a health system: health finance, human resources for health, health data and information systems, supply chain management, community engagement and gender. We also provide suggestions regarding coordination among the 3Gs overall. Strengthening and efficiently coordinating efforts on these components will also result in a stronger, more equitable and inclusive health system as a whole…”

WTO’s New Leader Puts Vaccine Nationalists on Notice https://www.bloomberg.com/news/newsletters/2021-04-15/supply-chains-latest-new-wto-leader- combats-vaccine-nationalism

Analysis of Ngozi’s pro-active role so far at the helm of WTO.

“Ngozi Okonjo-Iweala promised that life at the World Trade Organization on her watch would not be business as usual. So far, she’s delivering. Six weeks on the job, there is already a palpable sense in Geneva that the 66-year-old Nigerian economist is beginning to shake things up. During the past 45 days, Okonjo-Iweala has focused much of her time and energy on addressing “vaccine inequity” — not surprising considering her past work as the chair of the Global Alliance for Vaccines and Immunization. … Traditionally, the WTO director-general provides administrative and technical support to the organization’s 164 members by coordinating meetings, giving speeches and occasionally acting as a neutral mediator to help resolve conflicts. Okonjo-Iweala’s willingness to cast aside the more deferential approach of her predecessor has surprised some observers….”

HPW - Increased Funding For Leading Infectious Diseases; Neglected Disease Funding Stagnant https://healthpolicy-watch.news/increased-funding-for-leading-infectious/

From late last week. “Global funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB, and malaria, was US $3.876 billion, with the drop of US $185 million from 2018 reflecting COVID-related difficulties in data collection, according to the G-Finder Report, which tracks annual global investments. However, once participation is accounted for, the report estimates that 2019 funding was virtually unchanged from its record high in 2018, with only a marginal decline of US $8 million. On the other hand, funding for neglected tropical diseases (NTDs) remains stagnant as it had for the past decade, with most NTDs seeing little change to their individual funding levels (although the majority did receive small increases), according to findings in the report, launched on Thursday by the Australia-based Policy Cures Research group. …”

HPW - Africa’s New COVID-19 Disaster Recovery Framework To Respond To Future Pandemics https://healthpolicy-watch.news/africas-new-covid-19-disaster-recovery-framework/

“The African Union Commission (AUC) is developing a COVID-19 Disaster Recovery Framework to guide its member states on how to respond effectively and in a timely manner to future pandemics – as well as other health emergency risks. The framework, still in the initial stages of development, will soon be shared with the AUC’s 55 member states and regional organisations, and would become operational sometime in 2022, according to Kai Gatkuoth, technical coordinator for Disaster Risk Reduction at the AU’s Directorate of Rural Economy and Agriculture, in an interview with Health Policy Watch. Both the United Nations Development Programme (UNDP) and the Swedish Government are providing technical and financial support for the AU Disaster Risk Reduction Unit to help realize this objective….” “In a related development, the AUC is also in the process of developing a multi-hazard warning system that aims to link natural hazards, pandemics and pests and diseases as well as conflict….”

“…The new warning system comes in addition to ongoing efforts being carried out through the African Risk Capacity (ARC) – a specialised agency of the African Union…”

BMJ GH - Religion and the World Health Organization: an evolving relationship F Winiger et al; https://gh.bmj.com/content/6/4/e004073

“Much has been written about WHO. Relatively little is known, however, about the organisation’s evolving relationship with health-related personal beliefs, ‘faith-based organisations’ (FBOs), religious leaders and religious communities (‘religious actors’). This article presents findings from a 4-year research project on the ‘spiritual dimension’ of health and WHO conducted at the University of Zürich. … we identify three stages in this relationship. Although since its founding individuals within WHO occasionally engaged with religious actors, it was not until the 1970s, when the primary healthcare strategy was developed in consultation with the Christian Medical Commission, that their concerns began to influence WHO policies. By the early 1990s, the failure to roll out primary healthcare globally was accompanied by a loss of interest in religion within WHO. With the spread of HIV/AIDS however, health-related religious beliefs were increasingly recognised in the development of a major quality of life instrument by the Division of Mental Health, and the work of a WHO expert committee on cancer pain relief and the subsequent establishment of palliative care. While the 1990s saw a cooling off of activities, in the years since, the HIV/AIDS, Ebola and COVID-19 crises have periodically brought religious actors to the attention of the organisation. This study focusses on what we suggest may be understood as a trend towards a closer association between the activities of WHO and religious actors, which has occurred in fits and starts and is marked by attempts at institutional translation and periods of forgetting and remembering.”

And a few links:

• SCMP - Coronavirus: Chinese expert rails against Tedros and Wuhan lab leak theory on state media

“Unnamed scientist who investigated pandemic origins given state media platform to accuse ‘irresponsible’ WHO director general of pursuing controversial theory; Backlash has potential to cause a rift between China and WHO and harm future probes into pandemic origins, say experts.”

• Byline - Scientist Linked to Great Barrington Declaration Embroiled in World Health Organization Conflict of Interest (re research paper dismissing evidence that COVID-19 is airborne)

Covid key news

Guardian - Global death toll passes 3m as pandemic ‘grows at an alarming rate’ https://www.theguardian.com/world/2021/apr/18/global-death-toll-passes-3m-as-pandemic- grows-at-an-alarming-rate

Last weekend this tragic (official) milestone was passed. “A grim Covid-19 milestone was passed on Saturday when it was revealed that the global death toll from the disease had passed three million….”

Meanwhile, globally, new cases of coronavirus have hit a weekly record, according to WHO data. Last week, there were 5.24 million new cases, 200,000 more than the previous record reported the week ending 4 January.

See also Cidrap News - WHO: Pandemic shows no signs of easing (21 April) Based on WHO’s latest snapshot. “… Hot spots continue to vary by region, with the sharpest rises in the region that includes India, where daily cases today topped 300,000 for the first time. Other hard hit areas include the Middle East and the Western Pacific area, though cases are rising in all of the WHO's regions except for Europe. The main drivers of recent surges are probably the emergence of more transmissible variants and the inconsistent use and early release of public health measures, the WHO said….”

It’s clear that India’s horrible outbreak is now driving the global surge: see for example Washington Post And the Guardian - India hits global record of 315,000 new daily cases as Covid wave worsens

See also BMJ News - Covid-19: India looks to import oxygen as cases surge, overwhelming hospitals

And Devex (with focus on the (almost?) imploding health system) - ‘No light at the end of the tunnel’ as India battles second wave of COVID-19

UN News - COVID-19 infections approaching highest rates ever, WHO warns https://news.un.org/en/story/2021/04/1089932

On last week Friday’s media briefing.

“COVID-19 infections are approaching their highest rates since the pandemic began just over a year ago, the head of the World Health Organization (WHO) reported on Friday. “Around the world, cases and deaths are continuing to increase at worrying rates”, said WHO Director-General Tedros Adhanom Ghebreyesus, speaking during his regular briefing. “Globally, the number of new cases per week has nearly doubled over the past two months. This is approaching the highest rate of infection that we have seen so far during the pandemic.”…”

HPW - As COVID Cases Climb Globally For 8th Week In Row – Only 1% Of Vaccines Administered Were in Low Income Countries https://healthpolicy-watch.news/85189-2/

On Monday’s media briefing. Snippets:

“New COVID-19 cases climbed again globally last week for the eighth week in a row – while only 1% of the 100 million vaccine doses administered last week were in low- and middle-income countries – said senior WHO officials on Monday, citing two key barometers of pandemic policies….”

“Meanwhile, speaking at a WHO press conference ahead of this week’s planned White House Climate Summit, the teenage climate activist Greta Thunberg called upon global leaders to ensure that front line health workers and other high risk groups in low- and middle income countries are

vaccinated more rapidly – saying it was morally unacceptable that younger people in affluent countries should be able to access the vaccine ahead of high-risk groups elsewhere. “

“… Meanwhile, COVID cases were increasing among younger people aged 25-29 at an “alarming rate” Tedros said, possibly as a result of of the propagation of more transmissible SARS-CoV2 variants as well as increased social mixing among younger adults. That mixing, added WHO’s Maria Van Kerkhove, is not only due to more socializing and pandemic fatique, but also for work and religious reasons – following the Easter holidays, Ramadan, for instance, began just last week.

The more than 5.2 million new cases reported just last week made last week’s new case numbers the biggest yet – as the world also topped the record of 3 million deaths. “It took nine months to reach 1 million [deaths], four months to reach 2 million and just 3 months to reach 3 million deaths. Big numbers can make us numb. But each one of these lives lost is a tragedy for families, communities and nations,” Tedros said.

…While the African Union and the World Trade Organization last week held major conferences on the topic of expanding vaccine manufacturing – in the short term the focus needs to be on the redistribution of doses being produced right now, Bruce Aylward stressed, saying:

UN News - Vaccine equity the ‘challenge of our time’, WHO chief declares, as governments call for solidarity, sharing https://news.un.org/en/story/2021/04/1089972

“With the number of new COVID-19 cases nearly doubling over the past two months, approaching the highest infection rate the world has seen during the pandemic, the unequal distribution of vaccines is not only a moral outrage, but economically and epidemiologically self-defeating, the head of the UN health agency told a special ministerial meeting of the Economic and Social Council (ECOSOC) on Friday. The summit – held in virtual format on the theme, “A Vaccine for All” - brought together senior officials from the UN, government, business, the scientific community and civil society, who explored ways to guarantee equal access to the vaccine as a global public good, and to strengthen countries' readiness for its distribution. “Vaccine equity is the challenge of our time”, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) told the gathering in opening remarks. “And we are failing.”…”

WHO-backed global youth mobilization funds young people's ideas to combat impact of COVID-19 pandemic https://www.who.int/news/item/19-04-2021-who-backed-global-youth-mobilization-funds-young- people-s-ideas-to-combat-impact-of-covid-19-pandemic

“Initiative led by the world’s six largest youth organizations and supported by the World Health Organization and United Nations Foundation will fund the work of young people in communities impacted by the global COVID-19 pandemic; Impact of the global pandemic on young people to be addressed at Global Youth Summit; Young people will decide where the money goes and how it is spent; Global Youth Mobilization backed by UNICEF, USAID, UNFPA, European Commission, Salesforce, FIFA and Heads of State and Governments from around the world…”

“From today, young people around the world will be able to apply for funding to support innovative Local Solutions to address the impact of the COVID-19 pandemic, as part of a new initiative called the Global Youth Mobilization. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, climate change activist Greta Thunberg and youth representatives from the Global Youth Mobilization [will launch the call for applications at a press conference on Monday 19 April] …”

“… A Global Youth Summit, to be held virtually on 23- 25 April, marks the starting point for young people to get involved in the mobilization. …”

Related paper: Young people championing post-pandemic futures: policy recommendations from the 6 big youth organisations.

