IHP News 624 : One World (Not Yet) Protected

IHP news 624 : One World (not yet) protected

( 4 June 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 this newsletter issue you’ll find, among others, more coverage and final analyses on the 74th World Health Assembly, on which experts had mixed feelings. In his closing remarks, dr. Tedros emphasized “a pandemic treaty would represent “a generational commitment that outlives budgetary cycles, election cycles, and media cycles.” Good luck with that in the year 2021. Anyway, to be discussed again end of November. At the very least, the WHO DG will be pleased to see it’s raining new “Pandemic Sciences Centres” & “Pandemic Prevention Institutes” these days. Certainly won’t be for a lack of these if this turns out to be not the ‘last pandemic’.

We also cover the informal meeting of the TRIPS Council (May 31), where not much progress was made on the temporary waiver negotiations, the Gavi COVAX AMC Summit (June 2), hosted by Japan (watchwords were ‘dollars, doses & delivery’), and with the G7 summit coming up (June 11- 13), you probably also noticed the high-level advocacy, with among others a worldwide joint call by IMF/WB/WHO/WTO leaders earlier this week. As the pandemic reaches a "perilous point", Georgieva et al warned for a “two-track pandemic”, with richer countries having access and poorer ones being left behind. In the op-ed, they made the case for a $50 billion health, trade and finance roadmap to end the (acute phase of the) pandemic and secure a global recovery. PS: on the waiver proposal, they wrote: “All blockages to expanding supply must be removed, and we call on WTO members to accelerate negotiations towards a pragmatic solution around intellectual property. “ One for some of our pandemic treaty “champions” in Team Europe, I’d say.

In any case, whereas in 1984 I was still humming along with ‘Fe-e-e-d the world’ (Band Aid), in 2021 we clearly have to ‘Vaccinate the world’. Urgently. The world (and political economy) has gotten a bit more complicated over these decades for me, however, as I grew older (don’t know about wiser), so not counting on Bono or Boy George for this one. Let alone Justin Bieber.

In other news of the week, let us already flag here the 40th anniversary of HIV/AIDS (see related new Lancet publications), the 2nd Global Health Forum (GHF) of the Boao Forum for Asia, with evergreen theme ‘Health for All’ ( given the way geopolitical winds are blowing, an update of that mantra seems overdue (something with – “…but for our allies and future allies first”) ), a Global Vaccine Confidence summit (hosted by the UK), and upcoming governance changes at the Gates Foundation (we can think of a few ways to improve governance there ).

And oh yes, I still have to get used to the Alpha & Delta variants, which for mysterious reasons make me think of sororities at US campuses. Not quite sure that’s what WHO had in mind with its reform. True, the alternative – waiting till all countries have their “own” nasty variant, so that stigmatization won’t be an option anymore (hashtag #OneWorldNotProtected ) – is also not something you would expect WHO to root for :)

Enjoy your reading.

Kristof Decoster

See also The Guardian:

“…”Biden’s coronavirus coordinator, Jeff Zients, explained that the 80m doses comprised 13% of the total coronavirus vaccine doses produced in the US. He said in addition to ongoing donations, the administration will work with US vaccine manufacturers to ramp up domestic production. He said the administration plans to work with “partner nations”, pharmaceutical companies, and other manufacturers to enable vaccine production across the globe, to “not only beat this pandemic, but also [prepare] the world to respond to other future threats”, Zients said….”

HPW – Deal for COVAX Procurement Of Chinese COVID-19 Vaccines In the Works – Africa CDC https://healthpolicy-watch.news/deal-for-covax-procurement-of-chinese-covid-19-vaccines/

“A deal is in the works for the global COVAX vaccine facility to procure two Chinese-made COVID- 19 vaccines recently approved by the World Health Organization for emergency use – greatly expanding vaccine choices for low- and middle income countries, Africa Centers for Disease Control Director John Nkengasong, told Health Policy Watch on Thursday. … … Adding yet another vaccine to the array is a new Russian single dose COVID-19 vaccine that was just approved by the first African country. On Wednesday, Mauritius granted emergency use authorization to the “Sputnik Light vaccine, which also may be rolled out soon in India. …. … Another bright spot on the horizon, said Nkengasong, is the fact that the first donations of vaccines by rich countries are reaching more African countries now. There are, however, indications, that COVID-19 vaccination in Africa could soon be back on track with three African countries receiving doses of Oxford-AstraZeneca and Pfizer vaccines via COVAX….”

Reuters - GAVI in talks with China's Sinovax to expand COVAX supply - spokesperson https://www.reuters.com/business/healthcare-pharmaceuticals/gavi-talks-with-chinas-sinovax- expand-covax-supply-spokesperson-2021-06-02/

“The GAVI vaccine alliance is in talks with Chinese drugmaker Sinovac Biotch (SVA.O) to expand the COVAX dose-sharing portfolio available to poor countries following the World Health Organization's approval of its COVID-19 vaccine on Tuesday, a GAVI spokesperson said. "Gavi, on behalf of the COVAX Facility, is in dialogue with several manufacturers, including Sinovac, to expand and diversify the portfolio further and secure access to additional doses for Facility participants," she said on Wednesday….”

Links:

• HPW - Six Pacific Nations First To Benefit From New Zealand’s COVID-19 Vaccine Donation

“While welcoming New Zealand’s donation, Gavi called for an end to vaccine export bans in reference to the Indian government’s decision to suspend exports of vaccines from the Serum Institute of India (SII) to deal with domestic demand amid a growing number of infections in the the country. “Gavi and COVAX partners are additionally calling for an end to export bans, support for technology transfers and for public and private donors to fully finance the Gavi COVAX AMC with an additional US$2 billion by June 2nd for a total ask of US$8.3 billion to secure 1.8 billion doses.”…”

• Reuters - AstraZeneca says working with governments to boost COVAX donations

“AstraZeneca (AZN.L) CEO Pascal Soriot on Wednesday said the firm was working with the COVAX vaccine-sharing mechanism and governments to boost COVID-19 vaccine supplies to the scheme, including through donations of doses…”

C-TAP relaunch (28 May)

Let’s hope C-TAP will take off now, one year after its launch.

HPW - Indonesia and Bangladesh Reveal Massive Untapped Vaccine Production Capacity at C-TAP Anniversary https://healthpolicy-watch.news/indonesia-and-bangladesh-reveal-massive-untapped-vaccine- production-capacity-at-c-tap-anniversary/

Coverage of last week’s “Re-launch C-TAP” event (28 May), which also featured our minister, M Kitir.

“Indonesia could manufacture 550 million COVID-19 vaccine doses a year if pharmaceutical companies were prepared to share the know-how, Health Minister Budi Gunadi Sadikin told a World Health Organization event Friday. Sadikin was addressing the first anniversary of the WHO’s COVID-19 Technology Access Pool (C-TAP), set up to encourage countries and manufacturers of COVID-19 products to voluntarily share knowledge, intellectual property and data to facilitate the rapid expansion of manufacturing. … Sadikin said Indonesia is the largest vaccine manufacturer in Southeast Asia, and has the capacity to “upscale our vaccine productions to meet regional and global demand”. What it lacks, he said, is the know-how and technology needed to make some COVID-19 vaccines, particularly mRNA vaccines.

“Abdul Muktadir, Managing Director of Incepta Pharmaceuticals in Bangladesh, said his company was also ready to produce vaccines if know-how and technology were shared. “We have seen some statements like ‘Low- and middle-income countries do not have the ability to acquire the technology and deliver quality products,’ ” he said. Yet he pointed out that the vast majority of the world’s medicines are made by generic companies, particularly in Southeast Asia….”

“… WHO expects more countries and manufacturers will join C-TAP, and is currently in talks with two vaccine manufacturers and five diagnostics companies, said Mariangela Simao, WHO Assistant Director-General for Access to Medicines….”

74th WHA – More coverage & analysis

In this section, more coverage & analyses on the 74th WHA, both on specific agenda items and overall analysis.

HPW - Appeal for Pandemic Treaty, More Resources and Vaccine Equity Close World Health Assembly https://healthpolicy-watch.news/appeal-for-pandemic-treaty-more-resources-and-vaccine-equity- close-world-health-assembly/

Must-read coverage & analysis on closing day of the WHA.

“The 74th World Health Assembly (WHA) closed on Monday with appeals for vaccine equity, more resources for the World Health Organization (WHO) and support for a “pandemic treaty” to combat future pathogens.”

“WHO Director General Dr Tedros Adhanom Ghebreyesus devoted much of his concluding speech to the global body’s dearth of finances and the importance of the proposed pandemic treaty to put more teeth into international health rules around outbreak responses. Member states agreed at the WHA session that the proposed treaty would be discussed in detail at a special WHA session at the end of November….”

And a quote on the close links between human & planetary health: “… Referring to a visit Saturday to WHO by a group of health and climate activists DoctorsXR the WHO Director General also noted how the climate crisis has become interwoven with the pandemic as another risk to humanity whose signals need to be heeded now. … “Our human health is very much similar to Planet health,” he noted, “As you know, in human health, 37 ℃ is healthy. If you add 2 degrees, which is 39 ℃, you’re sick. If you add another 2 ℃, then you are at 41, and in danger. And then if you add more and it’s 37 ℃ plus 5℃, that’s too late. “And for the planet it’s the same thing. …”

“The WHA had the longest agenda in its history, and adopted over 30 resolutions, including new initiatives to promote local production of medicines; prevent and reduce non-communicable diseases; expand access to services for the treatment of diabetes, disabilities and eye care. It also considered reports from three different bodies – the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – which revealed the WHO weaknesses in dealing COVID-19 and how to address these. Despite the roaring debates that occurred on the Assembly’s margins, member states clearly sought to end the packed 8-day long meeting on a note of accord – if not exactly consensus. Disagreements over an IP waiver to spur vaccine protection or the future direction of the WHO-led investigation into the SARS-CoV-2 origins did not break out again onto the plenary floor, as could have occurred, in the closing hours of the Assembly. Rather, member states seemed happy to let the IP waiver debate move back to its natural arena in the World Trade Organization forum – which is set to meet on the issue once more next Monday …” “

“A key resolution of this WHA, “Strengthening WHO Preparedness for and Response to Health Emergencies, received final approval on Monday without objections – even though scientific critics and member states had complained that the already nuanced text touching on the investigation into the SARS-CoV2 origins had been weakened further during the course of negotiations. …”

See also Reuters – 'Time has come' for pandemic treaty as part of bold reforms - WHO's Tedros

“Tedros Adhanom Ghebreyesus, WHO director-general, told its annual ministerial assembly that the U.N. agency faced a “serious challenge” to maintain its COVID-19 response at the current level and required sustainable and flexible funding.

… “The one recommendation that I believe will do most to strengthen both WHO and global health security is the recommendation for a treaty on pandemic preparedness and response,” Tedros said. “This is an idea whose time has come.” … …. It could be a long road ahead if such a treaty is to be reached. The WHO’s Framework Convention on Tobacco Control - the world’s first public health treaty - was clinched in 2003 after four years of negotiations….”

“Under the resolution submitted by the European Union, and adopted by consensus, member states are to be firmly in the driver’s seat of the reforms through a year-long process….”

And Devex - Countries agree to a special session on pandemic treaty as WHA closes

WHO’s (daily) updates For quick overview of resolutions etc.

WHO - The Seventy-fourth World Health Assembly closes (31 May) Recommended. Overview of key resolutions adopted.

See also WHO Special session of the World Health Assembly to consider developing a WHO convention, agreement or other international instrument on pandemic preparedness and response

WHO - Update from the Seventy-fourth World Health Assembly – 29 May 2021 New resolutions on: Local production of medicines; Ending violence against children; Addressing social determinants of health.

WHO - Update from the Seventy-fourth World Health Assembly – 28 May 2021 New resolutions on the health and care workforce and strategic directions for nursing and midwifery; Decisions on patient safety; health, environment and climate change; chemicals management; coordination of work on noncommunicable diseases; Global Action Plan for Healthy Lives and Wellbeing for All; Prevention of sexual exploitation, abuse and harassment.

Guardian - ‘Protect and invest’: WHO calls for 6m more nurses worldwide https://www.theguardian.com/global-development/2021/may/28/protect-and-invest-who-calls-for- 6m-more-nurses-worldwide

Some more coverage on specific agenda items.

“Health ministers around the world [are being urged] to sign off on plans to create 6m more nursing jobs by 2030, amid warnings that Covid-19 has exacerbated a global shortage and could spark a “brain drain” from the developing world….”

“Delegates meeting virtually this week at the World Health Assembly, the key decision-making body of the World Health Organization, [adopted] a resolution calling on countries to transform the nursing profession through more investment, support and training. … The WHO’s strategic directions call on countries to improve nursing and midwifery training, create more jobs and ensure that countries, once they have enough people in position, are able to retain them. The WHO estimates that the current global nursing workforce of 27.9 million leaves it 5.9 million short of what is needed – and that the shortage is “overwhelmingly” felt by low- and middle-income countries. … The strategy … endorsed this week has been described as “a once in a generation opportunity to turn things around” for the profession, which now faces losing even more workers due to the pandemic….”

For more detail, see WHO - The WHO Global Strategic Directions for Nursing and Midwifery (2021- 2025)

AP - WHO chief concedes ‘slow’ response to Congo sex abuse claims

AP;

Coverage of roundtable talk on preventing sexual abuse on Friday at the WHA.

• See also Reuters - WHO to issue findings on Congo sexual abuse investigation by end August

“The World Health Organization, facing pressure from donors, said an independent investigation into allegations of sexual abuse in Democratic Republic of Congo against WHO aid workers should issue findings by the end of August….”

• And HPW - WHO Admits To Failures In Fight Against Sex Scandals: Announces Scale-Up Against Abuse Issues

“ A special strategic meeting at the 74th World Health Assembly on Friday discussed how the World Health Organization (WHO) is scaling up powers to investigate sexual exploitation, abuse and harassment in emergency situations. WHO officials said this effort involves a “mass of inspectors” to prioritise investigations in at least eight countries….”

