Covid-19” Holidays (Or So We Hope)

IHP news 579 : Going on “Covid-19” holidays (or so we hope)

( 3 July 2020)

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

Dear Colleagues,

Starting from this evening, IHP will take a few weeks of (hopefully also Covid-19 ) holidays. We trust you’ll get your Covid-19 related and other global health (policy) updates from our colleagues from Global Health Now, KFF, FT Health, Cidrap News, Stat News, Devex … in the coming weeks.

Earlier this week, Dr. Tedros described the world’s “new normal” like this: “The critical question that all countries will face in the coming months is how to live with this virus”, he said. “That is the new normal.” We can’t wait. In quite a few countries, meanwhile, Covid-19’s equivalent of Shakespeare’s “To be or not to be, (that’s the question)” turns out to be, “Is it a second wave, of rather the second peak of a first wave?”

Anyway. Last weekend I wrote a short blog on why I think “global health”, instead of seizing the corona moment, might be wasting it. I don’t want to get stuck here in endless discussions on ‘global health’, my blog clearly targeted some of the well-connected health experts in the North (who have the ear of at least some key decision makers and politicians) and what they could do (better) in this respect. Even if they’re, arguably, only one small part of the broader ‘global health’ community.

The background of this blog: it’s my deep conviction that far more people would support multilateralism and global solidarity (and more sustainably so), if they had faith in the fairness of their tax systems, so that the strongest shoulders contribute the most (including to Global Public Goods). As long as we don't get that right, things will only get uglier, I’m afraid. Including, very much, the global populist picture. Obviously, populism has a number of causes, but for sure, populists around the world also thrive on this (widely felt & mostly correct) deep sense of tax injustice - evidence of betrayed social contracts in many countries. While I’m all for #STAX and other vital taxes on Global Public Bads (already more than difficult enough to get implemented in their own right, unfortunately), I think ‘fair tax systems’ for the 21st century require more, especially asking ( a lot) more from the people with the deepest pockets, as well as MNCs (not the least including Big Pharma), and visibly so. In short, I think the time has never been more appropriate for global health to team up with the movement for global tax justice. The link with UHC has been a no brainer for a while, and the planetary emergency makes it even more urgent. And the current OECD- led process on global tax reform can use all extra advocacy, given how things are going.

From that point of view, it’s clear that “ Global Citizen’s” top priority should be: fair tax systems, all over the world. We can surely forget about a critical mass of “Global Citizens” if our social contracts of the 21st century fail to include fair tax systems. So let Bezos, Ma, Branson and other Ambanis show they’re ‘Global Citizens’ too by pushing governments, all over the world to raise fair taxes (and make sure they’re collected too). As dr. Tedros likes to say, “Solidarity”! 

And it’s not just Global Citizen, the “Global health” community should also make this case at every high-level occasion and venue, instead of settling for financing mechanisms that, in my opinion, at best date from the ‘Third Way’ MDG era (replenishments, fundraising events with stars, …). I’m also not convinced the WHO Foundation is major progress, by the way. (“We need less foundations in the SDG era, and more taxation ” – now here’s a nice slogan for Global Citizen! ). Or another one: “It’s time global health joins #BuildingBackBetter – as compared to #BuildingmoreoftheSame .”

We cannot just rely on civil society to make this case, no, it’s more than time to team up with them, and put massive pressure on global health (and other) power, not just in scientific papers or Comments, but through a collective campaign of Op-eds along these lines in globally read pieces, like the Guardian, NYT, FT, Project Syndicate, … And yes, some of the people I mention in my blog, have a special responsibility in this respect, I feel, as they have ‘access’ to these global media platforms. Also, in the current increasingly authoritarian world, Europeans and Americans have a special duty to do so – you can’t expect this from our Chinese or Russian colleagues, and India and Brazil are not far behind, sadly.

By linking global health explicitly with global tax justice, these global health opinion leaders could push many others in this direction, creating many new “global citizens” in the process.

Conversely, by failing to do so, we should probably also stop whining about “vaccine nationalism”, gross Big Pharma profiting and implosion of multilateralism. I’m exaggerating a bit, but you get the point.

This is a cataclysmic moment, it surely should also be one for global and planetary health. I have to say, my former colleague Gorik Ooms is sorely missed, these days. He famously quipped that perhaps first a “WW III” would be necessary to make a quantum leap forward on global health, global social protection and global justice in general. The Covid-19 pandemic is no world war, fortunately, but we urgently need people like him, daring to dream big these days. If not, we will indeed have wasted this moment.

Enjoy your reading.

Kristof Decoster

Featured Article

WGH India Dialogue Series: Amplifying the engagement of Female Frontline Health Workers in India’s COVID-19 Response.

WGH India (Preethi John, Deepika Saluja, Sapna Kedia and Sumegha Asthana wrote this on behalf of WGH India)

India’s response to COVID-19 relies heavily on the female Frontline Health Workers (FLWs), also known as Community Health Workers (CHWs). FLWs include Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and Anganwadi Workers (AWWs). From the beginning of the pandemic, they have been involved in surveillance, home visits, awareness generation about COVID-19 transmission and prevention, and facilitating access to COVID testing and treatment services along with their usual responsibilities as an FLW.

While there is wide recognition of the role of scientists and doctors in the COVID-19 response, contributions of ASHAs and AWWs continue to be unrecognized.

National and State Governments have issued guidelines to engage FLWs in the pandemic response, among others on the provisioning of additional financial incentives, Personal Protection Equipment (PPE), health insurance and other added benefits. Despite these measures, these workers continue to experience stigma, violence, delayed and insufficient payments, and lack of proper and adequate PPE while performing their tasks. Moreover, in a number of cases, FLWs who tested COVID-positive did not receive adequate support and care. These challenges not only hamper their performance but also have wider implications in the form of a delayed and ineffective health systems response to control COVID-19.

Concerns of these workers have been raised in presentations by worker’s trade unions, through journalistic writing and independent research studies. However, a more systematic approach to connect the voices of workers with policymakers and the public is still lacking. To address this gap, Women in Global Health India (WGHI), the national arm of the global WGH movement organized a series of dialogues to make the COVID-19 related contributions and concerns of the ASHAs and AWWs better known.

The series was designed to gain perspectives from stakeholders located at different levels of health systems including community, state, and national levels. It comprised three virtual dialogues in the second week of June. Discussants included health workers, workers representatives, trade union representatives, civil society members, researchers, state and national level policymakers, and international development partners. Around 393 participants from India and abroad affiliated with civil society, academia, advocacy groups, and development partners, interested in the issues of FLWs, health systems, gender, women empowerment, registered for the dialogue series.