HPW - WHO Emergency Committee To Member States: “Do Not Require Proof of Vaccination” As Condition Of International Travel https://healthpolicy-watch.news/who-sety-to-update-guidance-on-international-travel-following- request-by-international-health-emergency-committee/

“After months of stalemate, WHO looks set to update its guidance on managing COVID-19 infections in the context of international travel – but proof of vaccination should not be required as a condition of entry to any country, emphasized WHO’s International Health Emergency Committee. This was among the wide-ranging recommendations issued on Monday by the International Health Regulations Emergency Committee, which first declared that the COVID-19 outbreak constituted an International Public Health Emergency (PHEIC), in January of 2020….”

See also Reuters - WHO panel against requiring vaccination proof for travel - statement;

“ The World Health Organization's Emergency Committee recommended on Monday that proof of vaccination not be required as a condition of international travel, maintaining its stance on the issue under growing debate. The independent experts, in a statement issued after meeting last Thursday, cited limited evidence on whether vaccination against COVID-19 reduces people's ability to transmit the virus and "the persistent inequity in global vaccine distribution". States should recognise that requiring proof of vaccination deepens inequities and promotes unequal freedom of movement, the panel said….”

Washington Post - China to recognize Western shots for its vaccine passports, as it seeks to reopen https://www.washingtonpost.com/world/asia_pacific/china-vaccine-passport-visas- covid/2021/04/20/8a6422d0-a14e-11eb-8a6d-f1b55f463112_story.html

Encouraging news. “China has begun accepting U.S. coronavirus vaccination records in travel applications to the country, as it seeks to negotiate mutual recognition of vaccine passports with other nations. The Chinese Embassy in Washington said in an online notice late last week that Pfizer-BioNTech, Moderna and Johnson & Johnson vaccine records can be submitted as part of an application for a coronavirus QR “health code” — China’s version of a vaccine passport and a requirement to enter the country. … … The new consideration of Western vaccines reflects China’s

efforts to open up again as the pandemic wanes in some parts of the world and countries consider types of vaccine passports that can ease a return to international travel….”

Covid Science

Nature News - India’s massive COVID surge puzzles scientists https://www.nature.com/articles/d41586-021-01059- y?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“The virus is spreading faster than ever before in India despite previous high infection rates in megacities, which should have conferred some protection.”

FT - Vaccines are working: the charts that show the Covid endgame https://www.ft.com/content/d71729a3-72e8-490c-bd7e-757027f9b226

“Although infections are at a record high, lives are being saved in the countries with effective immunisation programmes.”

“…It is now clear that the vaccines are working. In countries where cases have been falling in recent months, the vaccines have saved lives. And in countries that are still struggling to suppress a third or fourth wave, the vaccines have also saved lives. An FT analysis of data from five countries — each facing very different scenarios — finds that rates of infections, hospitalisation and death have traced a lower path among the older, most vaccinated age groups than among the younger, who are least likely to have received the jab. This is regardless of the viral caseload — whether infections are rising or falling, or if a country is grappling with one of the new variants. … in the countries that have vaccinated the largest shares of their populations, there are tentative signs, as shown in the FT’s charts below, that Covid’s endgame may be in sight….”

And: “…The key to bringing India and Latin America out of the pandemic is the same as it is everywhere else: vaccines. …”

Next-generation Covid-19 vaccines are supposed to be better. Some experts worry they could be worse https://www.statnews.com/2021/04/16/next-generation-covid-19-vaccines-are-supposed-to-be- better-some-experts-worry-they-could-be-worse/

“…The concerns stem from a phenomenon that is known as imprinting, sometimes called original antigenic sin, which is believed to affect how we respond to some pathogens….” Not all experts are equally worried, though.

Stat - We know a lot about Covid-19. Experts have many more questions H Branswell; Stat;

“… More than two dozen virologists, epidemiologists, immunologists, and evolutionary biologists shared with us their top question. … There was surprising diversity in the questions, though many cluster around certain themes, such as the nature of immunity or the impact of viral variants. Knowing what scientists still want to learn shows us how far we’ve come — and how far we have left to go to solve the mysteries of SARS-2 and Covid-19….”

Nature (News) - COVID vaccines and blood clots: five key questions https://www.nature.com/articles/d41586-021-00998-w

“As safety concerns delay the use of two COVID-19 vaccines, Nature looks at the questions that scientists want answered.”

WHO – Statement of the Strategic Advisory Group of Experts (SAGE) on Immunization: Continued review of emerging evidence on AstraZeneca COVID-19 Vaccines https://www.who.int/news/item/22-04-2021-statement-of-the-strategic-advisory-group-of-experts- (sage)-on-immunization-continued-review-of-emerging-evidence-on-astrazeneca-covid-19-vaccines

(22 April): “…On the basis of this additional evidence, the Strategic Advisory Group of Experts (SAGE) on Immunization has updated its interim guidance on the use of the AstraZeneca vaccines against COVID-19 that are produced by different manufacturers (Astra Zeneca-Vaxzevria, Serum Institute India SII Covishield, and SK Bioscience). WHO continues to support the conclusion that the benefits of these vaccines outweigh the risks. Pursuant to the latest data, further clarification of precautions and types of risk (ie. Thrombosis with Thrombocytopenia Syndrome) has been added…”

Reuters - J&J scientists refute idea that COVID-19 vaccine's design linked to clots

Reuters;

“Scientists at Johnson & Johnson on Friday refuted an assertion in a major medical journal that the adenovirus-based design of their COVID-19 vaccine, which is similar AstraZeneca's, may explain why both have been linked to very rare brain blood clots in some vaccine recipients….”

FT - Johnson & Johnson’s Covid setback risks damaging its vaccine programme https://www.ft.com/content/0d085dde-cc02-4bad-8bbb-e2ad498e1ebf

“The blood clot concerns that led to a halt in Johnson & Johnson’s Covid vaccine rollout risk damaging confidence in its longer-term vaccines programme, according to experts who say that rebuilding trust in its jabs will take time. … … Unlike AstraZeneca, however, J&J has a vaccine business beyond coronavirus and is seeking to use the adenovirus method to treat other diseases….”

More links related to J&J vaccine:

• Reuters - EU regulator backs J&J shot, finds possible link to clots

“ Europe's drug regulator has found a possible link between Johnson & Johnson's (JNJ.N) COVID-19 vaccine and rare blood clotting issues in adults who received doses in the United States, but backed its overall benefits against any risks....”

• Atlantic - The Danger of a ‘Dudes Only’ Vaccine

“We still don’t know who’s most at risk of getting the Johnson & Johnson vaccine blood clots.”

Covid-19 - Tech transfer/Trips waiver discussion

Geneva Health Files - WHO & WTO converge on bilateral tech transfer for vaccines. What this means for the TRIPS Waiver

Geneva Health Files;

Also includes some analysis on the (pro-active) role of WTO DG Ngozi in this discussion.

“In Geneva, the WTO and WHO are converging in their approaches to address the acute vaccine shortages to rely on bilateral technology transfers that are determined by manufacturers. Our analysis today looks at what this means for improving access to vaccines and the implications for the TRIPS waiver discussions at WTO. The support for the IP waiver is holding up, but showing strains of continuing deadlock in these discussions….”

“The WTO vaccine equity event showed potential for spare manufacturing capacity and the willingness to finance it. But will this be followed up voluntary technology transfer to address production shortages, or will this be left to the discretion of bilateral deals decided by manufacturers? And was this event meant to draw attention away from the TRIPS waiver talks now reaching a critical stage?...”

A few excerpts:

“… While it is not clear yet which way discussions on the TRIPS waiver will go, there is an emerging shift within the support base of the proposal even as opponents gather to buy time to stall any meaningful progress towards negotiating on the text of the proposal…. … There are two meetings of the TRIPS Council this month, an informal one on April 22nd and a formal meeting on April 30th. In these meetings, countries will agree on a report to be submitted at the General Council meeting on May 5th and 6th that will discuss status of the waiver proposal. … … … … There are fears that the stalling tactics adopted by opposing countries (the U.S., UK, the EU, Norway, Switzerland, Canada among others) are inducing “waiver-fatigue”, a source said. In addition, bilateral meetings organized in wake of the vaccine equity meeting, between blocks of countries and vaccine manufacturers, may tempt some countries to rely on bilateral and voluntary licensing deals to secure vaccine production lines … … Finally there is a clear dynamic emerging within the support base of the waiver proposal, including in some civil society organizations who have increasingly

articulated on the limitations of the waiver alone in addressing the pandemic and pushing for more a “realistic” appraisal of such a legal solution that entails an international suspension of rules on intellectual property, copyright and trade secrets among others….”

On the same (WTO) meeting from last week, read also:

• TWN - WTO DG’s vaccine event marked by sharply differing perspectives

“The WTO director-general Ms Ngozi Okonjo-Iweala’s much touted meeting on addressing “equitable distribution of COVID-19 vaccines” brought sharply differing perspectives to the fore on various issues, including the role of IPRs and the need to finalize a decision on the temporary TRIPS waiver in ramping up global production of vaccines …”.

• TWN - Vaccine equity event enabled “frank” discussions, claims WTO DG

And this. Always worth a read for “another”, more critical take on ongoing WTO discussions re the Trips Waiver (and more in general).

WHO - Establishment of a COVID-19 mRNA vaccine technology transfer hub to scale up global manufacturing https://www.who.int/news-room/articles-detail/establishment-of-a-covid-19-mrna-vaccine- technology-transfer-hub-to-scale-up-global-manufacturing

Let’s hope this will be a game-changer.

“WHO and its partners are seeking to expand the capacity of low- and middle-income countries (LMICs) to produce COVID-19 vaccines and scale up manufacturing to increase global access to these critical tools to bring the pandemic under control. WHO will facilitate the establishment of one (or more, as appropriate) technology transfer hub(s) that will use a hub and spoke model (REF) to transfer a comprehensive technology package and provide appropriate training to interested manufacturers in LMICs. This initiative will initially prioritize the mRNA-vaccine technology but could expand to other technologies in the future. The intention is for these hubs to enable the establishment of production process at an industrial or semi-industrial level permitting training and provision of all necessary standard operating procedures for production and quality control. It is essential that the technology used is either free of intellectual property constraints in LMICs, or that such rights are made available to the technology hub and the future recipients of the technology through non-exclusive licenses to produce, export and distribute the COVID-19 vaccine in LMICs, including through the COVAX facility….”