• Devex - WHO is struggling to employ sexual exploitation inspectors

“The World Health Organization is struggling with efforts to hire inspectors to investigate sexual exploitation and abuse in its programming, according to an agency official. … … As part of its reform efforts, the agency has identified a need for a “critical mass of inspectors” to investigate acts of exploitation and abuse, said Dr. Ibrahima Socé Fall, assistant director-general in WHO’s emergency response division, during a meeting at the 74th World Health Assembly on Friday. It also identified high-priority countries where these inspectors should be placed first, including Afghanistan, DRC, Ethiopia, Somalia, South Sudan, Sudan, Venezuela, and Yemen.”

• Finally, a tweet from WHO: “WHO will establish a task team, led by a senior female staff member, to accelerate the implementation of organization-wide WHO policies and procedures, adopting a holistic approach to prevention and management of sexual exploitation and abuse and sexual harassment. #WHA74”

Times of India - Delegates approve 16 per cent increase to WHO budget Times of India; Will be 6.1 billion, for the next two years.

HPW - Debate Over WHO Investigation of SARS-CoV2 Virus Origins Heads For Showdown in World Health Assembly https://healthpolicy-watch.news/debate-over-sars-cov2-virus-origins-heads-for-showdown-in-wha/

“The debate over the future direction of WHO’s investigation into the origins of SARS-CoV2 appeared to be heading for a showdown in the closing days of the World Health Assembly – following another sharp statement from the United States on the issue – this time directed squarely at WHO and WHA member states. … The terse statement posted by the United States Mission in Geneva said: “Phase 1 of the WHO-convened COVID-19 origins study was insufficient and inconclusive. We call for a timely, transparent, evidence-based, and expert-led Phase 2 study, including in the People’s Republic of China….”

“… Speaking on Friday, Mike Ryan, the Executive Director of WHO’s Health Emergencies division, called upon member states not to politicize the science around the origins quest. … … However, it appears that the battle between scientists – and not only politicians, is becoming more and more toxic. … Scientists who support a “natural origins” theory for the SARS-CoV2 virus – as well as those that lean toward the “lab escape” theory – both appear to have become locked in a cycle of increasingly bitter attack. That is reflected in the heated exchanges taking place recently on social media – including insults and name-calling fired, back and forth….”

Reuters - WHO experts preparing proposal for next studies on virus origin - spokeswoman

Reuters;

“World Health Organization (WHO) experts are preparing a proposal on the next studies to be carried out into the origins of the virus that causes COVID-19, a spokeswoman said on Friday….”

And some related links:

Guardian - US must share intelligence on Covid origins, WHO-affiliated expert says

“Theory that coronavirus leaked out of a Wuhan lab was ‘not off the table’, Dale Fisher says.” And: “he urged the US to share any intelligence it had. “The Wall Street Journal is not really the way to share science,” he said….”

Devex - WHA reaches 'breakthrough moment' on diabetes https://www.devex.com/news/wha-reaches-breakthrough-moment-on-diabetes-100026

“The 74th World Health Assembly has adopted a first-ever resolution that civil society hopes could help “turn the tide on diabetes.””

HPW - Disagreement Over Gender identity and ‘Sexuality Education’ Impedes Resolution on Violence Against Children https://healthpolicy-watch.news/sexuality-education-delays-resolution-on-violence-against- children/

“The World Health Assembly (WHA) passed a resolution on preventing violence against women and girls at Monday’s plenary – but only after heated discussion during discussion on Saturday resulted in a watered-down version with no reference to “sexuality education”. …”

HPW - COVID Has Caused ‘Mass Trauma,’ Worsening Mental Health Globally https://healthpolicy-watch.news/covid-has-caused-mass-trauma-worsening-mental-health- globally/

““Mass trauma” from COVID-19 has worsened mental health worldwide, WHO officials said at the 74th World Health Assembly (WHA) on Monday. The long neglected issue received special attention on the Assembly’s closing day, with member states expressing broad support for more action – after a year that saw new mental health issues emerge even while mainstream mental health services were disrupted. …. … A proposal to extend WHO’s 2013-2020 Mental Health Action Plan for another decade, but including updated indicators and targets, received wide support among member states at the WHA, where they adopted a draft decision endorsing the updated Action Plan.;..”

Devex - 74th WHA: Historic or business as usual? Experts weigh in https://www.devex.com/news/74th-wha-historic-or-business-as-usual-experts-weigh-in-100048

Overall analysis. Must-read. “The 74th World Health Assembly was expected to provide solutions to bring an end to the COVID-19 pandemic and ensure the world is prepared for the next one. But some experts argued there was more talk than action….”

“ While adoption of a pandemic treaty at the assembly was unlikely, experts hoped countries would form a task force to draft and negotiate a treaty, or at the very least endorse a resolution in support of a treaty that world leaders could take up at the U.N. General Assembly in September. But at the conclusion of the WHA on Monday, countries agreed instead to create a member state- led working group that would look at the benefits of a treaty, a convention, or an international agreement, and discuss that at a special WHA session in November. Reynolds said the decision “essentially kicks the can further down the road on WHO reform, on preparedness, and on a pandemic treaty.”…”

“…. There is hope that the G-7 summit next week will pick up the slack after WHA….”

“…The WHA also agreed for a member state working group to consider the findings of the Independent Panel for Pandemic Preparedness and Response, the IHR Review Committee, and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.

Kate Dodson, vice president for global health strategy at the United Nations Foundation, told Devex the resolution is, “Hands-down ... the biggest accomplishment from this year’s historic World Health Assembly.” “The stakes were high to pass something, and it was extremely encouraging to see both a practical and cooperative resolution emerge from the week-long gathering,” she said, adding that the resolution signifies support for multilateralism and WHO “to remain at the center of the global health architecture.”…”

Also with the views of Roopa Dhatt (Women in Global Health), Thomas Schwarz (MMI) and others.

Geneva Health Files - Pandemic Treaty Talks Eclipse Prevailing Vaccine Inequities at WHA74

P Patnaik; Geneva Health Files

Neat overall analysis of the WHA (or at least a big chunk of it), as of last Friday.

“More than half way into the 74th World Health Assembly, a serious discussion on the efforts to address vaccine inequities have been conspicuous by its absence. What has instead dominated much of the Assembly proceedings are talks for a pandemic treaty to address health emergencies in the future, and the important, but continuing push towards investigations on the origins of the virus, among other matters…”

Some quotes re accountability: “It is striking that even as the world’s worst health emergency in a century continues to unfold and decimates health systems in many parts of the world, WHO member states cannot seek accountability on these issues. … … Given that WHO’s partner agencies have been leading on the delivery of vaccines, there appears to be no institutional mechanism that can enable member states to question powerful health agencies such as Gavi – The Vaccine Alliance, CEPI, and other actors, responsible for running the ACT Accelerator.” … … While governments are partly responsible for these numbers, there is no question that international actors at the forefront of this pandemic response have to be accountable. And there needs to be a space to do that.

BMJ GH (Editorial) – Pandemic treaty needs to start with rethinking the paradigm of global health security S Fukuda-Parr, P Buss & A E Yamin; https://gh.bmj.com/content/6/6/e005292

“…the treaty discussions provide an opportunity and an imperative to rethink the paradigm of global health security that has shaped the current international response to the COVID-19 pandemic. The prevailing paradigm is antithetical to the core purpose of global pandemic preparedness and response for five reasons….”

Nature (Editorial) - Wanted: rules for pandemic data access that everyone can trust https://www.nature.com/articles/d41586-021-01460-7

“In the wake of COVID, a pandemic treaty could be a way to agree on data access before the next emergency strikes.”

“… As Nature has previously reported, the jury is out on whether such a treaty is necessary. It is still not clear whether the idea has the support of a majority of nations, and it is being debated whether now is the time to be discussing a future pandemic, when so much remains to be done to end the current one. However, if there is to be such a treaty, it must include internationally agreed rules on accessing data in a pandemic — or any global emergency that has the potential to cause large- scale loss of life….”

“Discussions on pandemic data access are already taking place, and at some pace. The science academies of the G7 group of the world’s seven biggest economies — known as the S7 — have published a statement emphasizing the need for emergency data-access rules, including questions of governance (go.nature.com/2sjqj2v). These will be discussed at this month’s G7 meeting in Cornwall, UK. Discussions have also been taking place among the G20 science academies and at the World Health Organization. These separate conversations need to converge. ..”

Medico (blog) - Lost in (virtual) space A Wulf; https://www.medico.de/en/lost-in-virtual-space-18239

Overall analysis of the WHA by Andreas Wulf. “How to move forward in the pandemic? Geopolitical conflicts, the interests of rich countries and the exclusion of civil society make it difficult for the world to come together.”

Quote: “…geopolitical fault lines have not been resolved, even with the return of the United States under President Biden to the WHO. And the role of a critical civil society is even more precarious than before, particularly through the virtual format….”

And some links:

Devex - Audit flags weaknesses in WHO emergency procurement during COVID-19

WHO - Newsflash on NCDs With overview of everything related to NCDs at the WHA.

149th WHO Executive Board Meeting

Some coverage below.

HPW -United States Slams Syrian and Belarus Health & Human Rights Record at WHO Forum – Ahead of Biden-Putin “Geneva Summit” https://healthpolicy-watch.news/87104-2/

“A debate over human rights abuses in Syria and Belarus became a major theme at Tuesday’s World Health Organization Executive Board meeting – only a week after the Israeli-Palestinian conflict took centre stage for a full day at the World Health Assembly gathering of all 194 WHO member states. The unusually sharp criticism of the human rights record in the two countries was led by the United States – in what may also be a signal by Washington to Russia, ahead of a pending meeting in Geneva between US President Joe Biden and Russia’s Putin – that following a change in administration in Washington, the US is going to be speaking out more about human rights abuses of its proxy governments on the global stage. … The statements may also be a signal to WHO member states – that if the global health forum can also be a stadium for Washington to air its views on human rights – particularly in light of the politically-charged debates already occurring every year at the World Health Assembly over the participation of Taiwan and health conditions in the Occupied Palestinian Territories. … The debates occurred as both countries were elected to represent their respective regions in the WHO Governing Board – the 34-member state steering committee that is supposed to guide and watchdog the activities of WHO at close range. …”

HPW - WHO Internal Justice Needs Reforms; Staff On “Unequal Footing” With Administration https://healthpolicy-watch.news/who-internal-justice-needs-reforms-staff/

“Shortcomings and failures in the World Health Organization’s internal justice system – laid bare during revelations of sexual abuse and exploitation in DR Congo – require more systematic reform to make the system transparent, fair and equitable, the head of WHO’s Staff Association told WHO’s Executive Board governing body on Wednesday. …”

Trips Waiver negotiations & analysis

Reuters - Even after U.S. shift, opponents resist COVID-19 vaccine patent waiver

Reuters;

Coverage of the informal WTO meeting on Monday.

“A deal on an intellectual property waiver for COVID-19 vaccines at the World Trade Organization (WTO) was no closer to acceptance on Monday despite Washington's backing, due to expected scepticism about a new draft, sources close to the talks told Reuters….”

“Negotiations reopened at the WTO on Monday, focused on a highly anticipated revised draft submitted by India, South Africa and dozens of other developing countries last week. …. A surprise U.S. shift earlier this month to support a patent waiver heaped pressure on remaining opponents like the European Union and Switzerland that are home to numerous drugmakers. But Monday's

discussions - the 11th session since the initial waiver proposal in October - failed to achieve a breakthrough. …”

“… Three sources close to the talks see problems with the text. … "There is an ocean between this waiver proposal and what was suggested by the U.S.," said a source involved in the talks who declined to be named. "There's definitely no quick resolution for this." … Two aspects of the waiver draft that may harden opposition are its scope and duration….”

PS: Next TRIPS council formal meeting June 8-9 #TRIPSwaiver. Another informal meeting proposed later in July @wto.

Devex - Europe still can't get on board with the TRIPS waiver https://www.devex.com/news/europe-still-can-t-get-on-board-with-the-trips-waiver-100027

Analysis, at the start of this week, on the EU stance vs a temporary Trips waiver, and assessment of the updated version of the waiver proposal.

“A lot has changed in a year. The same European leaders who rallied those early funding efforts behind a promise of global solidarity are now the main obstruction to a waiver of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS. … … European skeptics have rallied around a framing of the waiver as a “false good idea” that will not quickly relieve the global COVID-19 vaccine imbalance, which has so far resulted in just 10 countries administering more than 75% of all doses. … Instead, the leaders of the European Commission, the EU’s executive branch, are pushing a package of interventions, including limiting export restrictions, improving vaccine manufacturing in the global south, and issuing voluntary licenses that would allow specific manufacturers to avoid intellectual property restrictions, without instituting a universal waiver….” “…. Access advocates are trying to maintain focus on the waiver proposal as critical to overhauling a system they say prioritizes intellectual property over people’s health. And as Europe has become the new battleground for that debate, they are accelerating efforts to overcome the opposition of key continental leaders. That includes championing a vote in the European Parliament that could come as early as June 7 on a resolution in support of the proposal. … “That vote would come alongside the next Council for TRIPS meeting at WTO scheduled to begin June 8, when the waiver proposal is set to be discussed. … . At the same time, activists are trying to convince leaders within countries that have been supportive of the waiver to challenge the commission’s opposition in the European Council. ….”

See also Jacobin – Big Pharma’s EU Lobbying Could Spell Disaster for Global South Vaccine Waivers

“ Pharma giants have spent big on lobbying European Union officials over vaccine waivers. It’s paid off: now key European power brokers oppose suspending global vaccine patents to fight the pandemic in the Global South.”