Each level of the health system was taken up in a separate dialogue and emergent issues from each level were then fed into the next level of the health system discussed in the series. The primary objective of the series was to create a common platform for various stakeholders to discuss issues

concerning the effective engagement of ASHAs and AWWs in the COVID-19 response and recommend broad policy responses for improving their engagement.

Based on the discussions, an effective policy response for addressing key challenges of these workers requires :

● Recognition of FLWs’ work by the government and their communities (through financial and non-financial incentives) ● Structured mechanisms for feeding FLWs’ experiences, needs, and gender, class, and caste realities in policymaking ● Development and dissemination of timely, clear and concise guidelines for FLWs ● Establishment of capacity building and supportive supervision initiatives developed in consultation with FLWs ● Developing support systems for ensuring the physical and mental well-being of FLWs ● Initiating broader health system reforms for FLWs including strengthening policies for fair recruitment, retention, financial protection, leave management, protection against sexual harassment, physical protection, and stigma prevention with clear accountability at all levels.

As WGH India concluded this series, it received interest for hosting more such dialogues from associations and networks working on the issues of women health workers. Consequently, WGH India will expand the series (in collaboration with other networks) and host similar dialogues on ANMs, female nurses, female doctors, women collectives, and women leaders in the health sector.

Through this forum, WGH India would like to advocate for the creation of more such platforms for open policy dialogues on emerging challenges of women health workers and developing a collective action plan.

Being a voluntary movement, turning the WGH India Dialogue Series into a success, wouldn’t have been possible without the hard work of its team, including, Deena Maryam, Deepshikha Chhetri, Karan Babbar, Kaveri Mayra, Kusuma Talluri, Mohit Varyani, Nitya Saxena, Poorva Patil, Shubha Nagesh, Sneha Krishnan, Sugandha Parmar, Stuti Chakraborty and Varuna Srinavasan; and our secretariat, Chitkara School of Health Sciences, Chitkara University, for its technical and administrative support in hosting the series.

To join WGHI, please share your expression of interest here, and write to [email protected] for any queries. Follow us on Twitter, LinkedIn, Facebook and Instagram for the reports and other upcoming announcements.

Highlights of the week

We start with a few events from late last week (and weekend).

ACT-Accelerator update (26 June)

HPW - Massive Mobilization Of US $31.3 Billion Required For COVID-19 Diagnostics, Drugs & Vaccines Accelerator https://healthpolicy-watch.news/massive-mobilization-of-us-31-3-billion-required-for-covid-19- diagnostics-drugs-vaccines-accelerator/

From late last week. “The World Health Organization aims to raise a whopping US $31.3 billion to fund the ambitious goals of the Access to COVID-19 Tools (ACT) Accelerator; a multi-stakeholder initiative that aims to develop and deploy diagnostics, drugs, and vaccines to control the virus. But so far, only $US 3.4 billion has been pledged towards the initial goals. And US $13.7 billion is ‘urgently needed’ in order to cover immediate needs, according to an investment case released by WHO on Friday. …. The funding will go toward: Scaling up development and delivery of 500 million diagnostic tests to low- and middle-income countries (LMICS) by mid-2021; Delivering 245 million courses of treatments to LMICs by mid-2021; Delivering 2 billion vaccine doses, of which 50% will go to LMICs by the end of 2021….”

The Four Investment Pillars Require Urgent Funding. As a reminder, the ACT Accelerator operates under four main pillars – diagnostics, therapeutics, vaccines, and the health systems connector.

• For more coverage, see also UN News - Global partners require $31 billion to speed up COVID-19 medicines for all

• And Cidrap News - Huge global effort to fast-track COVID-19 tools advances

“ A massive effort led by the World Health Organization (WHO) to fast-track the development of COVID-19 vaccine, treatments, and diagnostics—and make them available to countries that need them most—released its production targets today and the price tag needed to produce and deliver the items, which totals $31.3 billion….” As well as timelines.

(as a reminder), “The WHO, backed by several world leaders and global health groups, first launched the COVID-19 countermeasure scale-up effort on April 24 in response to a call from G20 leaders in March. Known as the Access to COVID-19 Tools (ACT) Accelerator, the effort was backed by several countries and regional organizations, as well as groups including the Bill and Melinda Gates Foundation. However, several big countries did not participate, including the United States, China, India, and Russia. … … … At a technical meeting today, the ACT-Accelerator published its investment case, which is to speed development, equitable allocation, and scaled up delivery to low- and middle-income countries (LMICs) of 500 million diagnostic tests by the middle of 2021, 245 million treatment courses by the middle of 2021, and 2 billion vaccine doses—half to LMICs—by the end of 2021….”

“…ACT-Accelerator activities are led by partner organizations and are grouped under four pillars. For example, the diagnostics pillar is led by the Foundation for Innovative and New Diagnostics (FIND) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the therapy one is led by Unitaid and Wellcome Trust, and the vaccine one by Coalition for Epidemic Preparedness Innovations (CEPI) and GAVI, the Vaccine Alliance….”

• And more specifically on the vaccines pillar, via Stat - WHO, partners unveil ambitious plan to deliver 2 billion doses of Covid-19 vaccine to high-risk populations

“…the World Health Organization and key partners unveiled a plan Friday to purchase 2 billion doses of Covid-19 vaccines for the highest risk populations of the world. The plan anticipates that by the end of 2021, the doses could be delivered to countries to vaccinate high risk individuals, likely including health care workers, people over the age of 65, and other adults who suffer from conditions like diabetes. The WHO and its partners — the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance — estimate it will cost $18.1 billion to deliver on the plan. The effort is one pillar of the WHO’s effort to ensure all countries have access to Covid-19 vaccines, therapeutics, and diagnostics, called the ACT Accelerator, short for Access to Covid-19 Tools….”

Key links:

WHO - The Access to COVID-19 Tools (ACT) Accelerator WHO - ACT-Accelerator Investment Case (26 June)

WHO - Act-Accelerator update https://www.who.int/news-room/detail/26-06-2020-act-accelerator-update

WHO’s press release on the published investment cases.

Couldn’t find an investment case for the (fourth) “health systems” pillar, though…

Covid-19 Pledging summit (27 June)

Reuters - Global COVID-19 fundraising meeting raises $6.9 billion, leaders want vaccine for all https://uk.reuters.com/article/uk-health-coronavirus-eu-vaccine/global-covid-19-fundraising- meeting-raises-6-9-bln-leaders-want-vaccine-for-all-idUKKBN23Y0RZ

“A global fundraising meeting on Saturday raised 6.15 billion euros ($6.9 billion) from the United States, the European Commission and numerous countries to fight COVID-19, with many participants stressing that an eventual vaccine should be available to anyone who needs it. The Commission together with the European Investment Bank pledged 4.9 billion euros ($5.50 billion), the United States $545 million, Germany 383 million euros, Canada C$300 million ($219 million)and Qatar $10 million. Forty governments took part in the summit….”