So, essence, as Tedros said, “We are calling for the original manufacturers of mRNA vaccines to contribute their technology and know-how to a central hub, and for manufacturers in low- and middle-income countries to express interest in receiving that technology.”

Geneva Health Files – Q&A: Hyo Yoon Kang on the financialization of intellectual property & COVID-19

Geneva Health Files;

Tuesday’s GHF newsletter included this must-read comprehensive interview with Hyo Yoon Kang on what intellectual property protection means during a pandemic and why this waiver proposal is crucial. … Among others, she zooms in on the skewed ‘patent bargain’ and stresses that tech transfer & IP waiver need to go hand in hand.

Quotes: “…While there is no need to repeat what has already been said, it bears pointing out that - a year into the pandemic - governments have created a de-facto oligopolistic market dominated by a handful companies that have been subsidised by governments and intellectual property protection, such as patents and trade secrets.”

“…How does such a skewed patent bargain play out on the global scale? At least since the 1995 TRIPS agreement, what counts as ‘public’ and ‘private’ in the context of IP can no longer be national categories. Yet the understandings of what is ‘public’ and ‘private’ in much of IP law discourse have remained rooted at the national level. The result is a dissonance of legitimacy between a transnationally enforceable IP legal structure and its justification based on 19th century concepts of sovereignty, colonisation and industrialisation….” “…This is why we ought to go back to the initial motivation that legitimised patent monopolies in the first place and conceive the notion of a public clearly as a global public, and not a national one. If TRIPS is the legal architecture that underpins the ability to extract monopoly rent on a global scale, then by the same token, transnational patent law needs to serve a global public’s interest.”

… The IP waiver is therefore necessary as an integral part of a concerted effort to share know-how and scale up production. We need the waiver in order to end the pandemic instead of prolonging it through artificial scarcity. Both IP waiver and tech transfer need to go hand in hand.”

Mail & Guardian - Africa could produce a Covid-19 vaccine sooner than you think https://mg.co.za/africa/2021-04-15-africa-could-produce-a-covid-19-vaccine-sooner-than-you-think/

This one went viral on social media. Africa could soon produce mRNA vaccines, more in particular.

Corporate Europe Observatory - Big pharma lobby’s self-serving claims block global access to vaccines https://corporateeurope.org/en/2021/04/big-pharma-lobbys-self-serving-claims-block-global- access-vaccines

“The self-serving arguments used by big pharma lobbyists at meetings with the European Commission to defend monopoly intellectual property rights on vaccines are demonstrably false. Corporate Europe Observatory has uncovered new documents from December 2020 which reveal how big pharma’s arguments – essentially, to ‘keep the patents in our hands, and trust us to distribute vaccines’ – contrast sharply with the current state-of-affairs: few in low-income countries will be vaccinated any time soon….”

Economist -Mariana Mazzucato, Jayati Ghosh and Els Torreele on waiving covid patents https://www.economist.com/by-invitation/2021/04/20/mariana-mazzucato-jayati-ghosh-and-els- torreele-on-waiving-covid-patents

By now familiar arguments for a real ‘People’s Vaccine’, but the fact that they were invited to make this case in the Economist shows that hopefully, there’s momentum.

“To control the pandemic, it is essential to suspend intellectual property rights on medical products related to covid-19… … The need for an intellectual-property waiver is clear for vaccines, but it is also important for treatments like drugs, ventilators, masks and other products….”

Guardian - Campaign to waive Covid jab patent highlights $26bn shareholder payouts https://www.theguardian.com/world/2021/apr/22/campaign-to-waive-covid-jab-patent- highlights-26bn-shareholder-payouts

“Three of the leading Covid vaccine manufacturers have paid out $26bn in dividends and stock buyouts to shareholders in the last year – enough to cover the cost of vaccinating the population of Africa, say campaigners. The People’s Vaccine Alliance argues that the profits made by the companies are inappropriate when most of the world cannot get the vaccines they need, which are expensive and in short supply. Campaigners want to see the companies waive their patents and help set up factories to make affordable versions of their vaccines around the world. The alliance estimates that Pfizer has paid out $8.44bn in dividends, Johnson & Johnson $10.5bn in dividends and $3.2bn in share buybacks, and AstraZeneca $3.6bn in dividends….”

And a link - TWN - CSOs challenge DG’s “third way”, as USTR discusses TRIPS waiver

(16 April) “Significantly, 243 civil society organizations (CSOs) issued a powerful missive to the WTO DG on 13 April challenging her “third way” approach that emphasizes “on industry-controlled bilateral agreements (with Big Pharma) as the primary approach to address global production constraints and supply shortages.” According to TRIPS negotiators, the DG seems determined to push the temporary TRIPS waiver under the carpet by pursuing the industry-controlled bilateral and voluntary agreements, which have failed to deliver the much-anticipated results and that they tried to conceal the root cause for the current global shortage of vaccines….”

One year Covax

Reuters - A year in the COVID-19 vaccine scheme COVAX Reuters;

With the (detailed) timeline of all Covax related events & announcements.

“The World Health Organization (WHO) and global vaccine charities launched the COVAX programme last April to distribute COVID-19 vaccines to some of the world's poorest people. The scheme, relied on by dozens of poorer countries, has faced setbacks: production glitches, a lack of support from wealthy nations and a recent move by India, the biggest vaccine manufacturer, to curb its exports. Besides the WHO, it is run by the Global Alliance for Vaccines and Immunization (GAVI), Coalition for Epidemic Preparedness Innovations (CEPI) and U.N. Children's Fund (UNICEF)….”

One World Protected - The Gavi COVAX AMC Investment Opportunity https://www.gavi.org/sites/default/files/covid/covax/Gavi-COVAX-AMC-Investment-Opportunity.pdf

As launched on 15 April.

WSJ - Why Covid-19 Vaccination in Poorer Nations Has Slowed, Posing Global Risks https://www.wsj.com/articles/why-covid-19-vaccination-in-poorer-nations-has-slowed-posing- global-risks-11618826934?mod=hp_lead_pos4

Update on Covax’ predicament. “ Efforts to vaccinate the poorest countries against Covid-19 have slowed to a trickle, leaving many with weakened defenses against the coronavirus just as the weight of the pandemic shifts from developed to developing nations. Covax recently slashed the number of shots it plans to ship by the end of May. That initiative, called Covax, will deliver 145 million doses instead of about 240 million because India, its main supplier, has largely stopped exporting shots as it fights a surge in cases at home. That is widening an already huge vaccination gap between rich and poor countries. While more than 200 million doses have been administered in the U.S., Covax has so far supplied fewer than 41 million of its planned two billion doses by the end of 2021.”

“… U.S.-based health charity CARE estimates that for every $1 spent on vaccine doses, governments need to invest an extra $5 in getting them into people’s arms, including on salaries for healthcare workers, information campaigns and cold-chain logistics….”

Guardian - Revealed: big shortfall in Covax Covid vaccine-sharing scheme https://www.theguardian.com/world/2021/apr/22/revealed-big-shortfall-in-covax-covid-vaccine- sharing-scheme

“Only a fifth of doses expected by May delivered as export bans, hoarding and supply shortages bite.”

“…In Africa, Rwanda has received just 32% of its allocation, the biggest percentage on the continent, ahead of countries including Nigeria, Kenya, Ethiopia and the Democratic Republic of the Congo, which have each received about 28% of the doses they are expecting. … … Overall, as of Wednesday this week, the program had delivered about 40.2m or 21.5% of the 187.2m doses it planned to distribute during or by the end of May. The analysis is based on data drawn from Airfinity, a life sciences analytics firm, and Unicef and Gavi, two of the organisations that are helping to run Covax….”

Reuters – COVAX in talks for other COVID-19 shots amid AstraZeneca supply problems Reuters;

“ The COVAX vaccine-sharing plan said on Thursday it is seeking to bolster its supplies of COVID-19 vaccines for poor countries from new manufacturers as it aims to mitigate supply problems of the AstraZeneca (AZN.L) shot from India. The global programme - co-led by the GAVI vaccine alliance and the World Health Organization (WHO) - said that while it was hoping to restart deliveries of doses from India's Serum Institute to COVAX participating countries "as soon as possible", it was also looking for additional potential supplies….”

Reuters - France kicks off Europe's vaccine donations to poorer states Reuters;

“France will soon become the first European Union member to send some of its own COVID vaccine supplies to developing countries via the international COVAX scheme, hoping others will join its bid to stave off new variants and compete with Russia and China. The French donation of an initial 100,000 doses of AstraZeneca's (AZN.L) COVID vaccine this month, announced on Wednesday, is a boost for COVAX…”

“… Macron has urged EU countries to send 5% of their own vaccine supplies to developing countries to help the bloc regain the initiative from Russia and China in vaccine diplomacy…. France has committed to sending 500,000 doses by mid-June, the French adviser said. The first batch of AstraZeneca doses, taken from France's own expected deliveries, will be sent to COVAX "imminently", the adviser said.”

Other Covid vaccine access & other bottleneck news

Guardian - Indian expansion of Covid vaccine drive may further strain supplies https://www.theguardian.com/world/2021/apr/19/indian-expansion-of-covid-vaccine-drive-may- further-strain-supplies

“India has announced it will soon open its vaccination programme to every adult [i.e. over 18 ] in response to soaring Covid-19 infections – a measure that could further strain supplies in parts of the world reliant on Indian-made vaccines for their own campaigns…”

HPW - India Makes US$ 550 Million Investments In Local Vaccine Production & Opens Private Market To Vaccine Imports https://healthpolicy-watch.news/india-makes-us-550-million-investments-in-local-vaccine- production-opens-private-market-to-vaccine-imports/

“In a twin bid to get ahead of a surging COVID-19 epidemic, the Indian government said that it will make “advance payments” totally some US$ 550 million to domestic COVID-19 vaccine makers – as

well as opening up the market to private sector import and sales of other approved COVID-19 vaccines. Under the plan, the Serum Institute of India, which is producing the AstraZeneca vaccine (Covishield) will be given an advance of Rs 300 billion rupees (US $400 million) and Bharat Biotech, the Hyderabad-based company producing an India-made vaccine, called Covaxin, will receive a 150 billion rupees ($US 200 million) advance. At the same time, domestic vaccine manufacturers will be able to sell up to 50% of the vaccines that they produce on the private market – to further incentivize the production ramp-up, the government said. …”

“Poonawala [Serum institute] said that he will be able to renew vaccine supplies to COVAX by June or July, provided he is able to ramp up production…”

HPW- Africa Gets €100m Boost From EU To Support COVID-19 Vaccination Campaigns https://healthpolicy-watch.news/africa-gets-e100m-boost-from-eu-to-support-covid-19-vaccination- campaigns/

“The European Union (EU) today pledged €100 million towards a humanitarian fund that will assist with COVID-19 vaccine roll-out in Africa. The initiative was announced today at a press briefing addressed by Dr John Nkengasong, Director of the Africa CDC and Janez Lenarčič, European Commissioner for Crisis Management. According to the EU, the new fund will support two complementary dimensions of the vaccination campaigns in Africa. A quarter of the fund will support the roll-out of the vaccination campaigns in African countries. It will also support capacity building of national health authorities and health care workers and will also support the management of information and vaccination coordination platforms….” “…A second tranche of €65 million is set aside to support the roll-out of vaccination campaigns in specific humanitarian settings, notably in conflict and hard-to-reach areas…”

FT - Vaccine patent gives US government ‘leverage’ over manufacturers https://www.ft.com/content/d0c70cc2-0ffa-42dd-b0d0-0f76eeb273f0

“Washington can boost global access to Covid shots by compelling groups to share technology, says top scientist.”