WSJ - Europe Pushes Alternative to U.S.-Backed Covid-19 Vaccine Patent-Waiver Plan https://www.wsj.com/articles/europe-pushes-alternative-to-u-s-backed-covid-19-vaccine-patent- waiver-plan-11622732952

“The European Union is pushing back hard against U.S.-backed calls to temporarily waive intellectual property rights for Covid-19 vaccines, preparing a rival plan that officials said would better safeguard drug companies’ patents and look for other ways to boost supplies for developing countries. … Brussels’ alternative plan would lift export restrictions on vaccines and their raw materials, expand manufacturing capacity around the world, and make it easier for countries to use existing rules to override patents in some cases, according to documents reviewed by The Wall Street Journal. The EU’s stance makes a quick deal on the waiver proposal less likely, and could sink it altogether, trade experts say. EU officials said they would present the proposal at the WTO next week, when members are also set to debate the waiver. They argue that removing patents won’t do much to help increase production in the short term and would remove incentives for pharmaceutical companies to do further work, such as updating vaccines for virus mutations….”

And a link:

Human Rights Watch - Seven Reasons the EU is Wrong to Oppose the TRIPS Waiver

Scroll In - Covid-19 vaccines: BRICS supports India, South Africa’s proposal to waive patents https://scroll.in/latest/996411/covid-19-vaccines-brics-supports-india-south-africas-proposal-to- waive-patents

As already flagged above.

“BRICS, a group of countries comprising Brazil, Russia, India, China and South Africa, on Tuesday supported a proposal to temporarily waive the patent on coronavirus vaccines. India and South Africa had moved a proposal on the matter in the World Trade Organization in October….”

BMJ Editorial - Suspend intellectual property rights for covid-19 vaccines P Krishtel et al; https://www.bmj.com/content/373/bmj.n1344

“…A successfully negotiated waiver would meet four important criteria. The waiver’s primary aim should be to save as many lives as possible. The Biden administration wants the waiver to focus on vaccines. This constraint should be removed. The original proposal applies to all medical technologies related to covid-19, including diagnostics, medicines, and ventilators. Many people are likely to become sick even if vaccination rates improve worldwide. Secondly, negotiations should be completed quickly. Governments should make substantial progress ahead of the WTO meeting on 8 June 2021. Thirdly, any waiver should be straightforward, unambiguous, for a reasonable duration, and limit manufacturers’ ability to file legal challenges that impede access. Finally, negotiating texts should be fully disclosed, with negotiations transparent to ensure all countries

negotiate as equals. In the past, powerful nations have used their leverage to extract concessions from less powerful countries behind closed doors….”

Big Pharma’s lobbying firepower in Brussels: at least €36 million a year (and likely far more) https://corporateeurope.org/en/2021/05/big-pharmas-lobbying-firepower-brussels-least-eu36- million-year-and-likely-far-more

By Corporate Europe Observatory.

And a few links:

IISD - Ottawa Group Weighs COVID Response Options, Including TRIPS Waiver

TWN – (3 June) - Revised TRIPS waiver bolsters demand for text-based talks at WTO

(a bit more optimist): “ the 63 co-sponsors of the proposed TRIPS waiver for saving human lives from the worsening COVID-19 pandemic have brought about a fundamental shift towards text- based negotiations at the WTO, with their revised proposal that calls for an early decision on a "proportionate legal measure for clearing IP barriers for ramping-up the production of COVID-19 vaccines, therapeutics, and diagnostics," said people familiar with the development….”

Ahead of G7 summit (11-13 June)

WP (Op-ed) - Why we are calling for a new commitment to vaccine equity and defeating the pandemic https://www.washingtonpost.com/opinions/2021/05/31/why-we-are-calling-new-commitment- vaccine-equity-defeating-pandemic/

New op-ed by IMF, WB, WHO & WTO leads.

“… ahead of next week’s Group of Seven summit, we are calling for a stepped-up coordinated strategy, backed by new financing, to vaccinate the world. …. A proposal from International Monetary Fund staff puts forward a plan with clear targets and pragmatic actions, all at a feasible cost. It builds on the ongoing work of the World Health Organization, its partners in the Access to Covid-19 Tools (ACT) Accelerator initiative and its global vaccine access program Covax, as well as the work of the World Bank Group, the World Trade Organization and many others….”

Cost: an estimated $50 billion. Arguing for a thee-pronged approach.

See also WHO - New US$50 billion health, trade and finance roadmap to end the pandemic and secure a global recovery

And HPW - Global Leaders Call for $50-billion Investment to End COVID-19, boost economies

With coverage of the media briefing on Tuesday. With the respective views (and emphases) of Georgieva, Malpass, Tedros and Ngozi.

Telegraph - Cut red tape to stop the rise of Covid variants, renowned British scientists tell G7 leaders https://www.telegraph.co.uk/global-health/science-and-disease/cut-red-tape-stop-rise-covid- variants-renowned-british-scientists/

“A leading group of British scientists including Sir John Bell, Regius Professor of Medicine at the University of Oxford, and Jeremy Farrar, have called on world governments to slash regulatory red tape in order to free up the supply of vaccines to the developing world. In an open letter published exclusively by The Telegraph, they warn that the world faces a race to stop new variants emerging and demand coordinated action from leaders meeting at the G7 in Cornwall later this month…. “ (also including Trevor Mundell (Gates Foundation) & J-A Röttingen).

“…The letter calls for five specific actions, including the elimination of “any unnecessary bureaucracy to expedite the approval of new vaccines and therapeutics”….”

Reuters – G7 must donate COVID shots to avoid 1918-scale pandemic disaster - CEPI chief Reuters;

“ Leaders of the Group of Seven (G7) rich nations must donate COVID-19 shots urgently to avoid an outcome akin to the 1918 flu which killed 50 million people, the head of the Coalition for Epidemic Preparedness Innovations (CEPI) told Reuters.” R Hatchett, that is.

WP - Biden set for G-7 boost in bid for all nations to impose minimum global corporate tax https://www.washingtonpost.com/us-policy/2021/05/31/global-minimum-corporate-tax-biden-g7/

“Finance ministers from Group of Seven nations meeting in London on Friday are expected to back President Biden’s call for a global minimum tax on corporate profits, giving him an early win in a grueling diplomatic campaign that is just beginning. The new minimum tax, one half of a two- pronged global reform effort, is designed to halt a cycle of corporate tax-cutting that has sapped government revenue around the globe. As part of a package deal, negotiators are also wrestling with European demands to tax American technology giants such as Google and Facebook, which earn substantial revenue in countries where they have little physical presence….”

See also the Economist - Twilight of the tax haven

“…Talks are focused on two main changes: reallocating taxing rights towards countries where economic activity takes place, rather than where firms choose to book profits; and setting a

minimum global tax rate, likely to be in the region of 15%. Finance ministers from the G7 group of rich countries are set to signal their approval at a meeting on June 4th-5th. The broader G20 could agree terms as soon as July, spurring the other 120 or so countries and territories involved in the talks to fall into line. …”

Bloomberg - G-7 Set to Back Green Rival to China’s Belt and Road Program https://www.bloomberg.com/news/articles/2021-06-01/g-7-set-to-back-green-rival-to-china-s-belt- and-road-program

“The Group of Seven nations plans to launch a green alternative to China’s Belt and Road initiative when the leaders meet at a summit next week, according to two people familiar with the matter. The strategy, expected to be called the “Clean Green Initiative,” would provide a framework to support sustainable development and the green transition in developing countries, the people said. The initiative will also be on the summit agenda for the leaders….”

“…In the lead up to next week’s summit, G-7 members have expressed different views on the geographical focus the initiative should have, said one of the people familiar with the discussions. Germany, France and Italy are keen for it to support activities in Africa, while the U.S. is pushing for action in Latin America and Asia. Japan argues for more focus on the Indo-Pacific region. But all nations broadly agree on the need for a more transparent alternative to the Chinese program, the person added….”

And a link:

FT - G7 criticised for Covid bailouts with no ‘green strings’ attached

“More than $189bn of recovery funds spent on fossil fuels despite pledges to cut emissions.”

Series of ODI essays re G7 summit 2021 https://odi.org/en/topics/g7-summit-2021/

“New commentary and analysis on the action G7 leaders must take to tackle our most pressing global challenges.”

We especially want to flag:

Ending the acute phase of the Covid-19 pandemic (must read, by Tom Hart et al) Check out the three actions ODI researchers suggest.

Delivering a successful G7 summit in the context of a climate emergency

G7 Health Ministers meeting (Oxford 3-4 June) https://www.g7uk.org/health-ministers/

See UK gov - New international approach to combat emerging health threats as crucial G7 health talks begin (with the usual PR blab la):

“G7 health ministers pledge to combat future health threats by working together to identify early warning signs from animals and the environment.

• UK-hosted G7 health meetings begin in Oxford to unite major democracies to take action on improving global health and tackling COVID-19 around the world • This comes as a new report demonstrates the impact of G7 on expanding global vaccine access and reducing infectious disease outbreaks in 70 countries”

“…As the G7 health ministers’ meetings start, the Health Secretary along with the Foreign Secretary Dominic Raab have published a new report on G7 progress to improve global health in developing countries. The Carbis Bay Progress Report shows that since 2015, G7 members have helped expand access to vaccines, supported developing countries to train, recruit and retain health workers, and assisted more than 70 countries to stop infectious disease outbreaks from spreading….”

PS: “The Health Track, led by the Department for Health and Social Care, [will] focus on the themes of: global health security; anti-microbial resistance; digital health; clinical trials in the development of vaccines, therapeutics and diagnostics.”

G7 Carbis Bay progress report: advancing universal health coverage and global health through strengthening health systems, preparedness and resilience UK Government;

By the G7 Accountability working group.

“At the 2015 G7 Elmau Summit, the 2016 Ise-Shima Summit and the 2017 Taormina Summit, G7 Leaders made ambitious commitments to work with low- and lower- middle income countries (LICs and LMICs) towards attaining Universal Health Coverage (UHC) with strong health systems and better preparedness for public health emergencies, and preventing and responding to future outbreaks. This report reviews the progress made against these G7 commitments, which are assessed together because UHC and Global Health Security (GHS) are interlinked goals…”

Check out the findings.

BMJ Editorial - Antimicrobial resistance at the G7 R Glover et al; https://www.bmj.com/content/373/bmj.n1417.full

“Cuts to overseas aid undermine global efforts to combat resistance.”

“The G7, under a UK presidency, is convening in an unprecedented pandemic year. Health ministers are meeting to discuss covid-19 but also antimicrobial resistance ahead of the leaders meeting on 11-13 June 2021. The UK government goes into the G7 with mixed messages: it is championing expensive interventions for antimicrobial resistance (such as antibiotic incentive schemes and high tech diagnostics) while also cutting millions of pounds of overseas development assistance for global public health research and activities. This risks increasing the emergence, transmission, and burden of antimicrobial resistance worldwide by pushing funding to a small set of technological solutions while undermining the global public health agenda….”

Oxfam - More than a million COVID deaths in 4 months since G7 leaders failed to break vaccine monopolies https://www.oxfam.org/en/press-releases/more-million-covid-deaths-4-months-g7-leaders-failed- break-vaccine-monopolies

Advocacy ahead of the G7 Health ministers’ summit.

“More than a million people have died from COVID since G7 leaders last met back in February, when they made vague pledges to increase the global vaccine supply, but crucially failed to collectively back the waiver of intellectual property rules and investment in manufacturing vaccines in developing countries that would really make the difference. As G7 Health Ministers meet today for talks ahead of the Leaders’ Summit next week, The People’s Vaccine Alliance is calling on the G7 to stop making empty promises and protecting the interests of pharmaceutical companies, and instead take urgent action to close the massive vaccine void between their nations and poorer countries. New calculations from the Alliance, which includes Health Justice Initiative, Oxfam, and UNAIDS, found that last month people living in G7 countries were 77 times more likely to be offered a vaccine than those living in the world’s poorest countries. Between them, G7 nations were vaccinating at a rate of 4.6 million people a day in May, meaning, if this rate continues, everyone living in G7 nations should be fully vaccinated by 8 January 2022. At the current rate – vaccinating 63,000 people a day - it would take low income countries 57 years to reach the same level of protection. Of the 1.77 billion doses of COVID vaccines given globally, 28 per cent have been in G7 countries. In contrast just 0.3 per cent of COVID jabs have been given in low-income countries, despite the fact G7 and low-income countries have a fairly similar population size. …”

G7 Global Vaccine Confidence Summit (2 June)

UK - World-leading experts commit to building vaccine confidence at UK hosted Global Vaccine Confidence Summit https://www.gov.uk/government/news/world-leading-experts-commit-to-building-vaccine- confidence-at-uk-hosted-global-vaccine-confidence-summit

“The Global Vaccine Confidence Summit convened world-leading experts to commit to greater international collaboration to build vaccine confidence globally.”

“As part of its G7 Presidency, the UK Government convened the Global Vaccine Confidence Summit today, a first-of-its-kind event, bringing together global experts from across the public and private sector to build and maintain confidence in vaccines…

UK Secretary of State for Health and Social Care @MattHancock announced a Global Vaccine Confidence Campaign led by the G7 Global Vaccine Confidence Working Group with a mission to promote confidence and trust in vaccines globally.

“… At the Summit, the UK Government announced ambitions for its G7 vaccine confidence activity designed to support global cooperation and more effective responses on vaccine confidence and addressing misinformation globally. An innovative digital insight platform, which will provide global and local insight, as well as trends on vaccine confidence and the harmful misinformation that is seeking to undermine it. More details will be announced soon. A coalition of some of the world’s best academic organisations to understand ‘infodemics’ and promote healthy information ecosystems. The coalition called IRIS is a collaborative project between the Vaccine Confidence Project (London School of Hygiene & Tropical Medicine), University of Cambridge, Sapienza University of Rome, Ca’ Foscari University of Venice, City University of London (and the Alan Turing Institute) and the Harvard T.H. Chan School of Public Health….”