For a full breakdown of the pledges, see the EC - Coronavirus Global Response: Breakdown of the pledges made today in the ‘Global Goal' Summit

Good to know perhaps: “…over $1.5B in Cash Grants and $5.4B in Loans and Guarantees for a Total of $6.9B Pledged for COVID-19 Relief. …” Ahum.

See also Global Citizen - 'Global Goal: Unite for Our Future' mobilized over $6.9 billion to help the world’s most vulnerable.

Et pour la petite histoire, « The Rock » (Dwayne Johnson) was hosting the event. See a Devex analysis ahead of the pledging event - Rockers and The Rock unite to boost COVID-19 funding momentum.

Kristof Decoster (blog) - “Global health” is wasting the corona moment http://kdecoster.blogspot.com/2020/06/global-health-is-wasting-corona-moment.html

My assessment of the current corona moment and how global health, so far, fails to seize it. See also the intro of this week. Our “global health financing toolbox” still seems, by and large, stuck in the neoliberal/Third Way MDG era. Anybody who believes that will suffice to deal with the challenges of the 21st century (not the least the climate emergency & widespread populism) can raise his/her hands. PS: that would include the fans of ‘Team Europe’.

Covid key news – 6 months, more than 10 million cases, half a million deaths, still accelerating… and “the worst is yet to come” (Tedros)

With among others, a focus on pandemic trends and key messages from WHO this week, but also some of the other key UN & other updates.

Cidrap News - Global COVID-19 cases pass 10 million, deaths top half million https://www.cidrap.umn.edu/news-perspective/2020/06/global-covid-19-cases-pass-10-million- deaths-top-half-million

From earlier this week (29 June): “Global COVID-19 numbers crossed two grim thresholds yesterday, with cases passing 10 million and deaths topping 500,000, with cases still rising in a number of hot spots and countries that have controlled their outbreaks battling pockets of resurgence…. ”

For recent data visualizations, see also the FT tracker :

Among others, "Latin America now accounts for 52% of average global deaths from #Covid19"

And a more recent global update from Cidrap News (July 1) - Huge daily jump pushes global COVID- 19 total past 10.5 million

“With the world total now topping 10.5 million COVID-19 cases, pandemic activity continues to accelerate, with more than 160,000 cases a day reported each day this past week, the head of the

World Health Organization (WHO) said today. Global cases have risen to 10,538,577, and 512,689 people have died from their infections, according to the Johns Hopkins online dashboard. As a media briefing today, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said 60% of the world's COVID-19 cases have been reported in the past month. …”

Telegraph – 'Long, hard road' ahead on Covid-19 for many countries, WHO warns https://www.telegraph.co.uk/global-health/climate-and-people/long-hard-road-ahead-covid-19- many-countries-warns/

“"Some countries have not used all the tools at their disposal and have taken a fragmented approach," Tedros said. "These countries face a long, hard road ahead." … …

Presenting figures demonstrating once again that the virus is only accelerating as it spreads to new parts of the globe, around six months after it first erupted in China, Dr Tedros …”

PS: and via the Guardian - The World Health Organization has warned that the Middle East is at a “critical threshold” in the pandemic after the region reached 1 million cases. See also Cidrap News on the situation in the Middle East.

And M Ryan on what it means ‘to learn to live with Covid 19’: “Every person needs to look at their #COVID19 risk.””

Economist Briefing – Covid-19 is here to stay. The world is working out how to live with it https://www.economist.com/international/2020/07/04/covid-19-is-here-to-stay-the-world-is- working-out-how-to-live-with-it

“People will have to change their behaviour to prevent second waves of the virus.”

Reuters - WHO sending team to China to investigate origins of coronavirus https://uk.reuters.com/article/uk-health-coronavirus-who-origins/who-sending-team-to-china-to- investigate-origins-of-coronavirus-idUKKBN2402DC

“The World Health Organization is sending a team to China next week to investigate the origins of the novel coronavirus, its head Tedros Adhanom Ghebreyesus told a briefing on Monday.”

But as Yanzhong Huang said on Twitter, don’t expect too much, it’s probably just ‘health diplomacy’.

More detail on (the background of) this story via HPW - World Health Organization Will Send Mission To China To Investigate COVID-19 Origins

Telegraph - No excuse for poor contact tracing, says WHO, as pandemic reaches grim six-month milestone https://www.telegraph.co.uk/global-health/science-and-disease/no-excuse-poor-contact-tracing- says-pandemic-reaches-grim-six/

“Pandemic is "not even close" to being over, warns WHO chief.” (see also Reuters )

“Describing contact tracing as difficult is a "lame excuse", World Health Organization chief Dr Tedros Adhanom Ghebreyesus said, as he warned many countries were not doing enough to get a handle on the virus six months on. The WHO director general pointed to the rigorous contact tracing that was carried out in the North Kivu region of Democratic Republic of Congo during its Ebola outbreak, which was declared over last week. At one point this active conflict zone saw more than 25,000 contacts reached each day. Dr Tedros told a press briefing: “Trust me, there is no excuse for contract tracing. If you can do contact tracing in that situation, doing contact tracing in stable countries should not come as such an issue.”…”

“However, so far only a handful of countries have managed to pull off contact tracing successfully, said Dr Michael Ryan, Executive Director of the WHO Health Emergencies Programme….”

WHO - WHO Director-General's opening remarks at the media briefing on COVID- 19 - 29 June 2020 https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media- briefing-on-covid-19---29-june-2020

He listed the five priorities that every country must focus on to save lives.

And also:

On the updated timeline: “Today, we are publishing an updated and detailed timeline of WHO’s response to the pandemic on our website, so the public can have a look at what happened in the past six months in relation to the response….”

And a sobering remark: “…We all want this to be over. We all want to get on with our lives. But the hard reality is: this is not even close to being over. Although many countries have made some progress, globally the pandemic is actually speeding up. We’re all in this together, and we’re all in this for the long haul….”

WP - The coronavirus is jeopardizing a ‘very, very finite’ workforce: Africa’s doctors and nurses https://www.washingtonpost.com/world/africa/africa-coronavirus-doctors-nurses-health-care- workers/2020/06/25/ebf19256-b4ac-11ea-9b0f-c797548c1154_story.html

“The coronavirus pandemic has tightened its grip on much of Africa, where reported cases have more than tripled over the last month, jeopardizing overstretched medical teams as the need for care soars. … Now African health officials and medical professionals are raising concerns about cracks in a crucial armor: Infections among health-care workers have shot up 203 percent since late May, according to the World Health Organization’s Africa arm, following a spike in community transmission and a drop in access to protective gear. … … The trends have alarmed epidemiologists at the Africa Centers for Disease Control and Prevention, who warned in a June report that most countries face a “catastrophic shortage” of medical professionals. … … Africa carries a disproportionately small fraction of the world’s caseload, though testing remains limited in some areas. But with infections on the rise, health leaders say medical staffs are up against growing obstacles to fend off worst-case scenarios — particularly in West Africa. Funds are often tight….”