“The US government can use its ownership of a crucial vaccine patent to push companies to share their expertise with other manufacturers and boost global access to coronavirus jabs, according to a top scientific official. Barney Graham, one of the US National Institutes of Health scientists who invented a key piece of technology used in the Moderna and BioNTech/Pfizer jabs, told the Financial Times the government’s patent gave Washington “leverage” over manufacturers….”

WB – World Bank Financing for COVID-19 Vaccine Rollout Reaches $2 Billion https://www.worldbank.org/en/news/press-release/2021/04/20/world-bank-financing-for-covid-19- vaccine-rollout-reaches-2-billion

“The World Bank announced today that it has reached $2 billion in approved financing for the purchase and distribution of COVID-19 vaccines for 17 developing countries. This financing is part of

the $12 billion envelope over 24 months for developing countries to acquire and deploy vaccines and strengthen their vaccination systems. For poorer countries financing is on grant or highly concessional terms. The Bank expects to support 50 countries with $4 billion financing for COVID-19 vaccines by mid-year….”

CGD (blog) - Money in the Bank: What’s Behind Slow Demand for MDB Financing for Vaccines? A Glassman; https://www.cgdev.org/blog/money-bank-whats-behind-slow-demand-mdb-financing- vaccines

Amanda Glassman’s five hypotheses for the following phenomenon: “…despite an early October 2020 commitment of $12 billion in available financing for vaccines and vaccination, the World Bank Group last week reported that only 8 projects totaling $1.3 billion (11%) had been approved up to March 18, 2021, with an additional $3 billion in the pipeline (36%). Similarly, the Asian Development Bank, which was an early mover in offering $9 billion to its borrowing member countries has also approved only 10% of this amount, mainly to Indonesia and the Philippines….”

ODI - A 'shot in the arm' for multilateral cooperation - why international public finance should step up its game for global vaccination https://odi.org/en/insights/a-shot-in-the-arm-for-multilateral-cooperation-why-international-public- finance-should-step-up-its-game-for-global-vaccination/

View from ODI experts.

Project Syndicate - The G7 Must Act to Vaccinate the World Gordon Brown, dr. Tedros, Winnie Byanyima, Kevin Watkins, … https://www.project- syndicate.org/commentary/g7-must-finance-equitable-global-covid19-vaccine-access-by-gordon- brown-et-al-2021-04

“The world’s richest countries are failing to champion the global cooperation needed to defeat the pandemic. At June’s G7 summit in the United Kingdom, leaders must agree on a financial plan to underpin international collaboration on COVID-19, starting with equitable access to vaccines….”

“… A G7 commitment of around $30 billion a year for the next two years, supplemented by wider measures to support vaccine self-reliance, would bring that goal within reach. …”

Duke (Policy brief) - Reducing Global COVID Vaccine Shortages: New Research and Recommendations for US Leadership https://healthpolicy.duke.edu/publications/reducing-global-covid-vaccine-shortages-new-research- and-recommendations-us-leadership

…. The uneven global distribution of COVID-19 vaccines has raised concerns and spurred demand for action to ensure equitable access, including growing calls to waive intellectual property protections. There are a number of challenges to scaling-up global access beyond intellectual property barriers, and addressing these challenges requires a multipronged, coordinated approach. Leadership from the US on safe, effective, and equitable global access to COVID-19 vaccines is imperative. In this paper, we present the scope of the global vaccine access challenge, and propose a complementary three-part US-led solution that: 1) increases and leverages funding for the global effort to advance vaccine access through COVAX; 2) undertakes coordinated bilateral and multilateral mechanisms to provide excess doses to countries in need; and 3) increases safe and reliable manufacturing and distribution capacity.”

Reuters - Sinovac supplied 260 mln COVID-19 vaccine doses globally Reuters;

“Sinovac Biotech (SVA.O) has supplied 260 million doses of its COVID-19 vaccine globally, with over 60% supplied to countries outside China, the company's chief executive Yin Weidong said on Tuesday. …”

Economist - A vaxxing problem American export controls threaten to hinder global vaccine production https://www.economist.com/science-and-technology/2021/04/17/american-export-controls- threaten-to-hinder-global-vaccine-production

“The world’s biggest vaccine-maker says it will feel the pinch in a month … ... Production lines in India, making at least 160m doses of covid vaccine a month, will come to a halt in the coming weeks unless America supplies 37 critical items. …”

Update via Politico (22 April) on these export controls:

“India wants the U.S. to ease restrictions on exporting raw materials for vaccine production as it struggles with its fierce new pandemic wave. So far, the White House has said only that it’s considering a range of options to help globally. But top diplomats – including U.S. Secretary of State Antony Blinken – have been in touch, and one optimistic Indian government official did tell Reuters his country expects the U.S. to lift the ban. The head of the Serum Institute of India, the world’s largest vaccine manufacturer, chimed in on Twitter, asking Biden to lift the embargo. But White House officials have danced around questions about exports….”

Stat - Most Americans say they should be vaccinated before the U.S. donates Covid-19 shots elsewhere Stat;

“Three-quarters of Americans believe the U.S. government should start donating Covid-19 vaccines to other countries, but only after every person in the U.S. who wants a vaccine has received one, according to a new survey from STAT and The Harris Poll. At the same time, just over half of Americans said they agree with the idea that the Biden administration should immediately start

donating vaccines to other countries in order to achieve global herd immunity, which reflects growing concern that the coronavirus cannot be contained until most of the world is vaccinated….”

Reuters - Cash-strapped Africa overwhelmed by COVID vaccine challenge https://www.reuters.com/world/africa/cash-strapped-africa-overwhelmed-by-covid-vaccine- challenge-2021-04-21/

“When Ghana received 50,000 COVID-19 vaccine doses from India last month, it hit a frustrating roadblock: it had not trained enough staff to distribute them. The country was still rolling out shots received in late February from the global vaccine-sharing scheme COVAX, and didn't have the capacity to expand that operation, according to the head of Ghana's immunisation programme. Rather than going straight into the arms of health workers, the additional doses were put in cold storage in the capital Accra, Kwame Amponsa-Achiano told Reuters, adding that his team had received two days' notice about the shipment….”

“… The problems faced by Ghana, one of sub-Saharan Africa's more economically developed nations, illustrate how a continent with experience in battling deadly infectious diseases has found itself ill-prepared to inoculate people against this pandemic. Many African countries, already facing a shortage of affordable vaccines, are being stunned by the unprecedented scale of the distribution challenge when doses do arrive. … … … Benjamin Schreiber, COVAX coordinator at the U.N. children's agency UNICEF, said logistical problems could mount in the coming weeks and months as countries tried to get vaccines to their general populations.

Nature - How COVID spurred Africa to plot a vaccines revolution https://www.nature.com/articles/d41586-021-01048- 1?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

Recommended. “For decades, Africa has imported 99% of its vaccines. Now the continent’s leaders want to bring manufacturing home.”

“Nature examines the opportunities and challenges that Africa's plans present….”

“…Kick-starting successful vaccine manufacturing needs at least four key ingredients: financing amounting to hundreds of millions of dollars; expanded research capacity; a commitment from governments to purchase vaccines; and regulatory bodies that meet international standards. Compared with other regions, African countries are lacking in all four….”

See also a Nature Editorial - Africa’s vaccines revolution must have research at its core

Excerpt: “…There will also need to be hard conversations with donor countries, their pharmaceutical companies, and funders and researchers — essentially, all those currently involved in supplying Africa with vaccines. If the goal is now African self-sufficiency in what some call the vaccine ‘value chain’, then international partnerships with the continent’s institutions will require a different approach. A partnership in which the objective is to empower the continent’s own researchers and businesses will need to be different from existing partnerships, in which the objective is to supply Africa with vaccines. Some international companies might regard African self-sufficiency

as a long-term risk to their business; some might fear a loss of influence. Firms and researchers from outside Africa shouldn’t take this view if they agree that a genuine partnership of equals is in everyone’s interests. Vaccines are essential to public health. And public health is essential to strong economies….”

“Some argue that the IP issue should be kept separate from Africa’s vaccine-manufacturing ambitions, but the reality is that they are closely linked….”

Reuters - African countries urged to use vaccines quickly after expiry confusion https://www.reuters.com/world/africa/african-countries-urged-use-vaccines-quickly-after-expiry- confusion-2021-04-22/

“The African Union's disease control body on Thursday urged countries to use COVID-19 vaccines donated to them quickly to save lives and livelihoods, after confusion in Malawi and South Sudan about whether doses they received had expired….”

Reuters - Spain to donate 5%-10% of its share of COVID-19 shots to Latin America Reuters;

“Spain will offer between 5% and 10% of its COVID-19 vaccine shots to Latin American and Caribbean countries this year, Prime Minister Pedro Sanchez said on Wednesday. "Spain will launch this commitment as soon as it reaches the mark of 50% of the Spanish population vaccinated…”

Finally, some bits via the ONE Aftershocks newsletter:

“While 85% of countries surveyed by the World Bank have vaccine readiness plans, only 30% have plans to train the large number of vaccinators who will be needed. A new UN Economic Commission for Africa poll of 3,200 people in eight African countries showed over 55s are confident in the vaccine. 44% of 15-34 year-olds are not, citing poor effectiveness and health risks.

A new way to ban Africans: Vaccine passports are being proposed by the same countries least likely to approve visas for Africans. So said Liberia’s former minister for public works, who is calling for African leaders to push back strongly on the policy of rich countries further restricting African travel after hoarding vaccine supplies.

Slow money: …the World Bank has committed $12 billion. It had been struggling to get it out the door, with only 11% of the money approved last month as bureaucracy and strict standards around which vaccines can be purchased hindered progress. The bank has responded by aligning eligibility criteria with COVAX.”