Other Global Health Governance, Financing & Global health security news

Lancet World Report – ACT Accelerator strains donors' aid budgets https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01284-8/fulltext

“The continued shortfall in funding for the international COVID-19 response raises the question of whether alternative forms of financing should be explored. Ann Danaiya Usher reports.”

“… The Access to COVID-19 Tools Accelerator (ACT-A) is facing a daunting funding crisis. Set up in April, 2020, by the European Commission, France, and the Bill & Melinda Gates Foundation, and coordinated by WHO, it aims to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. However, as of May 28, 2021, ACT-A is US$18 billion short of its $33 billion budget for 2021. Moreover, most of the money provided so far has paid for vaccines; tests, medical oxygen, and protective equipment for health workers are badly underfunded. The inability to raise the required funds from donors is raising the question of whether alternative forms of financing can fill the gap. For months, UN Secretary-General António Guterres has argued against using scarce official development assistance (ODA) to finance the pandemic response. Donor countries have not heeded these warnings, relying on their aid budgets to finance ACT-A. “

Options offered: expanding IFFIm; an extraordinary allocation of $650 billion in special drawing rights (SDRs) by the International Monetary Fund (IMF).

“…The Financial Working Group of the ACT-A Facilitation Council, chaired by Norway and South Africa, has considered both IFFIm and the SDR allocation in scenarios for generating resources to

fully finance the pandemic response. The working group has devised a formula for fair burden sharing of the ACT-A budget, where the USA would contribute approximately a quarter of the bill, EU 23%, the UK and Japan 5–6%, and so on. Norway and South Africa have carried out an unprecedented diplomatic effort to move the funding discussion out of the development ministries and into the finance ministries, “where it belongs”, as one diplomat put it.”

Hopes are now on the G7 summit….

Devex - Biden administration releases full budget request for fiscal year 2022 https://www.devex.com/news/biden-administration-releases-full-budget-request-for-fiscal-year- 2022-100024

“The Biden administration released its fiscal year 2022 budget request Friday, confirming a roughly 12% increase for foreign assistance programs and detailing how it would spend some $58.5 billion to accelerate its priorities around global health, combating climate change, and Central America. Global health security will get a major boost if this funding proposal is adopted by Congress. But it did not include increases for other global health priorities, including HIV/AIDS. It also recommends keeping funding flat for a number of other issues and agencies, including the Millennium Challenge Corp. and Peace Corps. … … This budget request includes about $10 billion to support global health, with one of the biggest increases in annual funding going to global health security. The proposal suggests nearly $1 billion for global health security programs, a roughly $800 million increase from the prior fiscal year. A majority of those funds, about $745 million, would be distributed by USAID … About $300 million of the USAID global health funding will support contributions to multilateral efforts including the Access to COVID-19 Tools Accelerator, and $250 million of the funding through the State Department will go to support a new health security financing mechanism “which would be developed alongside U.S. partners and allies, to ensure global readiness to respond to the next outbreak.”… “… The proposal does include a modest increase in funding for global reproductive health and family planning programs. But while it in effect repeals the Hyde Amendment prohibiting the use of government funds for abortion domestically, the foreign affairs counterpart — the Helms Amendment — remains…. “

FT - Gates foundation considers governance changes following divorce filing https://www.ft.com/content/27c44ac3-e03b-4c65-b555-f7917ee2f584

“The charitable foundation chaired by Bill Gates and Melinda French Gates is considering shaking up its governance in the wake of the billionaire couple’s divorce filing, weeks after saying that no such changes were planned. The Bill & Melinda Gates Foundation, which has distributed $55bn since its launch in 2000, differs from many large philanthropies by having no independent directors. Instead, it has been governed by three trustees: Gates, French Gates and Warren Buffett, the Berkshire Hathaway chair who pledged in 2006 to leave most of his estimated $110bn fortune to the foundation. “I’m actively discussing with Bill and Melinda steps they and Warren might take to strengthen the long-term sustainability and stability of the foundation given the co-chairs’ divorce,” Mark Suzman, the foundation’s chief executive, said after The Wall Street Journal first reported that French Gates had pushed for governance changes. … Suzman’s statement offered no explanation for the change of thinking on the foundation’s governance or details of how its governance might look in future….”

“… The pending divorce has thrown a question mark over the world’s largest private charitable foundation, which employs 1,600 people and disburses more than $5bn a year, largely to global health and development projects. Most of the estimated $124bn fortune Gates made as co-founder of the software group Microsoft has not yet been committed to the foundation, and the divorce has heightened speculation that the remaining tens of billions of dollars could instead be allocated to venture capital and philanthropic vehicles he and French Gates operate separately. “

Devex - Gates Foundation changes could bring transparency, accountability https://www.devex.com/news/gates-foundation-changes-could-bring-transparency-accountability- 100020

“Reports that Bill Gates and Melinda French Gates are discussing leadership changes for their foundation — including adding a board and outside directors — in the wake of their divorce announcement have renewed criticism about the organization’s governance model….”

“… Philanthropists like Gates who make their wealth in the tech industry often prefer more streamlined decision-making. However, such concentrated leadership is unusual, particularly for a charitable organization of the Gates Foundation’s size, with a staff of about 1,600 and a $49.8 billion endowment as of 2019. While this structure may have worked at the organization’s outset, family foundations typically begin to look beyond the donor family and consider outside board members as they grow. … … Philanthropy experts say changing the Gates Foundation’s governance could bring much-needed accountability to the world’s largest private foundation, whose influence extends far beyond its grant making. It’s also an opportunity for an organization with a stated mission to fight poverty, disease, and inequity to elevate the voices of people of color and those from diverse backgrounds at a time when traditional philanthropy has come under intense scrutiny, they say.;..”

PS: and they could even become a ‘role model’ for others: “…As more high net worth individuals structure vehicles for their philanthropy, they are sure to watch what steps the Gates Foundation takes to address its governance problems, since many other private foundations with living donors will face similar challenges. Increased democratic accountability is the main issue confronting contemporary philanthropy, Soskis said…”

PS: Tweet Tim Schwab:

“I'm writing a book about #BillGates & the #GatesFoundation. #TheGoodBillionaire My book takes on one of the most powerful & secretive people/institutions in the world. And I need your help to write it: documents, intel, stories, sources, whistleblowers.”

BRICS Ministerial meeting on Tuesday (1 June) https://www.thehindu.com/news/national/jaishankar-wang-yi-to-take-part-in-brics-ministerial- meeting-on-tuesday/article34661563.ece

Analysis ahead of the meeting. “Meeting [will] be watched closely for any expression of support for proposal on patent waiver for coronavirus vaccines.” Chaired by India.

“… The meeting will also be watched closely for any expression of support from the entire grouping for the India-South Africa proposal at the World Trade Organisation (WTO) that asks for a patent waiver for coronavirus vaccines, which would be a big boost for the proposal. About 60 countries have already backed the proposal, the U.S. has recently agreed to support it, while the European Union has yet to give its final decision on it. … The Ministers will also set the course for the BRICS summit to be held later this year, either in person or virtually, which will be hosted by Prime Minister Narendra Modi. “

Mint – BRICS seeks reform in multilateral fora https://www.livemint.com/news/india/brics-call-for-reforming-united-nations-imf-wto-and-who- 11622563520198.html

Coverage of the meeting. “The Foreign Ministers of Brazil, Russia, India, China and South Africa – also known as the BRICS countries – on Tuesday called for reforming and re-invigorating multilateral fora like the United Nations, the International Monetary Fund, World Bank, the World Trade Organisation and the World Health Organisation to strengthen their ability to tackle twenty-first century challenges. Meeting virtually under the chairmanship of India, the BRICS countries also laid out a list of changes that would make these institutions examples of effective and representative multilateralism.”

“India is the current chair of BRICS and the meeting of the foreign ministers is expected to pave the way for a summit of BRICS leaders in September. … The joint statement also said that the BRICS ministers “stressed the need to promote initiatives aimed at ensuring timely, affordable, and equitable access to, as well as the distribution of diagnostics, therapeutics, medicines and vaccines, and essential health products and technologies," to tackle the covid-19 pandemic. This comes against the backdrop of India and South Africa jointly moving a proposal at the WTO for a waiver of patents controlling the production of covid-19 vaccines and drugs … … “The Ministers reaffirmed the need to use all relevant measures during the pandemic, including supporting ongoing consideration in WTO on a covid-19 vaccine Intellectual Property Rights waiver and the use of flexibilities of the TRIPS agreement," to make covid-19 vaccines available to all, the statement said. … “They also reiterated the need for sharing of vaccine doses, transfer of technology, development of local production capacities and supply chains for medical products, promotion of price transparency and called for exercise of due restraint in the implementation of measures that could hinder the flow of vaccines, health products and essential inputs," the statement said.”

Bloomberg - HHS Partners With Investment Fund for Public Health Readiness https://news.bloomberglaw.com/health-law-and-business/hhs-partners-with-investment-fund-for- public-health-readiness

“The [US] federal government has partnered with the Global Health Investment Corp. to develop technologies and medical countermeasures for long-term pandemic preparedness, according to the General Services Administration. The Global Health Investment Fund finances the development of vaccines, therapeutics, and diagnostics for public health challenges, particularly for infectious diseases. Financing for the corporation comes from the Bill and Melinda Gates Foundation, GlaxoSmithKline Plc, the Pfizer Foundation, and Merck and Co. Inc., among others.

The contract is aimed at helping the Biomedical Advanced Research and Development Authority address “gaps in pandemic preparedness,” especially in response to new pathogens …”

PS: “The US government (ie taxpayers) will pay the corporation up to $500 million, to invest in R&D for drugs, vaccines & other technologies for future health emergencies.”

For more detail, see HHS Launches First Venture Capital Partnership to Develop Transformative Technologies to Combat Future Pandemics, Other Health Emergencies

Put the Global Fund at the Center of Pandemic Preparedness and Response C Collins; https://www.theglobalfight.org/put-the-global-fund-at-the-center-of-pandemic- preparedness-and-response/

Advocacy by Friends of the GF.

BMJ Opinion – We must seize the moment for a global pandemic surveillance and response scheme A Gill et al; BMJ Opinion

Written together with a number of other authors of the I-DAIR Pandemic Scientific Group.

“A leading group of scientists and experts, from every part of the world, must come together urgently to create a new, neutral, and trusted digital system that can revolutionize how data is gathered and used globally…. Yet, bringing this together globally won’t be easy for three reasons….”

Lancet Letter : The CEPI centralised laboratory network: supporting COVID-19 vaccine development https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00982-X/fulltext

“The Coalition for Epidemic Preparedness Innovations (CEPI) has established a global network of laboratories to centralise testing and enable comparison of immunological responses generated by COVID-19 vaccines….”

And a link:

AP – (US) Science chief wants next pandemic vaccine ready in 100 days

“The new White House science adviser wants to have a vaccine ready to fight the next pandemic in just about 100 days after recognizing a potential viral outbreak. In his first interview after being sworn in Wednesday, Eric Lander painted a rosy near future where a renewed American emphasis on science not only better prepares the world for the next pandemic with plug-and-play vaccines, but also changes how medicine fights disease and treats patients, curbs climate change and further explores space….”

Covid key news

This week, global Covid shots hit 2 billion - in more than six months of vaccination so far. See the Economist - Vaccinating the world: 2bn shots done, 13bn to go

However, “…. the distribution of vaccines remains highly skewed. According to a tally kept by Our World In Data, a website, 183 countries are now administering jabs (the holdouts are mostly countries in sub-Saharan Africa, along with Haiti and North Korea). But of the 2bn doses given, 37% have been dished out in North American and European countries with just 18% of the world's 7.6bn people (see left-hand chart, below). Sub-Saharan Africa, home to 13% of the global population, has administered less than 1% of total jabs….”

Cidrap News – Many regions have hot spots https://www.cidrap.umn.edu/news-perspective/2021/06/donor-summit-boosts-covax-funds- nations-share-doses

“… the World Health Organization (WHO) said yesterday in its weekly snapshot of the pandemic that although cases have dropped for the fifth week in a row, some countries across all of its regions are experiencing significant rises. …

“In its weekly epidemiologic report yesterday, the WHO said global cases have declined for the fifth week but are still at a high level, and deaths have dropped for the fourth week in a row. The agency warned, however, that cases are up significantly in some countries in all of its regions. The five countries that reported the most cases last week were Brazil, India, Argentina, the United States, and Colombia. Countries reporting double-digit or higher case rises last week include Uganda (191%), Colombia (40%), Malaysia (38%), Bahrain (32%), South Africa (24%), and Indonesia (20%). Yesterday, the WHO's African regional office said in its weekly outbreaks and health emergencies report that cases are up for the second week in a row, including in South Africa, with concerning rises in Namibia, Uganda, and Zambia….”

HPW - WHO Warning – Southern and Eastern African Countries Experiencing a Surge https://healthpolicy-watch.news/deal-for-covax-procurement-of-chinese-covid-19-vaccines/

“…. southern and eastern African countries are witnessing COVID-19 resurgence, underlining the need for an urgent boost in critical care capacity to prevent health facilities from being overwhelmed. “Weak observance of preventive measures, increased population movement and interaction as well as the arrival of winter in southern Africa have heightened the risk of COVID-19 resurgence in many countries,” said Dr Matshidiso Moeti, director of WHO’s Africa Regional Office, in another press briefing. Over just the last two weeks, the continent had recorded a 20% increase in COVID-19 cases compared to a fortnight ago. The pandemic is also trending upwards in 14 countries and in the past week alone, eight countries witnessed an abrupt rise of over 30% in cases ….”