PS: Via the Guardian – WHO Afro (Mrs Moeti) - WHO official says no large hidden toll in Africa

“The World Health Organization has said it does not believe African countries are harbouring a significant number of unrecorded coronavirus infections, though it said there may be underestimates in some places….”

WP - Latin America’s coronavirus crisis is only getting worse https://www.washingtonpost.com/world/2020/06/26/latin-america-coronavirus-crisis/

Focus on overall picture in Latin America, with Brazil & Mexico, obviously but also other countries in the region (including the rapidly deteriorating situation in Chile).

And a link - Telegraph Latin America’s flu season has started. Could there be a ‘double whammy’ of Covid-19 and influenza?

“So far, Covid lockdowns have also limited the spread of flu. But there are concerns that, once lifted, influenza infections will spiral.”

Guardian - More young people infected with Covid-19 as cases surge globally https://www.theguardian.com/world/2020/jun/26/more-young-people-infected-with-covid-19-as- cases-surge-globally

“… The age profile of new infections in the coronavirus pandemic appears to be younger following resurgences in countries such as the United States, Israel and Portugal linked to greater social contact among under 40s following the loosening of restrictions. … … The trend has been most marked in the US and noted by scientists at the World Health Organization, who have also seen infections of younger people in the developing world contributing to the shifting demographics….

… While some of the change can be explained by better and more extensive testing picking up more mild cases, other experts suggest that while older age groups have remained more cautious about shielding that has not been reflected in the behaviour of younger people….”

Stat News- New journal will vet Covid-19 preprints, calling out misinformation and highlighting credible research https://www.statnews.com/2020/06/29/new-journal-vet-covid-19-preprints/

“…On Monday, the MIT Press is announcing the launch of an open access journal that will publish reviews of preprints related to Covid-19, in an effort to quickly and authoritatively call out misinformation as well as highlight important, credible research…..”

“…The closest similar effort went live in April at Johns Hopkins University, where epidemiologist Emily Gurley and pathologist Kate Grabowski launched the 2019 Novel Coronavirus Research Compendium. Its 50 volunteers, mostly from Hopkins, include experts in mathematical modeling, diagnostics, vaccines, and related fields. Using keyword searches, they select new studies, both preprints and those published in journals, that they think contain important information for clinicians and policymakers. Postdoctoral fellows and graduate students summarize the paper’s findings, and flag its strengths and limitations. Two Hopkins faculty members vet and edit the reviews, which recently passed 220….

UN News - Hard times forecast for global job recovery in 2020, warns UN labour agency chief https://news.un.org/en/story/2020/06/1067432

“The impact of the COVID-19 crisis on jobs has been much worse than expected initially, the head of the UN labour agency said on Tuesday, in an appeal to Governments, workers and employers, to agree on a sustainable economic recovery plan to reduce inequalities laid bare by the pandemic….”

UN News - Pause before sharing, to help stop viral spread of COVID-19 misinformation https://news.un.org/en/story/2020/06/1067422

“The UN is asking people to make the same judgement calls they’ve been applying to social distancing, to social media, and take extra care before sharing. That’s the latest message from the United Nations’ Verified initiative, which wants people around the world to pause before sharing emotionally charged content on social media….”

UNGA - Omnibus Resolution on the COVID-19 Pandemic https://www.un.org/pga/74/2020/06/23/omnibus-resolution-on-the-covid-19-pandemic/

The Office of the President of the #UN General Assembly has released the revised version of the Omnibus Resolution on the #COVID-19 Pandemic.

For some analysis, see also South Centre - The UN General Assembly Resolutions on COVID-19: Solemn Assurances for Access to Health Technologies without an Action Plan

UN News – Stalled Security Council resolution adopted, backing UN’s global humanitarian ceasefire call https://news.un.org/en/story/2020/07/1067552

“The Security Council on Wednesday echoed the Secretary-General’s call for a worldwide ceasefire, to combat the coronavirus pandemic that has already claimed more than half a million lives. The UN chief welcomed the long-awaited move, calling for countries to "redouble their efforts for peace". Unanimously adopting resolution 2532 (2020) on Wednesday, the 15-member peace and security body demanded “a general and immediate cessation of hostilities in all situations, on its agenda.”…”

Better late than never.

Devex - Look to WHO, experts say, as US Senate searches for pandemic response solutions https://www.devex.com/news/look-to-who-experts-say-as-us-senate-searches-for-pandemic- response-solutions-97603

“As the Trump administration continues to consider withdrawing from the World Health Organization, the Senate Committee on Foreign Relations heard from experts about how the U.S. should approach pandemic response. Their message: Stay and reform WHO….”

“President Donald Trump has said that the U.S. will terminate its relationship with WHO. The latest reports are that the administration intends to move forward with withdrawal and is believed to be drafting a letter to that effect. Proposals from the administration and Congress have proposed potential new entities to tackle global health security, but most of the experts at the hearing said the U.S. should avoid trying to create any parallel structures and rather look to reform WHO and improve its response capabilities. They also recommended that the U.S. take a measured approach to internally reorganizing efforts to ensure that implementing agencies retain control and appropriate significantly more funding….”

Do read also how the experts perceive WHO’s Health Emergency Program, and the need for a lot more funding for WHO.

WP - Everyone will be affected by the U.S.'s withdrawal from the WHO Dr. Tedros; https://www.washingtonpost.com/opinions/2020/07/01/everyone-will-be-affected-by- us-withdrawal-who/

In an op-ed, Dr. Tedros hopes “the United States will keep working with the WHO so we can jointly continue the important progress we have made. There is so much more we can do together.”

Cfr a tweet B Meier: “With millions of lives depending on @WHO, it is inspiring to see @DrTedros fighting to engage the US in #InternationalCooperation for #Health — in the #COVID19 response & across #GlobalHealth efforts.”

WHO’s 2nd research & innovation Forum (Wednesday) UN News - https://news.un.org/en/story/2020/07/1067562

“WHO convened its second research and innovation forum on Wednesday, bringing together more than 1,000 scientists from all over the world to take stock of the progress made so far, discuss new research questions and knowledge gaps, and to define research priorities, going forward. Research and innovation have played a vital role since the beginning of the pandemic – and even before, said the WHO chief: “We have a shared responsibility to ensure that all people have access to the tools to protect themselves, especially those who are most at risk.”…”

• See also WHO - Global scientific community unites to track progress on COVID-19 R&D, identifies new research priorities and critical gaps (with good short overview of the summit)

• See also Cidrap News - Scientists weigh COVID-19 research progress, identify remaining gaps

“Among the takeaways from a large COVID-19 research and innovation meeting led by the World Health Organization (WHO) this week, the vaccine pipeline is healthy and scientists are eager to learn more about the impact of social distancing and other nonpharmaceutical interventions….”