Covid analysis

Devex - How 'vaccine passports' could exacerbate global inequities https://www.devex.com/news/how-vaccine-passports-could-exacerbate-global-inequities-99687

Analysis. “… Experts say that this clash over people’s ability to move could pale in comparison to the disruptions that will be caused by the potential introduction of “vaccine passports.” And the emerging efforts to restrict people’s movements based on whether they have received a COVID-19 vaccine are heightening concerns about inequities that have already been revealed or exacerbated by the pandemic….”

“… the broader restriction on who is allowed to travel regionally and internationally, specifically, may ultimately “compound the economic harm of the COVID-19 pandemic in low- and middle- income countries and keep students, scientists, and many others from participating in the globalized world, potentially for years to come,” [M] Kavanagh said….”

“The Africa Centres for Disease Control and Prevention and the World Health Organization have joined in the effort to push back against a vaccine passport, with WHO Spokeswoman Margaret Harris citing uncertainties about whether the vaccine prevents transmission, as well as concerns about equity. John Nkengasong, director at Africa CDC, was even more straightforward at a recent press briefing. “Our position is very simple,” he said. “That any imposition of a vaccination passport will create huge inequities and will further exacerbate them.”

O’Neill -The promise and peril of vaccine passports

A Vernikou et al ; https://oneill.law.georgetown.edu/the-promise-and-peril-of-vaccine-passports/

Expert column. Concluding : « …As vaccinations increase, governments will continue to weigh the benefits and drawbacks of vaccine passports. While seen as a way to incentivize vaccinations, vaccine passports raise ethical questions around vaccine equity and accessibility, even in countries where there is no shortage of vaccines. Incentivizing individuals to get inoculated as a way to gain access to an open economy still does not address the issue of vaccine hesitancy and misinformation that is working against the uptake of COVID-19 vaccines. Additional legal, scientific, and technical questions remain and any country utilizing vaccine passports should be fully transparent about the standard of implementation of the program, with a special focus on privacy protection. What works for one country may not for another and while we wait for international standards on vaccine passports, country-by-country implementation will result in a patchwork of what activities are acceptable to those fully vaccinated and those not, thus creating vaccine-stratified societies. The COVID-19 Law Lab will continue to track vaccination guidelines, exemptions, and passport programs for COVID-19 vaccines.”

Devex - How did we reach 3 million COVID-19 deaths? https://www.devex.com/news/how-did-we-reach-3-million-covid-19-deaths-99682

“It has taken just over three months for the death toll from COVID-19 to climb from 2 million to 3 million, with the devastating statistics reached on April 17 according to data from Johns Hopkins

University. But it was a toll that analyses from January never expected would be reached. Though the death toll was predicted to rise after the Christmas and New Year holiday periods, forecasts accounting for planned vaccine rollouts did not anticipate an additional million deaths. … … … The challenges that have emerged since January relating to vaccines and easing restrictions has seen the Institute for Health Metrics and Evaluation forecasting a devastating year ahead. Their current projections suggest a global death toll of 4 million will be reached by mid May, and 5 million if conditions worsen by the end of July. But these projections are based on the best available data. …”

See also NYT - The Years We’ve Lost to Covid

“The death toll of COVID-19 is an unfathomable tragedy: more than three million people. Another way to quantify those losses is by considering how premature the deaths were. Researchers estimate that COVID-19 has taken more than 20.5 million years of life…”

Lancet World Report – Statelessness in the COVID-19 pandemic https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00901-6/fulltext

“Millions of people have no nationality and are being overlooked in the response to COVID-19. Talha Burki reports.”

And a link:

Lancet Comment - Rethinking vaccine hesitancy among minority groups (by M Khan et al)

Impact Covid on other global health causes & programmes

Nature - How COVID hurt the fight against other dangerous diseases https://www.nature.com/articles/d41586-021-01022- x?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“Campaigns to battle tuberculosis, measles and polio have all been set back.” Greatest impact seems to have been on TB.

Plos One - A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic

Plos One;

Via Stat: “A large, new survey of pregnant and breastfeeding women from around the world finds that many of them report significant levels pandemic-induced loneliness and depression…”

And via Devex:

“Global health experts are worried that the COVID-19 vaccination rollout could overburden health workers and detract from routine childhood immunization programs, Sara Jerving reports….”

NCDs

HPW – Despite South Africa’s Sugar Tax Success, Food Industry Impedes Similar Taxes in Neighbouring Countries https://healthpolicy-watch.news/despite-south-africas-sugar-tax-success-powerful-multinationals- block-similar-taxes-in-neighbouring-countries/

“…research published on Tuesday by the Global Health Action on seven other countries in southern and east Africa found that the path to introducing a similar tax is being blocked by industries….”.

See below for more on this special issue.

Special issue Global Health Action – Special issue: Readiness for Sugar Sweetened Beverage Taxation in Sub-Saharan Africa https://www.tandfonline.com/toc/zgha20/current

Cfr. intro to this special issue: https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1918913

“This Special Issue of Global Health Action is dedicated to memory of Professor Peter Byass. In 2017, the SAMRC Centre for Health Economics and Decision Science (PRICELESS SA) launched an ambitious multi-country study to assess readiness to adopt a sugary beverage tax for the prevention of NCDs in sub-Saharan Africa. The study took place in seven countries, Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda and Zambia, and involved over twelve researchers from nine different countries. For many, this was the first research to be undertaken on sugary beverage taxation, or even NCD policy. This research provides a foundation for supporting future action on NCD prevention in sub- Saharan Africa. The study has culminated in this Special Issue of Global Health Action, “Readiness for Sugar Sweetened Beverage Taxation in Sub-Saharan Africa” guest edited by Boyd Swinburn and Zodwa Ndlovu….”

Make sure you read at least : The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-Saharan Africa

The Conversation - We mapped the landscape for taxes on sugary drinks in seven African countries S A Karim et al; https://theconversation.com/we-mapped-the-landscape-for-taxes-on-sugary-drinks- in-seven-african-countries-158243

Some coverage. “…The main findings show that implementing a sugar-sweetened beverage tax is possible in all seven countries. Critically, for researchers, it will also require an evidence base that

can be used to create political will and to engage with civil society to support the adoption of a tax….”

And a link:

HP&P - Sin taxes and their effect on consumption, revenue generation and health improvement: a systematic literature review in Latin America

UHC

WHO – Principles of Health Benefit packages https://apps.who.int/iris/bitstream/handle/10665/340723/9789240020689-eng.pdf?sequence=1

With 8 principles.

HS Governance Collaborative - Key messages from the Health Systems Governance Collaborative’s ‘Building the Reset’ Initiative B Rouffy-Ly, G Van Heteren et al; https://www.uhc2030.org/blog-news-events/uhc2030- blog/building-the-reset-moving-forward-from-covid-19-555471/

“In the many transformative health system governance debates triggered by the current pandemic, three fundamental considerations have surfaced time and again. In line with initiatives such as Reclaim Comprehensive Public Health and the Elders’ December 2020 report "Build Back Better for Universal Health", a consensus is emerging that now is the time to (1) revisit our public health systems and prepare for the future; (2) prioritize universal health coverage at national and global levels; and (3) promote healthier societies via holistic policies and inclusive social development…. “

Global Austerity Alert

IPS - Looming Budget Cuts in 2021-25 and Alternatives I Ortiz et al; http://www.ipsnews.net/2021/04/global-austerity-alert-looming-budget-cuts-2021-25- alternatives/

“… a global study just published by the Initiative for Policy Dialogue at Columbia University, international trade unions and civil society organizations, sounds an alert of an emerging austerity shock: Most governments are imposing budget cuts, precisely at a time when their citizens and economies are in greater need of public support. Analysis of IMF fiscal projections shows that budget cuts are expected in 154 countries this year, and as many as 159 countries in 2022. This means that 6.6 billion people or 85% of the global population will be living under austerity conditions by next year, a trend likely to continue at least until 2025….”

Ortiz & Cummins list a number of alternative approaches to avert this scenario.

Human Resources for Health

WHO - A review of the relevance and effectiveness of the five-year action plan for health employment and inclusive economic growth (2017-2021) and ILO-OECD- WHO Working for Health programme Remco van de Pas, Linda Mans, Percy Mahlathi, and Delphin Kolie; https://www.who.int/publications/i/item/9789240023703

“This report summarizes progress achieved through the five-year action plan during the period from its adoption in May 2017 to December 2020, and presents a pathway for the continuation of its agenda. The report is informed by an external, independent review of the action plan by the Antwerp Institute of Tropical Medicine, commissioned by WHO in November 2020. It is aimed at Member States, development partners, key stakeholders, international financing institutions, and all other constituencies with a broad influence and interest in driving workforce driving the health workforce policy, advocacy and investment agenda. It’s findings consider the COVID-19 pandemic, the evolution of the health workforce agenda, and shifting economic policy priorities. The report presents policy options for the continuation of the W4H programme agenda in 2022 and beyond.”

See also WHO - Health workforce - Working for health: five-year action plan for health employment and inclusive economic growth (2017–2021) (6-pager: report by WHO DG for upcoming World Health Assembly)

Decolonize Global Health

Plos Med – Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic

S Abimbola et al; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003604

The Coronavirus Disease 2019 (COVID-19) pandemic, the Black Lives Matter and Women in Global Health movements, and ongoing calls to decolonise global health have all created space for uncomfortable but important conversations that reveal serious asymmetries of power and privilege that permeate all aspects of global health.

Arguably, also one for the top section “Read of the week”, but hey, this one came in on the verge of the weekly IHP deadline : ). “In this article, we, a diverse, gender-balanced group of public (global) health researchers and practitioners (most currently living in the so-called global South), outline what we see as imperatives for change in a post-pandemic world. At the individual level (including and especially ourselves), we emphasise the need to emancipate and decolonise our own minds (from the colonial conditionings of our education), straddle and use our privilege responsibly (to empower

others and avoid elite capture), and build “Southern” networks (to affirm our ownership of global health). At the organisational level, we call for global health organisations to practice real diversity and inclusion (in ways that go beyond the cosmetic), to localise their funding decisions (with people on the ground in the driving seat), and to progressively self-decentralise (and so, divest themselves of financial, epistemic, and political power). And at both the individual and organisational level, we emphasise the need to hold ourselves, our governments, and global health organisations accountable to these goals, and especially for governance structures and processes that reflect a commitment to real change. By putting a spotlight on coloniality and existing inequalities, the COVID-19 pandemic inspires calls for a more equitable world and for a decolonised and decentralised approach to global health research and practice, one that moves beyond tokenistic box ticking about diversity and inclusion into real and accountable commitments to transformative change.”