“… Of the 53.5 million COVID-19 vaccine doses delivered so far to 50 African Region member states, 38.1 million doses have been administered, according to Africa CDC. … So far, only 0.54% of

the African population has been fully vaccinated, although that represents an increase of 0.8% compared to the previous week. WHO and CDC officials said. …. Five countries that are leading vaccine rollouts on the continent (Morocco – 14 million doses, Egypt – 2.4 million doses, Nigeria – 2 million doses, Ethiopia – 1.8 million doses, and Zimbabwe – 1 million doses). Five African Union member states – Tanzania, Saharawi Republic, Eritrea, Chad and Burundi – are yet to commence vaccine rollouts at all. ….”

See also UN News - Risk of COVID-19 surge threatens Africa's health facilities

“ Critical health facilities across Africa risk being overwhelmed by surging COVID-19 infections, the UN health agency [i.e. WHO Afro] said on Thursday.”

Stat – The name game for coronavirus variants just got a little easier https://www.statnews.com/2021/05/31/the-name-game-for-coronavirus-variants-just-got-a-little- easier/

“On Monday, WHO announced a new naming system it devised for so-called variants of interest and variants of concern, the forms of the SARS-CoV-2 virus with important mutations. Each variant will be given a name from the Greek alphabet, in a bid to both simplify the public discussion and to strip some of the stigma from the emergence of new variants. …”

Do read also Donald G McNeil Jr.’s view on this - Sigma Phi-ing Monkeyshines at the W.H.O.

“ Is it really easier to remember that the British variant is now named “Alpha” instead of B.1.1.7? Does Britain really need Geneva’s protection?...”

He argues for: “The point is to find something inoffensive but still catchy enough to stick in the memories of average readers, rather than virologists….”

Covid Science

WHO validates Sinovac COVID-19 vaccine for emergency use and issues interim policy recommendations https://worldhealthorganization.cmail19.com/t/ViewEmail/d/0104A200C64742492540EF23F30FEDE D/BD95C7108E817C31DCCB6820C4466A74

“WHO today validated the Sinovac-CoronaVac COVID-19 vaccine for emergency use, giving countries, funders, procuring agencies and communities the assurance that it meets international standards for safety, efficacy and manufacturing. The vaccine is produced by the Beijing-based pharmaceutical company Sinovac. …… On the basis of available evidence, WHO recommends the vaccine for use in adults 18 years and older, in a two-dose schedule with a spacing of two to four weeks. Vaccine efficacy results showed that the vaccine prevented symptomatic disease in 51% of those vaccinated and prevented severe COVID-19 and hospitalization in 100% of the studied population….”

This is the second clearance of a Chinese vaccine and the seventh vaccine to be listed.

AP – Vaccine protection may diminish need for yearly boosters https://apnews.com/article/us-news-coronavirus-pandemic-science-coronavirus-vaccine-health- d1c023524e87bbcf4add139ffcd349e9

“Scientists have found clues that the world’s leading COVID-19 vaccines offer lasting protection that could diminish the need for frequent booster shots, but they caution that more research is needed and that virus mutations are still a wild card. Critical studies are underway, and evidence is mounting that immunity from the mRNA vaccines made by Pfizer and Moderna does not depend exclusively on antibodies that dwindle over time. The body has overlapping layers of protection that offer backup. …Other experts say boosters may be needed only every few years….”

More news on Covid vaccine access & other bottlenecks

WSJ – Developed Countries Lock Up Covid-19 Vaccines Through 2023 https://www.wsj.com/articles/developed-countries-lock-up-covid-19-vaccines-through-2023- 11622665655?reflink=desktopwebshare_twitter

“The European Union, Canada and other developed countries have signed deals to get hundreds of millions of doses of Covid-19 vaccines and boosters over the next two years, furthering a divide between rich and poor countries. Under the recent deals, Pfizer Inc. and BioNTech SE agreed to supply the European Union up to 1.8 billion doses of their vaccine through 2023, while agreeing to supply Canada up to 125 million doses. Australia, Switzerland and Israel, meanwhile, are set to get Moderna Inc.’s shot through next year, and Switzerland has options for doses in 2023. The agreements will ensure the countries, including some that failed to lock up sufficient supplies of the mRNA vaccines earlier this year, have enough supplies to inoculate residents and protect them against potentially elusive variants, while providing a sales windfall to the manufacturers. Yet the deals once again leave out developing countries ….”

“Moderna sees Covax, the global-health initiative intended to get doses to low-income countries, as its primary means to supply lower- and middle-income countries, a spokesman said. The company said last month it would deliver 34 million doses in the fourth quarter of 2021 to Covax, which has an option to purchase another 466 million doses next year. Pfizer has pledged to provide 2 billion doses to low- and middle-income countries over the next 18 months, a company spokeswoman said. It also has agreed to provide 40 million doses to Covax this year for distribution, which have begun to reach more than a dozen countries, she said…”

“… About 6 billion doses have been purchased by more than two dozen rich nations and the European Union, according to the latest figures from the Duke University’s Global Health Innovation Center, which tracks vaccine purchases. By comparison, the rest of the world has combined to purchase more than 3 billion doses.”

“… Covid-19 vaccine sales are forecast to total $70 billion through next year for Pfizer and more than $27 billion for Moderna, according to Bernstein Research…. The Pfizer-BioNTech vaccine’s sales would make it among the top-selling pharmaceuticals of all time….” “…Pfizer has said it expects to produce 3 billion doses this year, and at least 4 billion next year. Moderna said it is targeting manufacturing up to 3 billion doses next year…. Some developing nations have reached deals with mRNA vaccine makers for doses, though supplies probably aren’t enough to vaccinate all their populations….”

“…Of the approximate 50 supply deals that Pfizer and BioNTech have with countries and groups like Covax, about half are with low- and middle-income countries, according to Duke’s Global Health Innovation Center. … Six of the 19 Moderna deals are for low- and middle-income countries, according to the Duke center. Moderna has said it would price its vaccine in low-income countries at its lowest-tier price….”

“… With developed countries securing more doses for the next few years, low- and middle-income countries will probably find themselves dependent on rich countries to share or reallocate doses, said Prashant Yadav, a senior fellow at the Center for Global Development who studies supply chains. He said that, if the divergence persists, more countries will likely sign supply deals with China and Russia, which have been eagerly providing doses made by their manufacturers.”

Reuters - Macron says France will help Africa make more COVID-19 vaccines locally https://www.reuters.com/business/healthcare-pharmaceuticals/macron-says-france-will-help- africa-make-more-covid-19-vaccines-locally-2021-05-28/

“President Emmanuel Macron said [last week] on Friday France would invest in boosting the production of COVID-19 vaccines in Africa, to help close a gap in the availability of the shots between African and Western nations.”

“… "How do we boost the production of vaccines on the African continent?" he said. "On this, we will this afternoon have an investment strategy to help these industrials produce more, and quite quickly." He said France already had a partnership with South Africa's Biovac Institute. Later on Friday, Macron opened another one with South African pharmaceutical company Aspen. … … He reiterated support for waiving intellectual property rights for COVID-19 vaccines, a move supported by U.S. President Joe Biden but opposed by Germany.

At the launch of his vaccine support initiative at Pretoria University, Macron called for regulated vaccine prices to prevent African nations being ripped off. "Poor countries are paying much more probably than the rich countries. We are crazy," he said. "Number one fight: ... we need common pricing. This is the best way not to waste public money."…”

Reuters - IFC and development groups to help fund vaccine production in Africa

Reuters

“Global development groups including International Finance Corp (IFC) said they will explore helping African producers such as Aspen Pharmacare Holdings Ltd (APNJ.J) boost vaccine

manufacturing in Africa, which received relatively few COVID-19 immunizations produced by rich nations. The news comes after the European Union last week promised 1 billion euros ($1.22 billion) to build vaccination manufacturing hubs in Africa. France's President Emmanuel Macron also promised on Friday to help the continent produce more vaccines locally. … IFC's partners, including U.S. International Development Finance Corp (DFC), Proparco and German Development Finance Institution, said they will provide financing to manufacturers to strengthen vaccine production capacity, build technical skills and enable knowledge sharing….”

Guardian - Vaccine inequality exposed by dire situation in world’s poorest nations https://www.theguardian.com/world/2021/may/30/vaccine-inequality-exposed-by-dire-situation- in-worlds-poorest-nations

“Analysis: the failings of the Covax programme, logistical issues and governments’ own inadequacies are making a bad situation worse.”

“From Africa to Latin America, Asia and the Caribbean, the same issues have been replicated. On top of finding enough doses, there have been logistical difficulties with delivery, problems over healthcare infrastructure and, in some countries, public hesitancy towards vaccines. Africa’s lack of vaccines – and the erratic supply of those that are eventually delivered – remains the No 1 challenge, however…”

FT - Covid-19 vaccines burnt as shelf-life complicates global rollout https://www.ft.com/content/8e1385cf-1569-4bf8-904e-fdc29367a758

“… Inefficiencies in the global distribution of vaccines and the relatively short shelf-life of the leading jabs have meant that doses have arrived in some countries too late for the shots to be used. … Part of the problem, according to the global vaccine alliance Gavi, is the “extremely cautious” expiry estimates attributed to the main coronavirus shots by manufacturers. The AstraZeneca jab, which must be stored at between 2C and 8C, has a shelf-life of six months. The BioNTech/Pfizer shot can be stored for six months at between -90C and -60C but only lasts up to five days once thawed and refrigerated. Sinopharm’s vaccine is one exception, with a fridge-temperature shelf-life of 24 months. Most non-coronavirus vaccines have an expiry date of about three years, Gavi says. … Amanda Harvey-Dehaye, task force leader at Médecins Sans Frontières for the WHO’s Access to Covid Tools Accelerator, said there needed to be a more transparent discussion about vaccine expiration. “Given the risk of thousands of doses being destroyed, it’s a shame we have so little visibility over stability tests run by manufacturers — and the subsequent extensions to shelf-life,” she said. “The current expiry dates add real pressure to vaccination campaigns that can already be heavily challenged.” The WHO says the main issue with expiry dates is potency, just like for small- molecule drugs, rather than safety….”

The Nation - We Can’t Trust Big Pharma to Make Enough Vaccines https://www.thenation.com/article/world/covid-vaccines-pharma/

Christopher Morten and Matthew Herder list two main reasons why we can’t trust Big Pharma to make enough vaccines.

And a quote: “…independent experts have surveyed supply and distribution chains, interviewed pharmaceutical companies around the world, and concluded that additional vaccine manufacturing could be brought online quickly—if not tomorrow, then in a matter of weeks or months. These estimates are much shorter than the 18 months or more that Moderna and other current market leaders often claim. In fact, in recent weeks, drug companies in Israel, Canada, Bangladesh, South Africa, and Denmark have all said they have unused vaccine manufacturing capacity that could be brought online in a matter of months, not years, to fight Covid- 19—but only if the existing incumbent manufacturers (or the governments that oversee and subsidize those manufacturers) share resources and knowledge, and create a legal pathway for new entrants to sell their vaccines….”

Telegraph - Vaccinating the world: the obstacles hindering global rollout – and how to overcome them https://www.telegraph.co.uk/global-health/science-and-disease/vaccinating-the-world/

In-depth overview of where things stand for the moment.

“…are things as bad as they seem? And what can be done to vaccinate the world? The hurdles – and the solutions – can be split into three broad categories: making, buying and distributing the shots. Here, we take a look at each. …”

Plus a quote: “… the Covax scheme – formed last April with the aim of protecting 20 per cent of the world by the end of 2021 – simply didn’t have the money to secure large supply deals until last summer; the first deal for 300m doses from AstraZeneca was announced in June. “Covax didn’t have the financial resources at the very beginning of the pandemic,” says Mr Cueni. He adds that the scheme initially bet on vaccines which appeared easier to distribute, rather than the more expensive and complex mRNA jabs made by Pfizer and Moderna. By the time Covax turned to these companies, “many governments had already signed up most of the available capacity”, Mr Cueni says. …”

Reuters - Sinopharm can provide more than 1 bln COVID-19 shots beyond China in second half of year Reuters;

“ China National Pharmaceutical Group (Sinopharm) has the capacity to provide more than 1 billion COVID-19 vaccine doses to the world beyond China in the second half of this year, the firm's chairman Liu Jingzhen said late on Wednesday. That level of supply capability assumes vaccination demand in China is being met, Liu said at a panel of the Global Health Forum of the Boao Forum for Asia. "Our annual production capacity exceeds 5 billion doses," Liu said, "This is our own capacity." He declined to disclose how many shots the state-backed drugmaker has agreed to give to the global COVAX programme for sharing doses, mainly with poor countries….”

Devex - The challenge of rolling out vaccines in African conflict zones https://www.devex.com/news/the-challenge-of-rolling-out-vaccines-in-african-conflict-zones-99932

“… Dr. Matshidiso Moeti, World Health Organization regional director for Africa, said the global health body and the United Nations are urging countries with ongoing conflicts, displaced persons, or humanitarian crises to commit some proportion of the vaccines that they’ve acquired for people in difficult areas. But Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said before the continent starts making plans to vaccinate in such areas, vaccine doses need to be secured. “Most vaccinations are happening in major cities which makes sense — that’s where the pandemic, which is the enemy, is,” he said. Adding that vaccinating large chunks of the population in major cities “will create herd immunity very early on.” “That will give us time to do a mop-up operation in those conflict areas, and just vaccinate them. You need to have vaccines before you start planning on vaccinating in conflict areas,” he said….”

Devex – Are health care workers in Africa getting vaccinated? https://www.devex.com/news/are-health-care-workers-in-africa-getting-vaccinated-99848

“…WHO relies on reporting from countries to track their vaccination efforts — including for priority groups — but many face challenges in collating and reporting data, particularly from outside capital cities. So far, 34 African countries have reported administering almost 2 million doses to health care workers, according to available data published by WHO. WHO is working to better understand the reasons for varying uptake of vaccines by health care workers, said Dr. Phionah Atuhebwe, the regional new vaccines introduction medical officer, who is coordinating the WHO Africa COVID-19 Vaccine Readiness and Equitable Delivery Taskforce….”