• For some more analysis, and key messages of the (media) Briefing after the Forum, see Priti Patnaik - WHO-led Research & Innovation Forum on COVID-19: July 2

Quote: “…the conference also found that bulk of the research was taking place in high income countries, Swaminathan said. There was recognition that research must be geared towards low and middle income countries, while also involving researchers and institutions from these countries….”

Other updates/analysis on Covid access to vaccines, medicines, oxygen…

Devex - COVID-19: Countries race to strengthen compulsory licensing legislation https://www.devex.com/news/covid-19-countries-race-to-strengthen-compulsory-licensing- legislation-97595

“Given the uncertainty over access to treatments for COVID-19, several countries have been laying the legislative groundwork to issue compulsory licenses for products that patent holders refuse to make accessible. … … Ecuador and Chile have taken initial steps, though compulsory licensing is not only a tool of low- and middle-income countries. Germany, Canada, and France are also preparing to make issuing compulsory licenses easier, if that becomes necessary, and Israel has already issued one to allow the country to import a generic coformulation of lopinavir and ritonavir, an early COVID- 19 treatment candidate that has since been proven ineffective. … … The goal now, said Sergey Golovin, intellectual property and access lead with the International Treatment Preparedness Coalition in Eastern Europe and Central Asia, is to convince governments of low- and middle-income countries that do not have critical legislation in place to begin the process of drafting or adopting it…..”

… Compulsory licenses are not the only flexibilities identified by trade agreements. In South Africa, the activist group Section 27 is calling for the introduction of an examination board that is authorized to use strict criteria for evaluating whether a new patent on an existing product is merited and, if not, to reject a local application. … … Countries could also begin establishing parallel importation schemes, which allow officials to import and resell patented drugs from another country where they may be on sale for less than the price set by the patent holder — because of competitive pressures or subsidies, for example. ….”

Devex - Crafting a framework for Africa's COVID-19 vaccine access https://www.devex.com/news/crafting-a-framework-for-africa-s-covid-19-vaccine-access-97578

Excellent report and analysis of the virtual vaccine summit (24-25 June) last week. Must-read.

“The African Union hosted a virtual conference on the continent's leadership role in developing a COVID-19 vaccine, with equity and accessibility at the forefront of conversations.”

“… Drastic measures to contain the spread of COVID-19, such as strict lockdowns, are not sustainable on many parts of the African continent because of crowded living conditions and the need to keep economies afloat. That’s why an effective vaccine is one of the best chances African countries have to return to normalcy, experts said this week. … … “A COVID vaccine would allow member states to return to a fully functional economy and society,” said Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, during a virtual two-day conference focused on the role the continent hopes to play in the development, production, and distribution of future coronavirus vaccines.

… “Unless we act now, Africa is at risk of being left behind in the global vaccine,” Nkengasong said.

Some of the challenges leaders on the continent face include raising funds to pay for vaccines, strengthening local manufacturing, increasing the number of local clinical trials, and ensuring communities actually want to be vaccinated. … … The conference, attended by government ministers, African Union and World Health Organization officials, researchers, private sector representatives, among others, was a first step toward creating a continent-wide framework on vaccines. The African Union plans to launch its official strategy in the coming weeks.

… … There are several global mechanisms in place to increase access to future COVID-19 vaccines. This includes WHO’s ACT Accelerator, which is an end-to-end effort to hasten the development of vaccines, and its COVID-19 Technology Access Pool. There is also the COVID-19 Global Vaccine Access Facility, headed by Gavi, the Vaccine Alliance, which aims to pay pharmaceutical companies upfront for doses of future vaccines. The facility would allow for pooled procurement of vaccines between high-, middle- and low-income countries, allowing for equitable distribution. But these mechanisms still don’t have the widespread support they need to ensure equitable access once vaccines are available, so African nations should also mobilize capital from global donors, as well as domestic resources, to secure an adequate supply of vaccines, Nkengasong said. They should also negotiate directly with manufacturers or countries that have the adequate manufacturing capacity, such as China or the United States.

The African Export-Import Bank is also in discussions with major donor agencies about providing market availability guarantees to help ensure equitable access to vaccines, said Benedict Oramah, the bank’s president….”

Geneva Health Files - WHO’s Allocation Framework on COVID19 health products P Patnaik; https://genevahealthfiles.wordpress.com/2020/06/27/whos-allocation-framework-on- covid-19-health-products/

Must-read analysis. Priti Patnaik zooms in on the WHO Allocation Framework (released last week by WHO), and had a related Q&A with Achal Prabhal, expert on access to medicines issues.

Science News - The line is forming for a COVID-19 vaccine. Who should be at the front? https://www.sciencemag.org/news/2020/06/line-forming-covid-19-vaccine-who-should-be-front

“U.S. and World Health Organization are already debating how to prioritize the initial distribution of a coveted vaccine.”

Cfr a tweet Soumya Swaminathan (WHO): “Initial supply of #COVID19 vaccine is going to be limited - the world must agree on a fair and equitable distribution mechanism, to reduce mortality & protect the vulnerable.”

Telegraph - More than $8.5bn committed to finding drugs and vaccines to fight coronavirus https://www.telegraph.co.uk/global-health/science-and-disease/85bn-committed-finding-drugs- vaccines-fight-coronavirus/

“US government is biggest funder of research but breakthroughs are likely to take some time.”

“Nearly $8.5 billion has so far been committed to finding diagnostics, treatments and vaccines to battle Covid-19, the fastest ever scale-up of research and development to fight an infectious disease. “

“The Covid-19 R&D tracker, put together by the global health think tank Policy Cures Research, has identified more than 850 product candidates in development to fight the virus with by far the greatest investment being made in vaccines. …. Some $4.9bn has been committed to vaccines, compared to $1bn for therapeutics and $731m for diagnostics. The rest of the funding is not specified. Governments are the major funders with the single biggest donor to R&D efforts being the United States government which has pledged nearly $3.4bn. This is followed by Germany which has committed just over $1bn. The UK is the third largest funder and has committed just over $700m. The UK’s biggest single donation is of $49m which has gone to the Covid-19 Therapeutics Accelerator, which is aiming to speed up the development of new drugs. … … China has committed nearly $300m but the tracker also reveals that many smaller, low and middle income countries have also committed to fight the virus.