Nature Medicine - Open letter to international funders of science and development in Africa

Ngozi A Erondu et al ; https://www.nature.com/articles/s41591-021-01307-8

Hard-hitting Letter from late last week on the flaws of the old “models” in global health (funding & delivery).

“Recently there was an announcement of a US$30 million grant awarded to the nonprofit health organization PATH by the US government’s President’s Malaria Initiative (PMI). The grant funded a consortium of seven institutions in the USA, the UK and Australia to support African countries in the improved use of data for decision-making in malaria control and elimination. Not one African institution was named in the press release. The past year has been full of calls from staff and collaborators of various public-health entities for equality and inclusion, so one might imagine that such a partnership to support Africa should be led from Africa by African scientists, partnering with Western institutions where appropriate, especially where capacity has been demonstrated….

“…We write this letter to the major international funders of science and development in Africa as African scientists, policy analysts, public-health practitioners and academics with a shared mission of improving the health and wellbeing of communities in our continent and beyond. We represent a diverse group of institutions and communities dedicated to achieving the United Nations’ Sustainable Development Goals and to establishing a more equitable world….”

Concluding: “…We are asking that all major international funders of science and development in Africa commit to finding and implementing short-term and long-term changes to these models [i.e. like the one use by PATH here ] with consideration of the points we have listed above and with further consultation with reputable Africa-based institutions and scientists.”

Plos Med - A call for diversity, equity, and inclusion: Highlights from the Consortium of Universities for Global Health 2021 conference B Odeny; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003607

Perspective linked to the first virtual Consortium of Universities for Global Health (CUGH) 2021 conference held in March, 2021.

Guardian - Amnesty International has culture of white privilege, report finds https://www.theguardian.com/world/2021/apr/20/amnesty-international-has-culture-of-white- privilege-report-finds

“Amnesty International has a culture of white privilege with incidents of overt racism including senior staff using the N-word and micro-aggressive behaviour such as the touching of black colleagues’ hair, according to an internal review into its secretariat….”

Guardian - Humanitarian system is failing people in crisis, says UN aid chief https://www.theguardian.com/global-development/2021/apr/21/humanitarian-failing-crisis-un-aid- relief

“The world’s multibillion-dollar humanitarian system is struggling because unaccountable aid agencies are not listening to what people say they need and instead are deciding for them, the UN’s humanitarian agency head will say this week. In a startling analysis of the programme he oversees, Mark Lowcock, the coordinator of the UN’s aid relief operation since 2017, will say he has reached the view that “one of the biggest failings” of the system is that agencies “do not pay enough attention” to the voices of people caught up in crises. “The humanitarian system is set up to give people in need what international agencies and donors think is best, and what we have to offer, rather than giving people what they themselves say they most need.”

“… In the speech, seen by the Guardian, he will call for increased funding for vital UN services that are overstretched and argue that millions of people are still being helped despite the severe funding shortages. However, he will also call for the appointment of an independent commission to make aid agencies accountable. The commission would be tasked with listening to people in crisis and grading the quality of agencies’ work….”

Blog - On declaring one’s privilege

Kristof Decoster; https://kdecoster.blogspot.com/2021/04/on-declaring-ones- privilege.html?spref=tw

In which I argue for a 3-D approach. And also for declaring one’s privilege in a ‘creative’ way. Among others .

And a link:

Health Affairs - Medicine’s Privileged Gatekeepers: Producing Harmful Ignorance About Racism And Health

Violence against women

Lancet Child & Adolescent Health (Editorial) - Endemic violence against women and girls https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00101-2/fulltext

“…An outpouring of anger marked March, 2021, as thousands took to the streets to protest violence and discrimination against women. The contexts varied hugely across settings such as Turkey, Australia, Mexico, the UK, and the USA, but the frustration was universal. Many women related the fear they live with, and a sense of despair and powerlessness at the situation. And yet the force of these conversations provides grounds for measured optimism for the future….”

On a recent (arguably bleak) WHO report. Concluding: …“to end violence against women, discussions & initiatives must span the genders & include adolescents -- to change cultural gender norms, create more gender equitable societies & foster healthy relationships”

Malaria

HPW - WHO Launches Initiative To End Malaria in 25 Countries On The Cusp Of Disease Elimination https://healthpolicy-watch.news/85289-2/

“Progress towards global malaria targets has stalled in recent years, and the COVID-19 pandemic has posed a serious threat to malaria responses worldwide, but a number of countries are nearing the goal of zero cases of malaria, said WHO, in a forum convened just ahead of World Malaria Day on 25 April. Meanwhile, the world’s first malaria vaccine has reduced severe malaria by about one- third among the 650,000 children in Ghana, Kenya, and Malawi, who have received the jab in a late stage clinical trial. That makes it a “promising additional tool in malaria prevention,” said Dr Matshidiso Moeti, WHO Regional Director of Africa, at the WHO forum on Wednesday. …”

“WHO launched a new initiative, E-2025, to halt transmission of the disease in 25 countries by 2025 – at a forum, “Reaching Zero: Virtual Forum on Malaria Elimination,” co-hosted by the RBM Partnership to End Malaria….” “…The E-2025 is a new elimination initiative that builds on the foundation of the E-2020. It includes a new cohort of 25 countries that are on the cusp of eliminating malaria….”

See also WHO: Zeroing in on malaria elimination: Final report of the E-2020 initiative

“Since 2017, WHO has supported a group of 21 malaria-eliminating countries through a special initiative called the “E-2020”. This report charts their progress towards a common goal: eliminating malaria within the 2020 timeline. According to this report, 8 E-2020 member countries reported zero indigenous cases of malaria in 2020…”

Guardian – Oxford Malaria vaccine proves highly effective in Burkina Faso trial https://www.theguardian.com/world/2021/apr/23/oxford-malaria-vaccine-proves-highly- effective-in-burkina-faso-trial

“A vaccine against malaria has been shown to be highly effective in trials in Africa, holding out the real possibility of slashing the death toll of a disease that kills 400,000 mostly small children every year. The vaccine, developed by scientists at the Jenner Institute of Oxford University, showed up to 77% efficacy in a trial of 450 children in Burkina Faso over 12 months. … The Oxford vaccine is the first to meet the WHO goal of 75% efficacy against the mosquito-borne parasite disease. Larger trials are now beginning, involving 4,800 children in four countries…”

Polio

Guardian - Killing of female polio vaccinators puts Afghan eradication campaign at risk Guardian;

“Rise in cases feared as murders halt campaigns and leave many women too afraid to work.”

HP&P - The effects of polio eradication efforts on health systems: a cross-country analysis using the Develop–Distort Dilemma D Rodriguez et al ; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czab044/6244781?searchresult=1

« We use the Develop–Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. …”

“…Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts.”

Some other news of the week

Deutsche Welle - OECD: Development aid could sink dramatically https://www.dw.com/en/oecd-development-aid-could-sink-dramatically/a-57207026

Analysis. “The world's richest industrialized countries spent record amounts on development aid in 2020, with a lot going to fighting the COVID-19 pandemic. But 2021 and beyond could see significant cuts to that funding.”

For a read with a similar message, see Global Fund Observer - Covid-19 sparks increase in foreign aid, but for how long? (by a Ithibu & A Whiteside)

Guardian - Millions at risk of famine without urgent help, governments warned https://www.theguardian.com/global-development/2021/apr/20/millions-at-risk-of-famine- without-urgent-help-governments-warned

“World leaders are facing a call to act immediately to stop multiple famines breaking out, exacerbated by the coronavirus pandemic and caused by conflict, climate crisis and inequality. On Tuesday, hundreds of groups working to combat inequality appealed to governments to respond to increasing levels of hunger caused by “an acute food insecurity situation” around the world. In an open letter to support the UN Call for Action to Avert Famine in 2021, they said millions of people faced starvation, and billions of pounds in investment was urgently needed….”

World Bank Launches Early IDA20 Replenishment to Help Poorest Countries Recover from the COVID-19 Crisis https://www.worldbank.org/en/news/press-release/2021/04/15/ida20-replenishment- launched?cid=SHR_SitesShareTT_EN_EXT cfr tweet Amanda Glassman: “With no specific mention of #health and suggesting recovery around the corner, @WorldBank Launches Early #IDA20 @WBG_IDA Replenishment to “Help Poorest Countries Recover from the #COVID19 Crisis.“

Google - Our commitment to COVID-19 vaccine equity https://blog.google/technology/health/our-commitment-covid-19-vaccine-equity/

On what Google is doing in this regard.

Some papers & reports of the week

Critical Public Health - What is critical about critical public health? Focus on health inequalities Ted Schrecker; https://www.tandfonline.com/doi/full/10.1080/09581596.2021.1905776?src=

“For many years I have discussed with colleagues, and more recently with students, the definition of critical perspectives (plural, for there are many) on public health. Based on those discussions, and with a focus on health inequalities, this article identifies five elements of such perspectives. First, they involve some degree of commitment to health equity. Second, they situate health inequalities with regard to underlying social arrangements or institutions. Third, history matters. Fourth, the potentially pernicious impact of medicalisation and the dominance of medical frames of reference must be acknowledged. Fifth, production of scientific knowledge must be recognized as a social process whose material and institutional contexts matter. The elements of critical perspectives interact and intersect in practice, as shown with illustrations.”

WB - Frontline: Preparing Healthcare Systems for Shocks https://www.worldbank.org/en/news/feature/2021/04/13/frontline-preparing-healthcare-systems- for-shocks

“A new report offers recommendations to better prepare health systems to respond to shocks - from seasonal demand surges to pandemics, climate change and disasters. The recommendations are based on lessons learned from disaster risk and emergency management practices to propose five areas of priority actions for more reliable, shock-resistant healthcare services.”

Global Public Health - National public health institutes: A scoping review S Myhre et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1910966

“During the last century, national public health institutes emerged to address enduring and emergency public health challenges. Previous outbreaks often compelled countries to establish national institutes of public health. Despite historic legacies and contributions to public health, no review of this literature has been published. The aim of this scoping review is to provide an overview of this literature and map characteristics including format, authorship, geographic focus, methods, language, focal topic and public health capacity building domains….”

HP&P - Using WhatsApp messenger for health systems research: a scoping review of available literature

K Manji, J Hanefeld et al ; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czab024/6226979?searchresult=1

“… little is known about the opportunities and challenges associated with the use of WhatsApp as a tool for health research. To inform our study, we conducted a scoping review of published health research that uses WhatsApp as a data collection tool… … We found a lack of attention paid to

research ethics across the studies, which is concerning given the controversies WhatsApp has faced with regard to data protection in relation to end-to-end encryption. We provide recommendations to address these issues for researchers considering using WhatsApp as a data collection tool over time and place….”