“… In theory, countries are following recommendations and prioritizing the vaccination of health care workers in their national deployment and vaccination plans … But the inoculation of health care workers depends on the overall success of countries’ vaccination campaigns. “Because of the supply constraints and particularly because of the situation in India, supply is coming through more slowly than we had anticipated… … … Fixing the supply problem overall, being ambitious in dose sharing from donor governments, and ramping up capacity by manufacturers are going to be critical, he added. Rwanda, Kenya, South Africa, and Nigeria have all reported vaccine shortages that will impact the progress of inoculating their health care workers….”

Covid analysis

WEF (blog)- 5 ways data can help build trust in vaccines WEF;

“A new World Economic Forum report outlines 5 ways to build trust in vaccines, by understanding the drivers of vaccine confidence.” Report: How to Build Trust in Vaccines: Understanding the drivers of vaccine confidence.

“the World Economic Forum ran an analysis in partnership with domain expert Dr Heidi Larson of the Vaccine Confidence Project (VCP) at the London School of Hygiene & Tropical Medicine, powered by NetBase Quid technology. The goal of their research was to get a deep understanding of the obstacles to vaccine adoption, barriers to building trust and the communication strategies that move people to action.”

The five key insights revealed are:

“1. Talk about the “protection” provided by the vaccine. That keyword has significantly more resonance and power than any other. 2. Avoid labelling, or an implication that there is a moral obligation on people to be vaccinated. 3. Keep messages simple, emphasizing gratitude, and flag relatable examples, rather than celebrities or politicians. 4. Seek to understand why people have low confidence and treat those concerns with empathy, not judgement. 5. Focus on the clearest benefit of vaccination: protection for communities from hospitalization and death because of COVID-19.”

IDS - Local Covid-19 syndemics and the need for an integrated response https://www.ids.ac.uk/news/local-covid-19-syndemics-and-the-need-for-an-integrated-response/

“…The article ‘Local Covid-19 syndemics and the need for an integrated response’ taken from the recent IDS Bulletin: Building a Better World: The Crisis and Opportunity of Covid-19, draws on emerging evidence from low- and middle-income contexts to highlight how Covid-19 becomes syndemic when it interacts with local vulnerabilities….”

BMJ GH (Commentary) - The governance of personal data for COVID-19 response: perspective from the Access to COVID-19 Tools Accelerator C Staunton et al ; https://gh.bmj.com/content/6/5/e006095

“COVID-19 is the world’s first digital pandemic with the use of digital technologies and personal data central to our response. The use of these data must be appropriately governed to ensure its use is in the public interest. The Framework for the Governance of Personal Data for the Access to COVID-19 Tools Accelerator provides a principle-based approach, implemented in a procedural guidance to govern the use of COVID-19 personal data….”

Guardian - Disaster patriarchy: how the pandemic has unleashed a war on women V (formerly Eve Ensler) https://www.theguardian.com/lifeandstyle/2021/jun/01/disaster-patriarchy- how-the-pandemic-has-unleashed-a-war-on-women

“As Covid-19 has swept the world there has been an explosion of violence against women, and a full-blown assault on their rights. It’s time to fight back against a system that allows women to be sacrificed, erased and violated. Covid has unleashed the most severe setback to women’s liberation in my lifetime. While watching this happen, I have started to think we are witnessing an outbreak of disaster patriarchy. … …. Naomi Klein was the first to identify “disaster capitalism”, when capitalists use a disaster to impose measures they couldn’t possibly get away with in normal times, generating more profit for themselves. Disaster patriarchy is a parallel and complementary process, where men exploit a crisis to reassert control and dominance, and rapidly erase hard-earned women’s rights. All over the world, patriarchy has taken full advantage of the virus to reclaim power – on the one hand, escalating the danger and violence to women, and on the other, stepping in as their supposed controller and protector….”

JAMA - When Vaccine Apathy, Not Hesitancy, Drives Vaccine Disinterest S Wood et al; https://jamanetwork.com/journals/jama/fullarticle/2780792

“This Viewpoint explains how vaccine apathy rather than hesitancy may lead to population undervaccination, and uses marketing principles to explain how public health messaging might differ to persuade apathetic persons to be immunized to achieve more widespread COVID-19 protection.”

Covid resources

WHO Afro - Key tool to aid Africa’s COVID-19 vaccine financing https://www.afro.who.int/news/key-tool-aid-africas-covid-19-vaccine-financing

“The COVID-19 Vaccine Introduction and Deployment Costing Tool (CVIC), is key to helping countries determine their funding needs and can help unlock more funds for the roll out COVID-19 vaccines. The COVID-19 vaccine delivery cost estimation tool provides the first step to a well- structured budget. It aims to help governments and partners estimate the incremental introductory and deployment cost of procuring and administering COVID-19 vaccines. …”

NYT – Tracking coronavirus vaccinations around the world https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html

Tracker.

40 years of HIV/AIDS & upcoming High-level UN meeting

Lancet Editorial - 40 years of HIV/AIDS: a painful anniversary https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01213-7/fulltext

Lancet Editorial dedicated to the anniversary.

Over the past 40 years, “… UNAIDS estimates that HIV/AIDS has killed 32·7 million people, with 75·7 million HIV infections globally. Today, the tools exist to eliminate HIV. Combination prevention interventions, such as pre-exposure prophylaxis, are highly effective at reducing HIV acquisition through sex, and antiretroviral therapy for those who have HIV can render the virus undetectable and untransmissible. Yet in 2019 alone, 690 000 people died from HIV/AIDS. Why are we so far off track in achieving the UN 2030 global target of ending AIDS?...”

The editorial concludes: “… An opportunity to accelerate greater equality and reduce discrimination comes on June 8–10, 2021, when the UN Secretary General António Guterres will convene the fifth High Level Meeting (HLM) on the Implementation of the Declaration of Commitment on HIV/AIDS, with equality as the central theme. The latest draft of the Declaration calls specifically for ending stigma and discrimination against key populations. However, The Lancet understands that some member states are pushing to remove even the mention of MSM, sex workers, and PWID from the Declaration text. These manoeuvres are counter-productive and morally wrong. As was the case 40 years ago, civil society—representing key and other affected

populations—has mobilised to fight back ahead of the HLM, calling for key populations to remain clearly specified in the UN Declaration. The Lancet stands with civil society's request.”

Check out also:

Lancet HIV (Comment) – The next decade

“40 years since the first published descriptions of disease caused by HIV, Talha Burki talks to some of the leading figures in the fight against HIV/AIDS about what must be achieved in the next decade.”

Lancet Comment - HIV services in sub-Saharan Africa: the greatest gap is men

Lancet World Report - 40 years of HIV/AIDS: an interview with Peter Piot

“June 5, 2021, marks 40 years since the first reports of what was later known to be AIDS. Udani Samarasekera spoke with Peter Piot about the past, present, and future of the HIV/AIDS response.”

Lancet Comment (by C Beyrer) - A pandemic anniversary: 40 years of HIV/AIDS.

Ahead of the HL meeting (8-10 June)

UNAIDS (report) - Forty years on and new UNAIDS report gives evidence that we can end AIDS https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2021/june/20 210603_global-commitments-local-action

“UNAIDS urges world leaders to adopt a bold political declaration on HIV at the United Nations General Assembly High-Level Meeting on AIDS, being held in New York and online next week, and to commit to achieving a new set of targets for 2025 to end AIDS by 2030.”

“Four decades after the first cases of AIDS were reported, new data from UNAIDS show that dozens of countries achieved or exceed the 2020 targets set by the United Nations General Assembly in 2016—evidence that the targets were not just aspirational but achievable. The report shows that countries with progressive laws and policies and strong and inclusive health systems have had the best outcomes against HIV. In those countries, people living with and affected by HIV are more likely to have access to effective HIV services, including HIV testing, pre-exposure prophylaxis (medicine to prevent HIV), harm reduction, multimonth supplies of HIV treatment and consistent, quality follow-up and care….” “…If reached, the targets will bring HIV services to 95% of the people who need them, reduce annual HIV infections to fewer than 370 000 and AIDS-related deaths to fewer than 250 000 by 2025. This will require an investment of US$ 29 billion a year by 2025. …”.

Coverage via HPW - Ending AIDS is Achievable With Progressive Laws and Policies, Says New UNAIDS Report

Devex – UN HIV meeting a chance to remind the world of an unsolved pandemic https://www.devex.com/news/un-hiv-meeting-a-chance-to-remind-the-world-of-an-unsolved- pandemic-100051

“…the response can be reinvigorated by reminding political leaders that “HIV is still here,” and that HIV prevention is “always better and cheaper than cure,” said Kamarulzaman (president of the International AIDS society). That speaks to the goal at next week’s U.N. High-Level Meeting on HIV and AIDS, taking place from June 8 to 10. Kamarulzaman said the world is off-target on HIV prevention and in preventing deaths caused by AIDS, and the situation has worsened since the COVID-19 pandemic. … “It's an important opportunity for member states to refocus and recommit attention to HIV,” she said. … … There are a few key lessons the current COVID-19 response can learn from 40 years of the HIV/AIDS response…. “

PS: Kamarulzaman also sees the issue of IP posing a barrier in accessing some of the newer HIV therapies.

• MSF statement concerning intellectual property and access to medicines in the 2021 UN High-Level Meeting on HIV/AIDS Declaration

MSF is concerned. “As negotiations continue on the declaration for the upcoming UN High-Level Meeting (HLM) on HIV/AIDS, Médecins Sans Frontières (MSF) urges all member states to recognise and retain the full rights and use of internationally agreed public health safeguards enshrined in the Agreement on Trade-related Intellectual Property Rights (TRIPs) for access to affordable generic antiretroviral (ARV) drugs and other medicines for HIV…..”

“According to informed sources following the text negotiations of the UN HLM Declaration, several important paragraphs in the zero draft have become controversial, with some powerful countries trying to water down or delete texts addressing intellectual property (IP) and access to HIV medicines….”

• MSF Opinion - UN HIV declaration must throw a lifeline to people with Advanced HIV Disease

UHC

WHO - Voice, agency, empowerment: Handbook on social participation for universal health coverage https://www.who.int/publications/i/item/9789240027794

Launched on Monday 31 May.

“The Handbook on Social Participation for UHC is … designed to provide practical guidance, anchored in conceptual clarifications, on strengthening meaningful government engagement with the population, communities, and civil society for national health policy-making. It draws on best practices and lessons learned to support government institutions in setting up, fine-tuning, improving, and institutionalizing new or existing participatory health governance mechanisms. The handbook follows through the different tasks which policy-makers must reflect on and undertake when bringing in people’s voice into health policy-making. Examples include creating an enabling environment for participation, ensuring good representation, strengthening capacities, increasing policy-uptake of participatory process results, and sustaining participatory engagement over time. A fundamental premise of the handbook rests on the idea that policy-makers can leverage format and design elements of a participatory process to address power dynamics amongst participants, thereby fostering more meaningful contributions to the process.”

PHM - Letter to WHO on Commercialisation of Healthcare Systems https://phmovement.org/letter-to-who-on-commercialisation-of-healthcare-systems/

“Eight organisations, including PHM, sent an open letter to Ms Zsuzsanna Jakab, Deputy Director- General of the World Health Organisation raising concerns about a recent WHO report that could encourage privatisation of health care amidst a raging Covid-19 pandemic. The contents of the Report are being operationalised without prior discussion and approval by the World Health Assembly (WHA), despite the importance and sensitivity of the issue. The statement also notes a lack of consultative process with a diverse group of civil society organisations in development of this report.”

UHC 2030- How to strengthen health systems for UHC and equitable access to Covid19 tools https://www.uhc2030.org/blog-news-events/uhc2030-news/how-to-strengthen-health-systems-for- uhc-and-equitable-access-to-covid19-tools-555489/

Eight lessons from the UHC2030 Related Initiatives.

And a link & recording:

• WHO Bulletin Editorial - Including oral diseases and conditions in universal health coverage

• Rebuild for Resilience consortium webinar - Getting on the same page: the concept and assessment of ‘health systems strengthening’ (recording with Kabir Sheikh, S Witter, …)

For quick overview of the webinar, see this blog - The concept and assessment of health systems strengthening (by L Keeru)

Check out especially the HSS Evaluation Collaborative : “…an inter-agency collaboration commissioned by the Bill and Melinda Gates Foundation (BMGF). The project aims to bring together a wide-ranging group of stakeholders, including national governments and country stakeholders, HSS investment institutions and technical evaluators, to move the agenda for HSS evaluation beyond its current fragmented form.”

And Rebuild: Evidence review of what works for health systems strengthening, where and when?

Report commissioned by the UK government’s Foreign, Commonwealth and Development Office from the ReBUILD for Resilience and ReSYST research consortia.

World No Tobacco Day (31 May) https://www.who.int/campaigns/world-no-tobacco-day

“This yearly celebration informs the public on the dangers of using tobacco, the business practices of tobacco companies, what WHO is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations.” This year’s theme was “Commit to quit”.

See WHO - WHO supports people quitting tobacco to reduce their risk of severe COVID-19 Cfr: “…Smokers face a 40 – 50% higher risk of developing severe disease and death from COVID-19.”

More coverage via UN News - The COVID-19 pandemic motivates millions of tobacco users to quit, but they need support.

““Quitters are the real winners in the case of tobacco”, says the World Health Organization as part of a campaign to help smokers that have decided to quit during the COVID-19 pandemic, but lack the support to do so. A new chatbot and even an AI assistant are ready to aid them in their quitting journey.”

Link: WHO - More than 100 reasons to quit tobacco.

Blog P Marquez - An ominous fact on World No Tobacco Day – 2021: Smoking kills more people than COVID-19 https://blogs.worldbank.org/health/ominous-fact-world-no-tobacco-day-2021-smoking-kills-more- people-covid-19

More than worth a read.