… for drugs and treatments the picture is less promising, the tracker reveals. So far only one antiviral - remdesivir - has been conditionally approved by a regulatory authority, and most of the drugs being studied are existing treatments….”

TWN - COVID-19 vaccines: EU prioritises preferential access, paying lip-service to global solidarity https://twn.my/title2/health.info/2020/hi200609.htm

Analysis by S Shashikant et al.

TWN - COVID-19: Global Concern that Gavi’s Vaccine Initiative Promotes Inequitable Access https://www.twn.my/title2/health.info/2020/hi200611.htm

More analysis by S Sashikant (TWN). “The proposal by Gavi, the Vaccine Alliance to create a facility that will enter into advance purchase agreements with pharmaceutical companies guaranteeing the purchase of vaccines, has generated significant global concerns about its impact on equitable access for populations especially in developing countries….”

GAVI Q&A with Seth Berkley – What is the Covax Pillar, why do we need it and how will it work? https://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax-pillar

Seth Berkley on 6 questions.

Economic Times - Over 100 global leaders appeal to declare covid-19 vaccines a common good Economic Times; “Over 100 global leaders, thinkers and industrialists … …have joined Nobel peace prize winner Muhammad Yunus in an appeal to declare Covid-19 vaccines a global common good so that the vaccines can be produced and distributed for free.”

“About 18 Nobel winners, 32 former chief of state and governments, political leaders, international NGOs and institutions have signed the call initiated by Yunus Centre of Bangladesh….”

Reuters - CanSino's COVID-19 vaccine candidate approved for military use in China https://www.reuters.com/article/us-health-coronavirus-china-vaccine-idUSKBN2400DZ

“China’s military has received the greenlight to use a COVID-19 vaccine candidate developed by its research unit and CanSino Biologics (6185.HK) after clinical trials proved it was safe and showed some efficacy, the company said on Monday. The Ad5-nCoV is one of China’s eight vaccine candidates approved for human trials at home and abroad for the respiratory disease caused by the new coronavirus. The shot also won approval for human testing in Canada. China’s Central Military Commission approved the use of the vaccine by the military on June 25 for a period of one year, CanSino said in a filing. …”

With some early comments & analysis, via Twitter:

Tweets Helen Branswell (Stat):

1. China gives first emergency use approval for a #Covid19 vaccine, allowing CanSino's adenovirus vectored vaccine to be used by the military. There is already evidence this vaccine may not work that well in some people. (see next tweet)

2. The Phase 1 trial of the CanSino #Covid19 vaccine showed a problem experts expected was indeed an issue with this vaccine. A lot of people have pre-existing immunity to the adenovirus used as the backbone of this vaccine. They don't get as good a take.

3. Former @US_FDA head @ScottGottliebMD assesses the thought process behind China's decision to deploy the CanSino #Covid19 vaccine in the military based on data to data: Some protection is better than none. “ China's goal was always shots in arms. Their bet is that even a partially protective Covid vaccine is going to be sufficient to restore confidence and restart economic activity. It's a huge risk given the unknowns about not just efficacy, but safety.”

4. Another thought on why use China would use the CanSino #Covid19 vaccine in the military from @dho — it could serve as a priming vaccine, followed up by a booster with another vaccine later.

Tweet Mara Pilinger

“Hot take: This is a giant Phase III trial, even if China isn’t calling it that. But could force US & other countries to weight decisions about how to prioritize vaccine distribution in scary ways.”

FT - Gilead to charge governments $2,340 for Covid-19 treatment remdesivir https://www.ft.com/content/4969b0a6-9e70-4135-a703-eac438d8ef50

There’s no business like “Big Pharma Business”. “US drugmaker releases proposed pricing for one of most promising coronavirus medicines.”

“… Gilead Sciences has said it will charge governments $2,340 for a course of remdesivir, a drug that has been shown to shorten recovery times in Covid-19 patients. The US biotech group said government healthcare programmes in developed markets globally would be charged a flat fee of $390 per vial for the drug. A five-day treatment uses six vials….”

HPW – Medicines Access Experts Challenge US $2340 Per Remdesivir Treatment Course Price Set By Gilead For Developed Countries https://healthpolicy-watch.news/gilead-to-charge-us-320-per-vial-of-remdesivir-in-developed- countries/

“… the price is still high compared to the cost of manufacturing, according to medicines access experts, who say that remdesivir could be produced for below a dollar a day….”

“Private insurers in the United States will pay US $3,120 for a five-day course, or $520 per vial. Out- of-pocket payments will be determined by individuals’ coverage plans. In 127 developing countries, Gilead has allowed generics companies to manufacture the drug, pricing a five-day course at about US $600. …”

“Cost of production for the drug can be as low as US $0.93 per day, according to a paper by Dr Andrew Hill, a senior visiting research fellow at the University of Liverpool, and his colleagues. “Gilead will turn a nice profit with its set price. Especially considering that the company has benefitted from significant government financing for the development of the drug; which apparently has not been discounted,” Ellen t’Hoen, director of Medicines, Law and Policy, told Health Policy Watch. … … The company could turn a US $2.3 billion profit on the “blockbuster” drug this year alone, according to a blog by Ellen t’Hoen….”

Guardian - US buys up world stock of key Covid-19 drug remdesivir https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-world-stock-of-key-covid-19-drug

“The US has bought up virtually all the stocks for the next three months of one of the two drugs proven to work against Covid-19, leaving none for the UK, Europe or most of the rest of the world. Experts and campaigners are alarmed both by the US unilateral action on remdesivir and the wider implications, for instance in the event of a vaccine becoming available. The Trump administration has already shown that it is prepared to outbid and outmanoeuvre all other countries to secure the medical supplies it needs for the US….”

See also the Telegraph - US move to buy global supply of remdesivir sets 'dangerous precedent' for pandemic response, experts warn

“There are concerns that the decision undermines global unity in tackling Covid-19 and heightens concerns about "vaccine nationalism".” With quotes by Devi Sridhar, among others.

• But guess what, FT already reported, the day after - Brussels in talks to secure doses of remdesivir for EU

“The European Commission is in talks with Gilead Sciences, the US pharmaceuticals business, to reserve doses of the drug remdesivir to combat coronavirus after Washington announced that it had bought up much of the global supply. Stella Kyriakides, health commissioner for the 27-country EU, has held a series of negotiations with the company, including over its production capacity, Brussels said. “Commissioner Kyriakides has been in multiple discussions with the manufacturer, Gilead,

including on their production capacity,” the commission said. “The commission is also currently in negotiations with Gilead to reserve doses of remdesivir for EU member states.”…”

Looks like ‘Team Europe’ isn’t just into ‘global solidarity’ & ‘People’s vaccines’.