CUSP - Welfare systems without economic growth: A review of the challenges and next steps for the field https://www.cusp.ac.uk/themes/aetw/ccw-ad-tj-welfare-postgrowth/

New paper by CC Walker, Tim Jackson et al.

See also Ecological Economics - Welfare systems without economic growth: A review of the challenges and next steps for the field

(WHO) - Alliance - 2020 annual report https://ahpsr.who.int/publications/i/item/2020-annual-report

Check it out.

PS: for a brand new funding opportunity from the Alliance, see below (section ‘Global Health Events & Opportunities’).

Blogs of the week

Brookings - Poverty and fragility: Where will the poor live in 2030? J Baier et al ; https://www.brookings.edu/blog/future-development/2021/04/19/poverty-and- fragility-where-will-the-poor-live-in-2030/

« …The world is experiencing a tipping point in its fight against poverty. By 2022, more than half of the world’s people living in extreme poverty will be living in fragile states, according to projections by World Data Lab. There are currently 39 fragile states that the World Bank classifies as “countries with high levels of institutional and social fragility” and “affected by violent conflict.” They are home to almost 1 billion people, 335 million of which lived in extreme poverty in 2020. Projections by the World Data Lab’s World Poverty Clock suggest that by 2030, there will be 359 million people living in extreme poverty in today’s fragile states, representing 63 percent of the world’s poor (see Figure 1). This means that while most stable countries can anticipate the end of extreme poverty, more than a third of the population in fragile states will live in extreme poverty….”

LSE (blog) - The future is a “health for all” economy M Delgrange; https://blogs.lse.ac.uk/globalhealth/2021/04/21/the-future-is-a-health-for-all- economy/

“In this blog, MSc student Marine Delgrange discusses themes from the recent Global Health Initiative and Department of Health Policy event, How much is your health worth? The Human and Economic Value of Health in the Era of COVID-19.” I.e. the event with Tedros, Mazzucato & C Wenham. On: reaffirming the centrality of health in our societies: health as a “social good. ”

Some tweets of the week

Alexandra Phelan “It is an absolutely catastrophic tragedy what is happening in India. This pandemic is not over. We need to immediately remove every potential barrier to manufacturing: We need global equitable distribution of vaccines, treatments and oxygen.”

Ian Bremmer “Risk of blood clots J&J vaccine .00001% Birth control pills: .05% COVID infection: 16%.”

Yanzhuang Huang “SinoVac chairman: Chinese vaccine makers have started manufacturing Covid vaccines in six BRI countries; Sinovac’s daily manufacturing capacity has reached 6m doses and will pick 10 more countries for tech transfer.”

Siva Thambisetty

“End the vaccine super league.”

Global health events & opportunities

Alliance for Health Policy and Systems Research: funding opportunity https://ahpsr.who.int/funding-opportunities

Call for proposals: Health policy analysis for health taxes: Lessons from countries. Deadline: 14 June.

“This call for proposals is for up to eight country case studies examining how political economy factors influence the design, adoption and implementation of health taxes at national or sub-national levels. Informed by qualitative data from key country stakeholders, research teams will develop analytical case studies based on a common conceptual framework. Principal Investigators must be based in a research institution in one of the following countries: Bangladesh, Ethiopia, Ghana, Indonesia, Mongolia, Myanmar, Nepal, Nigeria, Pakistan, Peru, Timor-Leste, Uganda, Ukraine or Viet Nam. The case study proposed should be about one of the above countries.”

FfD Forum Calls for Designing COVID-19 Recovery Strategies to Accelerate SDGs http://sdg.iisd.org/news/ffd-forum-calls-for-designing-covid-19-recovery-strategies-to-accelerate- sdgs/

Coverage of last week’s (ECOSOC) Financing for Development Forum. “The outcome document asserts that COVID-19 recovery strategies "need to be designed to accelerate the implementation of the 2030 Agenda in the decade of action". On the side of the formal meetings, UN entities launched a tool for investors and a set of policy briefs on financing for development….”

As a reminder: … Addressing the Forum, UN Secretary-General Antonio Guterres called for six urgent actions to ensure an “equitable, sustainable and resilient response and recovery from COVID-19”: making vaccines available to all countries; reversing the fall in concessional financing; directing funds to where they are needed most, to reduce extreme inequalities; extending debt service suspension into 2022 and other measures discussed during a meeting of Heads of State and Government on the International Debt Architecture and Liquidity hosted by the UN with the Prime Ministers of Jamaica and Canada in early April 2021; invest in people through a “new social contract”; and relaunch economies to be more consistent with the SDGs and the Paris Agreement on climate change….”

Coming up - April 25-30, 2021: Planetary Health Week https://www.planetaryhealthannualmeeting.com/

Includes the 4th Planetary Health Annual Meeting (PHAM).

J&J Center for Health Worker Innovation launches new event series: Front Line in Focus The first event of the series is on April 28th and will focus on global issues related to health worker respect and recognition and dive into policy, lived experience, and promising initiatives underway, among other topics.

“Building Due Respect & Recognition for the Health Workforce.” will open with a discussion on the policy and systems-level challenges health workers face with a panel of health workers and advocates from around the world speaking to their lived experiences and expertise. The event will also feature a number of advocacy actions that people can take to help ensure midwives, nurses, and community health workers can thrive in their professions. Register here.

Upcoming 74th World Health Assembly (24 May-1 June) https://apps.who.int/gb/e/e_wha74.html

Early docs.

Global governance of health

Book - Coronavirus Politics: The Comparative Politics and Policy of COVID-19

Edited by Scott Greer et al; https://www.fulcrum.org/concern/monographs/jq085n03q

“Coronavirus Politics identifies key threads in the global comparative discussion that continue to shed light on COVID-19 and shape debates about what it means for scholarship in health and comparative politics. Editors Scott L. Greer, Elizabeth J. King, Elize Massard da Fonseca, and André Peralta-Santos bring together over 30 authors versed in politics and the health issues in order to understand the health policy decisions, the public health interventions, the social policy decisions, their interactions, and the reasons….”

CGD - Forging an MDB System: The Missing Piece in the Governance Architecture

N Lee et al; https://www.cgdev.org/blog/forging-mdb-system-missing-piece-governance-architecture

“Few would argue that collaboration and collective efforts across the multilateral development banks (MDBs) are not urgently needed. Yet while the logic and need are obvious, the actual extent of collaboration between MDBs is limited. Our recent paper explores how this gap in the international financial architecture might usefully be filled. It addresses what a new cross-MDB governing body might do and what it might look like.”

Guardian – UK aid cuts: ‘tragic blow’ as opaque numbers signal big reductions https://www.theguardian.com/politics/2021/apr/22/uk-aid-cuts-tragic-blow-as-opaque-numbers- signal-big-reductions?CMP=Share_iOSApp_Other

“The UK has released the first details of how it intends to impose as much as £4bn worth of cuts to international aid, prompting campaigners to accuse the government of having “lost its moral compass”. The long-awaited statement on planned spending for 2021-22 did not fully spell out future commitments for specific countries or programmes, but its new classifications for how it plans to distribute £8.1bn in aid imply massive reductions in key areas….”

Planetary health

Guardian - So what has the rest of the world promised to do about climate change? https://www.theguardian.com/environment/2021/apr/19/so-what-has-the-rest-of-the-world- promised-to-do-about-climate-change

On the NDCs (Nationally Determined Contributions) of a number of big countries.

Guardian - A great deception’: oil giants taken to task over ‘greenwash’ ads https://www.theguardian.com/business/2021/apr/19/a-great-deception-oil-giants-taken-to-task- over-greenwash-ads

“ClientEarth calls for tobacco-like health warnings on advertisements from fossil fuel firms.”

Devex - Development banks considering $250M joint climate facility https://www.devex.com/news/development-banks-considering-250m-joint-climate-facility-99666

From last week. “[Next week], the heads of the world’s top multilateral development banks are set to discuss creating a joint $250 million facility aimed at improving their public and private sector clients’ climate strategies…”

Infectious diseases & NTDs

HPW - COVID-19 Provides Lessons for TB Vaccine Development https://healthpolicy-watch.news/covid-19-provides-lessons-for-tb-vaccine-development/

Coverage of a TB Vaccine conference.

“… Encouraged by how fast vaccines have been developed for COVID-19, tuberculosis advocates launched a “TB vaccine roadmap” on Tuesday and aim to use lessons from the pandemic to jumpstart the quest for a TB vaccine. The purpose of the roadmap, said Frank Cobelens of the Amsterdam Institute for Global Health and Development, is to provide “key actionable priorities” to develop affordable vaccines for use in low and middle income countries….”

SS&M - A social network analysis of the organizations focusing on tuberculosis, malaria and pneumonia

S De Rosis et al ; https://www.sciencedirect.com/science/article/abs/pii/S0277953621002720

“In this paper,we present an original study on the use of social media data to analyze the structure of the global health networks (GHNs) relative to health organizations targeted to malaria, tuberculosis (TBC) and pneumonia as well as twitter popularity, evaluating the performance of their strategies in response to the arising health threats. We use a machine learning ensemble classifier and social network analysis to discover the Twitter users that represent organizations or groups active for each disease. We have found evidence that the GHN of TBC is the more mature, active and global. Meanwhile, the networks of malaria and pneumonia are found to be less connected and lacking global coverage….”

WHO – RTS,S malaria vaccine reaches more than 650 000 children in Ghana, Kenya and Malawi through groundbreaking pilot programme https://www.who.int/news/item/20-04-2021-rts-s-malaria-vaccine-reaches-more-than-650-000- children-in-ghana-kenya-and-malawi-through-groundbreaking-pilot-programme

“Two years on from the launch of a pilot programme, more than 1.7 million doses of the world’s first malaria vaccine have been administered in Ghana, Kenya and Malawi, benefitting more than 650 000 children with additional malaria protection. The number of children reached in this relatively short period indicates strong community demand for the vaccine as well as the capacity of the countries’ child immunization programmes to deliver the vaccine on a novel schedule (4 doses up to about age 2 years)….