Decolonize Global Health

Guardian - ‘Sponsor a child’ schemes attacked for perpetuating racist attitudes https://www.theguardian.com/global-development/2021/may/31/sponsor-a-child-schemes- attacked-for-perpetuating-racist-attitudes

“International child sponsorship schemes have come under attack for perpetuating racist thinking, as an apology by a charity to thousands of children in Sri Lanka has sparked a debate over the money-raising schemes….”

Link:

Textual Practice - On Decolonisation and the University by (P Gopal)

Planetary Health

Guardian - Investing 0.1% of global GDP could avoid breakdown of ecosystems, says UN report https://www.theguardian.com/environment/2021/may/27/nature-financial-value-investing-global- gdp-avoid-breakdown-ecosystems-un-report-aoe

“The world needs to quadruple its annual investment in nature if the climate, biodiversity and land degradation crises are to be tackled by the middle of the century, according to a new UN report.”

“Investing just 0.1% of global GDP every year in restorative agriculture, forests, pollution management and protected areas to close a $4.1tn (£2.9tn) financial gap by 2050 could avoid the breakdown of natural ecosystem “services” such as clean water, food and flood protection, the report said. The State of Finance for Nature report, produced by the UN Environment Programme (Unep), the World Economic Forum (WEF) and the Economics of Land Degradation Initiative (ELD), said a total investment of $8.1tn was required to maintain the biodiversity and natural habitats vital to human civilisation, reaching $536bn a year by 2050, projected to be about 0.13% of global GDP….”

Guardian – World must rewild on massive scale to heal nature and climate, says UN https://www.theguardian.com/environment/2021/jun/03/rewild-on-massive-scale-to-heal-nature- and-climate-says-un-decade-on-ecosystem-restoration-aoe

“The world must rewild and restore an area the size of China to meet commitments on nature and the climate, says the UN, and the revival of ecosystems must be met with all the ambition of the space race. Existing conservation efforts are insufficient to prevent widespread biodiversity loss and ecosystem collapse, the global body has warned at the launch of the decade on ecosystem restoration, an urgent call for the large-scale revival of nature in farmlands, forests and other

ecosystems. Governments must deliver on a commitment to restore at least 1bn hectares (2.47bn acres) of land by 2030 and make a similar pledge for the oceans, according to the report by the UN Environment Programme (Unep) and the Food and Agriculture Organisation (FAO) to launch the decade….”

SRHR

SRHM - Menstrual health: a definition for policy, practice, and research

J Hennegan et al; https://www.tandfonline.com/doi/full/10.1080/26410397.2021.1911618

“The term “menstrual health” has seen increased use across advocacy, programming, policy, and research, but has lacked a consistent, self-contained definition. As a rapidly growing field of research and practice a comprehensive definition is needed to (1) ensure menstrual health is prioritised as a unified objective in global health, development, national policy, and funding frameworks, (2) elucidate the breadth of menstrual health, even where different needs may be prioritised in different sectors, and (3) facilitate a shared vocabulary through which stakeholders can communicate across silos to share learning. To achieve these aims, we present a definition of menstrual health developed by the Terminology Action Group of the Global Menstrual Collective. We describe the definition development process, drawing on existing research and terminology, related definitions of health, and consultation with a broad set of stakeholders. Further, we provide elaboration, based on current evidence, to support interpretation of the definition.”

Other News of the week

BMJ Opinion - Political censorship in academic journals sets a dangerous new precedent R Muhareb et al; BMJ;

“… In March 2020, The Lancet published a letter we wrote alerting the medical community to the dangers of a covid-19 outbreak in the Gaza Strip. We warned that the pandemic had “the potential to devastate one of the world’s most vulnerable populations.” Since then, this fear has become reality and Palestinians in the Gaza Strip have now endured a fifth largescale Israeli military assault that has killed 256 Palestinians, including 66 children, injured nearly 2,000, and internally displaced some 107,000 people. As we highlighted in our letter, decades of structural violence targeting Palestinian people have brought Gaza’s healthcare system to the brink of collapse. A densely populated area, the majority of Palestinians in the Gaza Strip are refugees denied their right of return since 1948. Meanwhile, Israel’s illegal closure and blockade of Gaza since 2007, amounting to collective punishment, have meant that supplies for covid-19 testing, treatment, and vaccination have been severely limited. …. “

“Although structural racism has increasingly been recognised worldwide as exacerbating the impacts of covid-19, the publication of our letter was met with what Richard Horton, the editor-in- chief of The Lancet, informed us was a threatened boycott of the journal. [Previously, Horton

informed us, there had been a similar “sanctions” campaign against The Lancet for publishing a letter in 2014 deploring the morbidity and mortality resulting from Israeli state violence against Gaza’s besieged Palestinians. According to Horton, the ordeal that followed took a “traumatic” personal toll on The Lancet’s employees. …. … The Lancet, we were later told, could not sustain yet another campaign of this nature and, within three days, our letter had been removed from the journal’s website… “

People’s Health Dispatch https://peoples-health-dispatch.ghost.io/watch-this-space/#/portal/signup

New newsletter. “Tired of corporate media takes on vital issues related to health? From tomorrow (May 31), we bring you People’s Health Dispatch, a fortnightly newsletter with the latest on health workers’ struggles and the politics behind policy making…”

Cidrap News - COVID-19 raised global drug spending by $88 billion, report says https://www.cidrap.umn.edu/news-perspective/2021/06/covid-19-raised-global-drug-spending- 88-billion-report-says

“… In IQVIA's latest 5-year forecast through 2025, the life sciences analytical institute says COVID-19 increased spending on pharmaceuticals by $88 billion, or a compound annual growth rate (CAGR) change of 4.6%, compared with 4.5% if the pandemic hadn't happened. The 50-page report looks at how the pandemic affected medicine use, pharmaceutical markets, and various therapeutic areas, as well as the world's general growth rates and spending. While COVID-19 vaccine spending is projected to add $157 billion to the market through 2025 (range, $73 billion to $213 billion), the authors say the pandemic caused a $68 billion loss due to disruptions. Overall, excluding COVID-19 vaccines, market spending will look largely similar to pre-pandemic times and should result in a 3% to 6% CAGR, according to the report….”

Telegraph - 'Engineered pandemic' as big a threat as nuclear war, report warns Telegraph;

“One in six chance that a catastrophic event could occur in the next 100 years, expert calculates.”

"A New Deal for Africa" - Op-ed article by President Charles Michel, and more than 30 European and African leaders https://www.consilium.europa.eu/nl/press/press-releases/2021/05/31/a-new-deal-for-africa-op-ed- article-by-president-charles-michel-and-more-than-30-european-and-african-leaders/

Excerpt: “… Vaccination is the world’s most important economic policy at this moment: its benefits are measured in trillions, its cost in billions. It is the highest-yielding investment in the short term. We must therefore mobilize innovative financial instruments to increase funding for the ACT Accelerator, in order to reach Africa’s vaccination coverage target, set at 60-70% by the Africa Centres for Disease Control and Prevention. We call on the IMF to recognize the use of special drawing rights (SDRs, the Fund’s unit of account) to finance this effort. Moreover, as the Rome Declaration of the Global Health Summit held on May 21 affirms, the key to combating future

pandemics is transferring not only licenses but also expertise to developing country vaccine producers. Pending the conclusion of an agreement on intellectual property currently under negotiation at the World Trade Organization, Africa must be able to produce vaccines using messenger RNA (mRNA) technology and break a deal, within the WTO, on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) regime. With the impetus of the Paris summit for African, European, and financial leaders, held on May 18, such production partnerships will be financed and move ahead in the coming months. The second component of a New Deal for Africa is large-scale investment in health, education, and the fight against climate change…..”

Some more papers & reports of the week

WHO Bulletin – June issue https://www.who.int/bulletin/volumes/99/6/en/

Do start with the great editorial by Adnan Hyder et al - Inequitable COVID-19 vaccine distribution and its effects

“…We propose that the approach to COVID-19 vaccination needs to address key ethical and social justice concerns….” “… We believe that four issues are key to understanding current challenges to COVID-19 vaccination. …”

“… We use the issues described above to propose the use of the term vaccine poverty to approach vaccination programmes. First, this term highlights the poverty of vaccination – those needing vaccines do not get them, or do not get them at the right time, representing a health system failure of delivery. Second, the term refers to the poverty caused by lack of vaccines; as long as some population groups remain unprotected, they are liable to contract the disease and succumb to its consequences. Third, the term refers to poverty of allocation, when needed resources have not been optimally allocated to the production and distribution of the COVID-19 vaccine. …”

IJHPM - Special Issue on "Analysing the Politics of Health Policy Change in Low- and Middle-Income Countries: The HPA Fellowship Programme 2017-2019 https://www.ijhpm.com/issue_694_701.html

Do start with the Editorial (by Lucy Gilson, Z C Shroff et al) : Introduction to the Special Issue on “Analysing the Politics of Health Policy Change in Low- and Middle-Income Countries: The HPA Fellowship Programme 2017-2019”

“This special issue presents a set of seven Health Policy Analysis (HPA) papers that offer new perspectives on health policy decision-making and implementation. They present primary empirical work from four countries in Asia and Africa, as well as reviews of literature about a wider range of low- and middle-income country (LMIC) experience….”

See also the Alliance (News) - Analysing the politics of policy change

“The special issue is the result of the Health Policy Analysis Fellowship Programme, supported by the Alliance and coordinated by the University of Cape Town in South Africa. …”

Lancet (Perspective) - Revitalising global social medicine M Pentecost et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01003- 5/fulltext

“…What is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. These essays arise from collaborations between social medicine programmes and practitioners in Asia, Africa, Europe, and the Americas who are working to increase global exchange in scholarship and practice at the intersection of social science, medical practice, and public health. The social is all too often overlooked in health-care systems that emphasise technological solutions. The essays seek to amplify the knowledge, techniques, and practices of social medicine practitioners and call attention to the social contexts of interventions….”

Canadian Institutes of Health Research (CIHR) - Global Health 3.0: CIHR’s Framework for Action on Global Health Research 2021-2026 https://cihr-irsc.gc.ca/e/52503.html

“With this updated Framework for Action on Global Health Research, CIHR articulates and firmly positions itself in a new era – what we are calling “Global Health 3.0” – where health is understood to be an outcome of globally shared risks and responsibilities that require collective action to achieve good health for all….”

BMJ GH supplement - Social and ethical issues of poor quality and poor use of medical products https://gh.bmj.com/content/6/Suppl_3/

First batch of papers in this supplement is out.

Do start with Elusive quality: the challenges and ethical dilemmas faced by international non- governmental organisations in sourcing quality assured medical products (by K Enright)

BMJ GH – Defining global health: findings from a systematic review and thematic analysis of the literature M Salm et al ; https://gh.bmj.com/content/6/6/e005292

« …The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.”

« … Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future….”

PS: “Stakeholders tend to define the ‘what’ of global health: its spaces, objects and practices. Our findings suggest that the debate around definition should shift to more pragmatic and reflexive questions regarding ‘who’ defines global health and towards what ends.”

Brookings (report) – Extreme poverty in the time of COVID-19 By H Kharas et al; https://www.brookings.edu/research/extreme-poverty-in-the-time-of-covid-19/

And related Policy brief.

Blogs of the week

IHP - From COVID-19 shot to headshot to mugshot: Myanmar medics’ fate under the coup https://www.internationalhealthpolicies.org/featured-article/from-covid-19-shot-to-headshot-to- mugshot-myanmar-medics-fate-under-the-coup/

Poignant read by Conan Ko (pseudonym).

GIZ - ‘One day our children will ask us: What did you do in 2021?’ https://health.bmz.de/stories/one-day-our-children-will-ask-us-what-did-you-do-in-2021/

“At GIZ in Berlin Dr Eckart von Hirschhausen and Karin Kortmann discuss the three global crises and our generation’s responsibility.”

“… Their exchange, which was part of GIZ’s ‘Köpfe und Ideen’ (‘Heads and Ideas’) series, focused on three concurrent global crises: climate, biodiversity loss and the COVID-19 pandemic. It moved between scientific facts about the size and urgency of the problems; shared smiles about personal learning and hope; warnings and heartfelt pleas to politicians as well as deep concern: ‘One day our children and grandchildren will ask us: ‘What did you do in 2021?’ …”

IDS - Africa follows up the Biden proposals for international tax reforms https://www.ids.ac.uk/news/africa-follows-up-the-biden-proposals-for-international-tax-reforms/

“Sol Picciotto, a Senior Fellow from the International Centre for Tax and Development (ICTD) analyses the politics and potential of recent proposals to reform global corporate tax rules and proposes a way forward.”

Some tweets of the week

Thea Riofrancos “As US vaccinations rose I predicted when we reached herd immunity @nytimes would eliminate its daily print section on international Covid coverage. This section, however imperfectly, covered global public health. The US is at 41% full vaccination & it's already gone. Says a lot.”

Global governance of health

Devex – UK government faces surprise vote on aid cuts https://www.devex.com/news/uk-government-faces-surprise-vote-on-aid-cuts-100064

“Rebel Conservative members of Parliament in the United Kingdom have raised the stakes for the government, bringing an amendment to Parliament designed to force a vote on the stark cuts to the aid budget.”

Devex – PEPFAR's top 10 faith-based health partners https://www.devex.com/news/pepfar-s-top-10-faith-based-health-partners-99501

“For the current U.S. government fiscal year — running from October 2020 to September 2021 — PEPFAR’s total allocations sit at $4.2 billion, according to amfAR, The Foundation for AIDS Research’s database of PEPFAR country and regional operational plans. These plans set out the budgets for implementing partners, the targets, and the expected impacts of PEPFAR’s funding. … While most funding will be allocated for delivery through NGOs, private contractors, and universities, nearly $129 million — or about 3% — will be allocated through FBOs. … … All of the FBOs set to receive PEPFAR funding throughout the 2021 U.S. fiscal year are based in Cameroon, Kenya, Malawi, Uganda, Zambia, or Zimbabwe. …”. Check them out.