• PS: How secret deals could keep a COVID-19 drug out of reach for millions

“The American pharmaceutical giant Gilead Sciences is coming under scrutiny for agreements that activists say will restrict global access to remdesivir, an experimental antiviral drug that has shown promise in treating COVID-19. The Foster City, Calif.-based company has signed confidential licensing deals with nine pharmaceutical manufacturers — including seven in India — that would prevent the generic version of the drug from being distributed in dozens of countries, including the U.S., that account for nearly half the world’s population. Although the terms of the licenses have not been publicly disclosed, Gilead has said they allow for a cheaper, generic form of remdesivir to be distributed in 127 countries, including nearly all of the world’s poorest nations. But the agreements exclude countries with some of the worst coronavirus outbreaks — including the U.S., Brazil, Russia, Britain and Peru — leading to allegations that Gilead aims to sell only its much costlier, name-brand version of the drug in middle-income and wealthy nations that are desperate for the treatment. “

SMCH - Oxygen shortage looms as virus cases head to 10 million

SMCH ;

See also last week’s IHP news. “The world faces a shortage of oxygen concentrators as the number of worldwide cases of coronavirus infection nears the 10 million mark, according to the World Health Organisation….”

“… The WHO has purchased 14,000 oxygen concentrators from manufacturers and plans to send them to 120 countries in coming weeks, Tedros said. A further 170,000 concentrators — valued at some $US100 million ($146 million)— will be potentially available over the next six months. … … A few companies dominate 80 per cent of the global medical oxygen market, and in much of the world, the commodity is expensive and hard to get, highlighting lethal inequalities both between and within countries….”

PS: Some are calling on WHO & other global health stakeholders to negotiate a #COVID19 plan with big oxygen in same way they work with big pharma on vaccines/meds.

FT - Pandemic reopens wounds on IP rights https://www.ft.com/content/9ed5ca5e-9360-11ea-899a-f62a20d54625

“The ethics of pharmaceutical monopolies are under scrutiny.”

“The race to develop vaccines and treatments for Covid-19 has been described by many world leaders as the greatest challenge of our lifetimes. But the coronavirus pandemic has reignited a longstanding debate about intellectual property protection and wider public access to medicines,

as well as whether some protections should be temporarily overridden to deal with a global pandemic….”

And a link:

AP - Brazil signs deal to produce experimental virus vaccine

“The Brazilian government announced on Saturday an agreement with Oxford University and pharmaceutical company AstraZeneca to produce a promising coronavirus vaccine that is undergoing tests. Brazilian Health Ministry authorities said at a news conference that the country will pay $127 million and receive material to produce 30.4 million doses in two batches in December and January, which would allow it to quickly start inoculation efforts if the vaccine is certified to be safe and effective. They said the total deal is for 100 million vaccines for a country of about 210 million residents….”

Covid funding, debt relief, …

Project Syndicate - Making Multinationals and the Wealthy Pay J A Ocampo et al ; Project Syndicate;

“The poor and vulnerable are already suffering the most from the COVID-19 pandemic; they must not be left to carry the economic burden of rescue packages as well. It is time for those who have the most – and have long avoided paying their fair share – to start pulling their weight.”

A few excerpts:

“It is impossible to say how far global tax revenues will fall as a result of the COVID-19 crisis. But, between tax breaks for corporations and falling incomes, it is safe to assume that the decline will be much larger than the 12% drop during the 2007-09 global financial crisis.”

“Clearly, governments need to find a way to increase their revenues. Cutting taxes for corporations isn’t it. Nor is raising taxes on ordinary workers, which would exacerbate already-widening income and wealth inequality. As we argue in the latest report of the Independent Commission for the Reform of International Corporate Taxation, governments should focus instead on boosting corporate tax revenues, including by introducing more progressive tax systems and putting a floor under tax rates, in order to curb competition….”

Potential new tax revenues obviously exist. … The op-ed also provides an update on the BEPS reform.

For the report, see The global pandemic, sustainable economic recovery and international taxation

“The report lists five steps governments can take to tackle tax avoidance ―which has left governments with fewer resources to meet critical priorities in the wake of the pandemic― end the era of tax havens and the ‘race to the bottom’ on corporate taxation. …”

CNBC - ‘Enormous bias’ clouds international approach to African debt relief, experts say https://www.cnbc.com/2020/07/01/enormous-bias-clouds-international-approach-to-african-debt- relief-experts-say.html

Interesting analysis.

“African governments spend more on servicing debt than on health care, and calls for debt forgiveness have been leveled at international institutions, individual nations and private creditors amid the coronavirus crisis. Elizabeth Rossiello, founder and CEO of Kenyan cross-border payments and trading platform AZA Finance, told a webinar on Friday that the international perception of African debt markets is tinged with “bias.””

And a quote by an investment management expert: ““One of the dangers of talking about a blanket debt relief is you damage the potential growth of capital markets at a time when African corporates in particular need access to capital probably more than ever before, and that’s partly because the African continent is performing much more strongly than it did 20 years ago,” said Rohm.” He also argues that disparity between the debt profiles of individual African nations meant that international treatment of African debt should be approached on a sovereign by sovereign basis.

Global Policy - Breaking Out of the Double Squeeze: The Need for Fiscal and Policy Space during the COVID-19 Crises https://www.globalpolicyjournal.com/blog/26/06/2020/breaking-out-double-squeeze-need-fiscal- and-policy-space-during-covid-19-crises

“Kevin P. Gallagher and Richard Kozul-Wright call on international financial institutions to adopt a series of measures to give developing countries the space to fight and recover from COVID-19.”

CGD (blog) - As the Pandemic Surges in Poor Countries, Why Does the IMF Still Forecast a Milder Economic Crisis for Them? Justin Sandefur et al ; https://www.cgdev.org/blog/pandemic-surges-poor-countries-why-does-imf- still-forecast-milder-economic-crisis-them

“Last week, the IMF revised the post-COVID growth forecasts it had made originally in the April World Economic Outlook (WEO). The April growth forecasts numbers projected a significantly more optimistic outlook for EMDEs compared with advanced economies. It turns out that the latest June forecast maintains this relative optimism for EMDEs.” The authors wonder whether this is right.

Covid science

Starting with this assessment: “Around 90 per cent of the world’s population is still susceptible to the coronavirus, the WHO’s chief scientist has said. “

Science News - One U.K. trial is transforming COVID-19 treatment. Why haven’t others delivered more results? https://www.sciencemag.org/news/2020/07/one-uk-trial-transforming-covid-19-treatment-why- haven-t-others-delivered-more-results

“Clinical study has been helped by a simple design, a centralized health care system, and lots of infections.”