NCDs

Link:

Globalization & Health - Beyond nutrition and physical activity: food industry shaping of the very principles of scientific integrity

Sexual & Reproductive / maternal, neonatal & child health

GHSP - Galvanizing Collective Action to Accelerate Reductions in Maternal and Newborn Mortality and Prevention of Stillbirths https://www.ghspjournal.org/content/early/2021/04/16/GHSP-D-20-00575

“Historically, global efforts to accelerate progress toward achieving health and well-being for women and children have appeared separate, despite the inextricable links among maternal, perinatal, and newborn health outcomes. Accelerating progress demands that the maternal and newborn health (MNH) community more rapidly and effectively share learning, new evidence, and program experiences. A new global initiative, AlignMNH, will establish a country-driven, multidirectional knowledge hub and series of convenings to promote purposeful knowledge sharing and problem solving and align on priorities for action. These efforts are intended to facilitate increased application of evidence and regular review of progress ultimately contributing to improved MNH and prevention of stillbirths.”

CGD (blog) - Biden Wants to Eliminate Lead Poisoning in American Children. We Propose an Even More Ambitious Goal: Global Eradication.

S Hares et al; https://www.cgdev.org/blog/biden-wants-eliminate-lead-poisoning-american- children-we-propose-even-more-ambitious-goal

“We applaud the Biden Administration's effort to address lead poisoning in the US. But we suggest Biden adopt an even more ambitious goal: not just national elimination, but global eradication of lead poisoning, especially in children. A global eradication campaign—modelled loosely on prior and ongoing global efforts to eradicate smallpox, polio, and guinea worm, mixed with inspiration from the WHO’s Framework Convention on Tobacco Control—would offer a tremendous contribution to global welfare, economic growth, and even world peace. …”

Lancet GH - Evaluating the potential economic and health impact of rotavirus vaccination in 63 middle-income countries not eligible for Gavi funding: a modelling study https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00167-4/fulltext

“Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccine Alliance, have been slow to adopt rotavirus vaccines. Few studies have evaluated the cost-effectiveness and benefit–risk of rotavirus vaccination in these settings. We aimed to assess the potential economic and health impact of rotavirus vaccination in 63 MICs not eligible for funding from Gavi.”

Conclusion: “… In most MICs not eligible for Gavi funding, rotavirus vaccination has high probability to be cost-effective with a favourable benefit–risk profile….”

Links:

• International Journal for Equity in Health - Inequalities in antenatal care coverage and quality: an analysis from 63 low and middle-income countries using the ANCq content- qualified coverage indicator

• BMJ Global Health - The principles of Nurturing Care promote human capital and mitigate adversities from preconception through adolescence

Human resources for health

Draft - The WHO Global Strategic Directions for Nursing and Midwifery (2021- 2025) https://www.who.int/publications/m/item/global-strategic-directions-for-nursing-and-midwifery- 2021-2025#.YH-6leeWzUo.twitter

“The draft WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 presents evidence-based practices and an interrelated set of policy priorities that can help countries ensure that midwives and nurses optimally contribute to achieving universal health coverage and other population health goals. It was developed in response to Decision WHA73(30) which requested WHO, “to engage with all WHO regions to update the Global Strategic Directions for Nursing and Midwifery 2016–2020 and, following consultations with Member States, submit this update to the Seventy-fourth World Health Assembly for its consideration.””

Link:

Human Resources for Health - How can human resources for health interventions contribute to sexual, reproductive, maternal, and newborn healthcare quality across the continuum in low- and lower-middle-income countries? A systematic review

Miscellaneous

Science News - Fifteen journals to outsource peer review decisions https://www.sciencemag.org/news/2021/04/fifteen-journals-outsource-peer-review-decisions

“… Now, 15 journals are outsourcing something central to science itself: the peer review process. The journals, which include BMJ Open Science and Royal Society Open Science, say they will accept articles reviewed by a nonprofit “peer community” organization. It’s the first time that journals have guaranteed that they will accept the recommendations of another body with no further review, says Chris Chambers, a cognitive neuroscientist at Cardiff University and one of the founders of the peer review organization, called Peer Community In Registered Reports (PCI RR). The service—which PCI RR will provide free to authors and journals—will add to the existential questions facing journals, says Jason Hoyt, CEO of PeerJ, an open access family of journals that has signed up for the initiative. “What are you paying publishers to do, exactly?” he asks. For PeerJ, which is committed to low publishing fees, outsourcing peer review provides an opportunity to innovate, he says….”

Guardian - Microbes are ‘unknown unknowns’ despite being vital to all life, says study https://www.theguardian.com/environment/2021/apr/19/microbes-are-unknown-unknowns- despite-being-vital-to-all-life-says-study

“A new study has highlighted how little is known about microbes – the hidden majority of life on Earth. Life on the planet relies on an enormous quantity of bacteria, fungi and other tiny organisms. They generate oxygen, keep soils healthy and regulate the climate. Microbes play a crucial role in food production, such as cheese, beer, yoghurt and bread. But despite their importance to human life and the health of the Earth, a new scientific paper has shown our “profound ignorance” of microbial biodiversity and how it is changing….”

Lancet World Report – The death penalty continues unabated globally https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00902-8/fulltext

“Executions continue to decline, but according to Amnesty International's annual report on capital punishment serious concerns remain. Talha Burki reports.”

Extra Covid section

Global Public Health - Social policy as an integral component of pandemic response: Learning from COVID-19 in Brazil, Germany, India and the United States S Greer et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1916831

“It is easy but mistaken to think that public health emergency measures and social policy can be separated. This paper compares the experiences of Brazil, Germany, India and the United States during their 2020 responses to the COVID-19 pandemic to show that social policies such as unemployment insurance, flat payments and short-time work are crucial to the effectiveness of non-pharmaceutical interventions as well as to their political sustainability. Broadly, public health measures that constrain economic activity will only be effective and sustainable if paired with social policy measures that enable people to comply without sacrificing their livelihoods and economic wellbeing. Tough public health policies and generous social policies taken together proved a success in Germany. Generous social policies uncoupled from strong public health interventions, in Brazil and the US during the summer of 2020, enabled lockdown compliance but failed to halt the pandemic, while tough public health measures without social policy support rapidly collapsed in India. In the COVID-19 and future pandemics, public health theory and practice should recognise the importance of social policy to the immediate effectiveness of public health policy as well as to the long-term social and economic impact of pandemics.”

Global Public Health - Addressing COVID-19 vulnerabilities: How do we achieve global health security in an inequitable world A B Sehovic et al ; https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1916056

“…More than a year into the pandemic, SARS-CoV-2 has exposed the dangerous hollowness of a global commitment to global health security. Global health security (GHS) has no uncontested definition, and despite ample pandemic warnings (HIV, H1N1, SARS, MERS-CoV, Ebola, Zika) the world, remains woefully unprepared for an adequate pandemic response; its lack of preparation the predicable result of inattention to equity and with it global health security. The first section of this paper lays out the particular challenges of COVID-19 for less well-resourced countries. The second part discusses the inequities being perpetuated and accentuated in the development and distribution of COVID-19 vaccines. The third section discusses ways to address these global inequities and its related complexities. We conclude by restating some of the key priorities for achieving GHS.”

Bureau of Investigative Journalism – Pfizer backs down over unrealistic terms in South-Africa Vaccine deal https://www.thebureauinvestigates.com/stories/2021-04-19/pfizer-backs-down-over-asset- seizing-clause-in-south-africa-vaccine-deal

“Pfizer has backed down over its controversial demand that the South African government put up sovereign assets guaranteeing an indemnity against the cost of any future legal cases. During Covid- 19 vaccine negotiations, the company sought indemnity against civil claims from citizens who had

experienced adverse vaccine effects – meaning that the government would have to cover the costs instead….”

FT - UK launches drive to ‘supercharge’ search for new Covid treatments https://www.ft.com/content/1d352634-b493-4861-abd9-42102afad4a1

“New antivirals task force will seek to develop medicines people can take at home.”

“The UK government has launched a drive to “supercharge” the search for new home-based drug treatments for Covid-19, adding another weapon in the armoury against the disease on top of vaccines. The aim is to have at least two effective antiviral treatments, in tablet or capsule form, as early as the autumn which could be taken at home to stop the infection spreading and speed up recovery time. They could be offered to people who test positive, or have been exposed to the disease, officials said….”

Reporters Without Borders - 2021 World Press Freedom Index: Journalism, the vaccine against disinformation, blocked in more than 130 countries https://rsf.org/en/2021-world-press-freedom-index-journalism-vaccine-against-disinformation- blocked-more-130-countries

“The group Reporters Without Borders said in an annual report that the pandemic has led to a deterioration in people's access to information, with governments blocking reports critical to their COVID responses.”

CGD (blog) - A Framework to Assess the Impact of COVID-19 Vaccine Certificates Y Teerrawattanon et al ; https://www.cgdev.org/blog/framework-assess-impact-covid-19-vaccine- certificates#disqus_thread

« … in March 2021, the Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand, and the National University of Singapore (NUS) convened a regional initiative, the COVID-19 Vaccination Policy Research and Decision Support Initiative in Asia (CORESIA): a regional study on vaccination certificates. It aims to develop guiding principles for the development and implementation of such instruments at national and regional levels by considering health, economic, social, ethical, and implementation issues. Our initial work has led to the development of a framework to assess the potential impact of introducing COVID-19 vaccination certificates for international travel, explored below….”

Unicef - Protecting and Transforming Social Spending for Inclusive Recoveries Financing Social Spending in Lower and Middle-Income Countries during COVID- 19: Monthly Update #1 https://www.unicef-irc.org/files/documents/d-4167-Social_Spending_Monitor_Update_April21.pdf

First edition of UNICEF's Social Spending monitor. Each monthly update provides detailed information on the financial response to COVID-19 by country.

Nature Medicine (Comment) -Leave no one behind: ensuring access to COVID-19 vaccines for refugee and displaced populations M Zard et al ; https://www.nature.com/articles/s41591-021-01328-3

“Ensuring access to vaccines against COVID-19 for refugee and displaced populations and addressing health inequities are vital for an effective pandemic response.”

Science – Clear link emerges between COVID-19 and pregnancy complications https://www.sciencemag.org/news/2021/04/clear-link-emerges-between-covid-19-and-pregnancy- complications

“New study bolsters the case for vaccinating pregnant women.”

Pathogens & Global Health - The Covid-19 pandemic in low- and middle-income countries, who carries the burden? Review of mass media and publications from six countries https://www.tandfonline.com/doi/abs/10.1080/20477724.2021.1878446?journalCode=ypgh20

“…This review showed that those who suffered the most from the lockdown were migrants, workers in the large informal sector, small businesses, slum dwellers, women and elderly, revealing the social, cultural and economic inequalities of societies. Financial and food support for the poor was inadequate and sometimes mismanaged. In the better organized societies, the resilience was stronger (South Korea, Kerala/India) but here also the poor had to suffer the most….”

And some links:

Devex - Unitaid chief: We need to ‘double down’ on R&D for COVID-19 treatment