Economy & Society - Charismatic violence and the sanctification of the super-rich L McGoey et al ; https://www.tandfonline.com/doi/abs/10.1080/03085147.2018.1448543

Oldie but goldie (2018).

« Drawing historical comparisons between the nineteenth century and the present, this paper describes and analyses how an elite section of the global rich, through mega-giving and a re- emerging notion of ‘noblesse oblige’ that is enshrined in the philanthrocapitalism movement, have fostered a sacred rationale for their extreme wealth. Not only do the new nobles hold the power of wealth but, through mega-giving, they generate a moral imagery akin to religious figures who ostensibly self-sacrifice for the good of everyone else. This generates a form of charismatic authority that affords the super-rich an influential space from which to spread a ‘theodicy of privilege’ – shielding growing wealth concentration from criticism and sanctifying the claim that individual mega-wealth is collectively beneficial. Through its contribution to and facilitation of the inegalitarian status quo, this theodicy engenders various forms of structural violence. Here we explore the mechanisms that enable wealthy donors to position themselves as apparent benefactors of humanity, including a reliance on metrics that appear to justify the claim that targeted philanthropic expenditures can and are reducing global wealth and health inequalities, but which raise unanswered questions surrounding the actual effects of the outcomes claimed.”

Planetary health

Guardian - Climate crisis: rich countries falling short on vow to help poorer ones https://www.theguardian.com/environment/2021/jun/03/climate-crisis-rich-countries-falling-short- on-vow-to-help-poorer-ones

“The UK and the US are the only two G7 countries to have set out proposals to increase climate finance in recent months, according to a report by Care Denmark, a member of the international NGO network. Climate finance is used by poor countries to reduce their greenhouse gas emissions, for instance through investment in clean energy generation, and to adapt to the impacts of extreme weather such as floods and droughts. Care found, in a report called Hollow Commitments: An analysis of developed countries’ climate finance plans, that most G7 countries have still made no new commitments on climate finance, despite a pledge by the developed world made in 2009 to provide $100bn (£70bn) a year to developing countries by 2020, which has not been met….”

Vox - Where could the next coronavirus jump to humans? New research offers clues. https://www.vox.com/22456392/coronavirus-pandemic-bats-forests-spillover-china-indonesia

“Scientists mapped regions where new coronaviruses may be most likely to spread from wildlife to people. … A new analysis, published Monday in the journal Nature Food, begins to answer that important question — specifically, by pinpointing where another coronavirus could jump to humans from horseshoe bats, which are known to carry SARS-related coronaviruses. By combining data on horseshoe bat habitats, land-use change, human population density, and other factors known to increase the risk of spillover, the researchers produced a map of “hot spots” in Asia and Europe where the risk is highest. … Alarmingly, the study finds that in many regions, especially southern China, these spillover risks are high…”

Lancet (Perspective) - Climate disasters and global social medicine V Adams et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01000- X/fulltext

« Disaster medicine has focused attention on the acute response to provide immediate relief to victims. An environment-focused global social medicine approach to climate change disasters calls for something more. …”

« … First, an environment-focused global social medicine approach recognises that the growing risks are unevenly distributed. … Second, we need to direct attention to caregiving. … Third, we need to expand the conceptual timeframe of disaster response. … Fourth, this reorientation towards caregiving over time and beyond the clinic reveals the need for physicians to connect with local organisations, led by people who represent their community, to learn how to help mitigate the health effects of climate crises. This expansion of clinical care beyond prevention to advocacy is something that practitioners of social medicine have historically always aspired to do. Yet this advocacy needs to target the structural racism and other inequities that put some people at increased risk….”

Guardian - Human-induced global heating ‘causes over a third of heat deaths’ https://www.theguardian.com/environment/2021/may/31/human-induced-global-heating-causes- over-third-heat-deaths

“Between 1991 and 2018, human activity contributed to 37% of all heat-related deaths in locations studied. …. More than a third of all heat-related deaths around the world between 1991 and 2018 can be attributed to human-induced global heating, research has found. Climate breakdown has a range of effects ranging from wildfires to extreme weather. As the temperatures rise, more intense and frequent heatwaves disproportionately affect elderly people and those with underlying chronic conditions such as asthma, making them more vulnerable to disease and premature death. A study, published in the journal Nature Climate Change, used data from 732 locations in 43 countries to calculate the number of deaths attributed to heat levels higher than the ideal temperature for human health, which varies across locations….”

Guardian - Climate crisis is suffocating the world’s lakes, study finds https://www.theguardian.com/environment/2021/jun/02/climate-crisis-is-suffocating-the-worlds- lakes-study-finds

“The climate crisis is causing a widespread fall in oxygen levels in lakes across the world, suffocating wildlife and threatening drinking water supplies. Falling levels of oxygen in oceans had already been identified, but new research shows that the decline in lakes has been between three and nine times faster in the past 40 years. Scientists found oxygen levels had fallen by 19% in deep waters and 5% at the surface….”

Guardian – Climate tipping points could topple like dominoes, warn scientists https://www.theguardian.com/environment/2021/jun/03/climate-tipping-points-could-topple-like- dominoes-warn-scientists

“Analysis shows significant risk of cascading events even at 2C of heating, with severe long-term effects.”

Infectious diseases & NTDs

Plos Med - Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003646

The authors conducted a systematic review and meta-analysis to determine the effect of offering ART initiation in the community on HIV treatment outcomes.

Conclusions: “Based on data from a limited set of studies, community ART initiation appears to result in higher ART uptake, retention, and viral suppression at 1 year compared to facility-based ART initiation. Implementation on a wider scale necessitates broader exploration of costs, logistics, and acceptability by providers and PLWH to ensure that these effects are reproducible when delivered at scale, in different contexts, and over time.”

HPW - Despite COVID-19, Pakistan and Afghanistan Make Good Progress in Eradicating Polio https://healthpolicy-watch.news/despite-covid-19-pakistan-and-afghanistan-make-good-progress- in-eradicating-polio/

“Despite the 18-month COVID-19 pandemic, Pakistan and Afghanistan have observed a sharp decline in polio cases which the health authorities attribute to their effective back-to-back anti-polio drives. Officials leading the polio eradication programme believe that the decline occurred due to uninterrupted polio vaccination campaigns, improved security and the polio field teams’ accessibility to the population in high-risk areas. However, despite a remarkable decline in poliovirus cases, officials believe that ‘vaccine refusal and hesitancy’ by parents remains a bigger challenge than COVID in completely eradicating the virus….”

HPW - African Experts Welcome WHO Guidance on Ethics, Standards, and Governance of Genetically Modified Mosquito Research https://healthpolicy-watch.news/african-experts-who-mosquito-research/

“Researchers engaged in mosquito gene drive technologies are optimistic that new World Health Organization (WHO) guidance on best research practices will ensure that their work is safe and ethical. Such guidance also helps research results advance from laboratories to be used in the field, the researchers told Health Policy Watch….”

Plos Med - Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study A Devine et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003614

“…we quantified the global economic cost of vivax malaria and estimated the potential cost benefit of a policy of radical cure after testing patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency….”

NYT – A man in China is found to have H10N3 bird flu, a reminder of a continued ‘concern for pandemic flu.’ https://www.nytimes.com/2021/06/02/world/asia/h10n3-bird-flu.html

No human-to-human transmission so far.

NCDs

FT - Nestlé document says majority of its food portfolio is unhealthy https://www.ft.com/content/4c98d410-38b1-4be8-95b2-d029e054f492

“Internal company presentation acknowledges more than 60% of products do not meet ‘recognised definition of health’.”

“… The world’s largest food company, Nestlé, has acknowledged in an internal document that more than 60 per cent of its mainstream food and drinks products do not meet a “recognised definition of health” and that “some of our categories and products will never be ‘healthy’ no matter how much we renovate”. A presentation circulated among top executives early this year, seen by the Financial Times, says only 37 per cent of Nestlé’s food and beverages by revenues, excluding products such as pet food and specialised medical nutrition, achieve a rating above 3.5 under Australia’s health star rating system. This system scores foods out of five stars and is used in research by international groups such as the Access to Nutrition Foundation. Nestlé, the maker of KitKats, Maggi noodles and Nescafe, describes the 3.5 star threshold as a “recognised definition of health”….”

See Reuters for the Nestle response - Nestle, under fire over unhealthy products, working on new strategy

“Nestle (NESN.S) said on Monday it was working on updating its nutrition and health strategy after the Financial Times reported an internal document at the food giant described a large portion of its food and drinks as unhealthy….”

BMJ Feature -Covid 19: How harm reduction advocates and the tobacco industry capitalised on the pandemic to promote nicotine https://www.bmj.com/content/373/bmj.n1303

“Scientific papers suggesting that smokers are less likely to fall ill with covid-19 are being discredited as links to the tobacco industry are revealed, report Stéphane Horel and Ties Keyzer”

Sexual & Reproductive / maternal, neonatal & child health

BMJ GH - Health systems factors impacting the integration of midwifery: an evidence-informed framework on strengthening midwifery associations

C Mattison et al ; https://gh.bmj.com/content/6/6/e004850

“Our objective was to generate a framework for evidence-informed midwifery association strengthening….”

Access to medicines

Health and Human Rights Journal - Should COVID-19 Vaccines Authorized for Emergency Use Be Considered “Essential” Medicines?

M J Smith et al; https://www.hhrjournal.org/2021/06/should-covid-19-vaccines-authorized-for- emergency-use-be-considered-essential-medicines/

“A critical debate in the race to develop, market, and distribute COVID-19 vaccines could define the future of this pandemic: How much evidence demonstrating a vaccine’s safety and efficacy should be required before it is considered “essential”? If a COVID-19 vaccine were to be designated an essential medicine by the World Health Organization, this would invoke special “core” human rights duties for governments to provide the vaccine as a matter of priority irrespective of resource constraints. States would also have duties to make the vaccine available in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at an affordable price. This question is especially critical and unique given that COVID-19 vaccines have in many cases been authorized for use via national emergency use authorization processes—mechanisms that enable the public to gain access to promising medical products before they have received full regulatory approval and licensure. In this paper, we examine whether unlicensed COVID-19 vaccines authorized for emergency use should ever be considered essential medicines, thereby placing prioritized obligations on countries regarding their accessibility and affordability.”

Extra Covid Section

KFF - Two-Thirds of the Public Say the U.S. Should Play a Major Role in Distributing COVID-19 Vaccines Globally, But Not Most Republicans KFF;

“…two-thirds of the public (66%) say that the U.S. should play at least a “major role” in distributing COVID-19 vaccines to other countries, including about a quarter (27%) who say it should play a “leading role.” Nearly 9 in 10 Democrats support the U.S. taking at least a "major role" (87%), while most Republicans (57%) say the U.S. should play a “minor role” or “no role at all,” a larger share than the 41% who want the U.S. to play a “leading” or “major role.”…”

Think Global Health – Just How Do Deaths Due to COVID-19 Stack Up? https://www.thinkglobalhealth.org/article/just-how-do-deaths-due-covid-19-stack

“Despite a likely undercount in many places, COVID-19 is the #1 killer in most of Latin America and Western Europe.”

Guardian –Vietnam discovers new hybrid Covid variant, state media reports https://www.theguardian.com/world/2021/may/29/vietnam-discovers-new-hybrid-covid-variant- state-media-reports

“Strain is a combination of UK and India variants and is said to spread quickly.”

University of Oxford to launch Pandemic Sciences Centre https://www.ox.ac.uk/news/2021-05-28-university-oxford-launch-pandemic-sciences-centre

“The University of Oxford has today announced the launch of a new centre of global research collaboration and excellence, the Pandemic Sciences Centre. “

“The Pandemic Sciences Centre, which will include a number of core institutes, will harness the strong global research collaborations that the University of Oxford has developed over more than forty years. Its mission will be to ensure that the world is better equipped to create global, and equitable science-driven solutions to prepare for, identify, and counter future pandemic threats. The new centre will also build on the strong and unique collaborations developed in record time across national borders between academia, industry and public health bodies during the coronavirus pandemic. …”

In similar news, a tweet from Rockefeller Foundation: “@RockefellerFdn is launching a Pandemic Prevention Institute to detect & share early warning signals to trigger rapid responses to stop a pandemic”

Reuters - Peru revises pandemic death toll, now worst in the world per capita Reuters;

“Peru on Monday almost tripled its official COVID-19 death toll to 180,764, following a government review, making it the country with the worst death rate per capita, according to Johns Hopkins University data….”

BMJ (Analysis) - What does it mean to engage the public in the response to covid- 19? https://www.bmj.com/content/373/bmj.n1207

“Naomi Scheinerman and Matthew McCoy explain how governments and other authorities should respond to calls for public engagement in covid-19 response and recovery.”

Nature News - Coronavirus variants get Greek names — but will scientists use them? https://www.nature.com/articles/d41586-021-01483-0

“From Alpha to Omega, the labelling system aims to avoid confusion and stigmatization.”

Global Policy - The World Trade Organization Is Threatening Vaccine Equity and Climate Goals - An Interview with Jayati Ghosh https://www.globalpolicyjournal.com/blog/01/06/2021/world-trade-organization-threatening- vaccine-equity-and-climate-goals-interview

“The huge COVID-19 vaccine supply gap between rich and poor countries exposes the deadly problem of intellectual property (IP) rights and the dangerous monopoly power of Big Pharma. It also exposes in glaring terms the failures of the entire system of global trading rules regulated by the World Trade Organization (WTO). In this interview, Jayati Ghosh, one of the world’s leading development economists, dissects the question of intellectual property rights relating to vaccines and argues that the WTO is a vehicle for international imperialism… .” PS: also with respect to the climate threat.