Karolinska Institutet - Immunity to COVID-19 is probably higher than tests have shown Karolinska;

“New research from Karolinska Institutet and Karolinska University Hospital shows that many people with mild or asymptomatic COVID-19 demonstrate so-called T-cell-mediated immunity to the new coronavirus, even if they have not tested positively for antibodies. According to the researchers, this means that public immunity is probably higher than antibody tests suggest. The article is freely available on the bioRxiv server and has been submitted for publication in a scientific journal….”

Telegraph – Exposure to common cold could provide immunity to Covid-19 https://www.telegraph.co.uk/global-health/science-and-disease/exposure-common-cold-could- provide-immunity-covid-19/

“T-cells not antibodies may be the key to fighting off the virus, study shows.”

“Exposure to the common cold could provide some measure of immunity to Covid-19, a new study suggests. The key to this immunity lies in T-cells, a type of white blood cell that helps the immune system fight off viruses, which experts believe may have just as important a role to play as antibodies in fighting off the virus. Researchers at Tubingen University in Germany compared blood cells from patients who had recovered from Covid-19 with those that had not had the disease. Their research, published on the pre-print server Research Square and not peer reviewed, showed that 81 per cent of the 185 people they tested who had not had the disease had a T-cell response to Sars-Cov-2, the virus that causes Covid-19. And this immune response was linked to previous exposure to common cold coronaviruses, the researchers found….”

WP - This coronavirus mutation has taken over the world. Scientists are trying to understand why. https://www.washingtonpost.com/science/2020/06/29/coronavirus-mutation-science/?arc404=true

Excerpts: “… A change in the virus was appearing again and again. This mutation, associated with outbreaks in Europe and New York, eventually took over the city. By May, it was found in 95 percent of all the genomes Ozer sequenced. … At a glance, the mutation seemed trivial. About 1,300 amino acids serve as building blocks for a protein on the surface of the virus. In the mutant virus, the genetic instructions for just one of those amino acids — number 614 — switched in the new variant from a “D” (shorthand for aspartic acid) to a “G” (short for glycine). “G” hasn’t just dominated the outbreak in Chicago — it has taken over the world. Now scientists are racing to figure out what it means.

“At least four laboratory experiments suggest that the mutation makes the virus more infectious, although none of that work has been peer-reviewed. Another unpublished study led by scientists at Los Alamos National Laboratory asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others. … … The mutation doesn’t appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.

“The epidemiological study and our data together really explain why the [G variant’s] spread in Europe and the U.S. was really fast,” said Hyeryun Choe, a virologist at Scripps Research and a lead author of an unpublished study on the G variant’s enhanced infectiousness in laboratory cell cultures. “This is not just accidental.” …the switch occurred in the part of the genome that codes for the all- important “spike protein” — the protruding structure that gives the coronavirus its crownlike profile and allows it to enter human cells the way a burglar picks a lock. And its ubiquity is undeniable. Of the approximately 50,000 genomes of the new virus that researchers worldwide have uploaded to a shared database, about 70 percent carry the mutation, officially designated D614G but known more familiarly to scientists as “G.”

Telegraph - Alarm in Indonesia over high number of Covid-related deaths among children https://www.telegraph.co.uk/global-health/science-and-disease/alarm-indonesia-high-number- covid-related-deaths-among-children/

“Widespread pneumonia and malnutrition make children more vulnerable to the virus, experts warn.”

“… Last week the Indonesian Paediatric Society (IDAI) reported that more than 200 children, including newborns and infants under five years old, were suspected to have died from the coronavirus outbreak that has strained the country’s fragile health system to breaking point. …”

… Infants were also at higher risk because of the disruption to essential health services, including “maternal and child health, family planning, nutrition services, diarrhoea management and immunisation,” she warned….”

Gates Open Research – Younger ages at risk of Covid-19 mortality in communities of color K Klugman et al ; https://gatesopenresearch.org/articles/4- 69/v1?utm_source=AuthorEmail&utm_campaign=GORArticleMilestone&utm_medium=Social

Younger people are dying from #Covid19 in Africa.

“in South Africa initial data suggest that the majority of deaths from Covid-19 are under 65 years of age. These observations suggest significant potential for increased Covid-19 mortality among younger populations in Africa and South Asia and may impact age-based selection of high-risk groups eligible for a future vaccine.”

Cidrap News - Worrisome details noted in kids with COVID inflammatory syndrome https://www.cidrap.umn.edu/news-perspective/2020/06/worrisome-details-noted-kids-covid- inflammatory-syndrome

“Today the New England Journal of Medicine published two studies spotlighting the serious manifestations of COVID-19–related multisystem inflammatory syndrome in children (MIS-C), the first involving 186 kids in 26 states and the second involving 99 patients in New York. … … Both studies revealed the same high level of intensive care: 80%....”

Telegraph - ‘Second wave’ is an unhelpful concept, top infectious disease expert warns https://www.telegraph.co.uk/global-health/science-and-disease/second-wave-unhelpful-concept- top-infectious-disease-expert/

“… Dr Tom Frieden, who served as director of the US Centers for Disease Control and Prevention (CDC) for eight years under Barack Obama, told The Telegraph that the term “implies that this [virus] will act as the flu acts”. “We don't know that - it might, but it might not,” he said. “Basically we will have outbreaks as long as there is exposure.” Instead he advocated a surfing analogy - peaks and troughs in cases should be described as “riding a wave”. …”

Boston Review - The Shape of Epidemics

D Jones et al ; http://bostonreview.net/science-nature/david-s-jones-stefan-helmreich-shape- epidemics

Neat essay. “Waves have taken pride of place in the COVID-19 crisis, serving not just to predict but also to persuade. As new infections soar in the United States, their special blend of mathematical and moral messaging will help to shape the future of the pandemic.”

“…This essay sketches this backstory of epidemic waves, which falls roughly into three eras: waves emerge first as a device of data visualization, then evolve into an object of mathematical modeling

and causal investigation and finally morph into a tool of persuasion, intervention, and governance. …”

Guardian - Covid-19: risk of death in UK care homes 13 times higher than in Germany https://www.theguardian.com/world/2020/jun/28/covid-19-risk-of-death-in-uk-care-homes-13- times-higher-than-in-germany?CMP=share_btn_tw

“Care home residents were more likely to die of Covid-19 in the UK than in any of the major European countries apart from Spain, analysis of global data has revealed. The proportion of residents dying in UK homes was a third higher than in Ireland and Italy, about double that in France and Sweden, and 13 times higher than Germany. The analysis of official statistics was carried out by academics at the London School of Economics as part of the International Long Term Care Policy Network….”

NYT - How the Coronavirus Short-Circuits the Immune System https://www.nytimes.com/2020/06/26/health/coronavirus-immune-system.html

“In a disturbing parallel to H.I.V., the coronavirus can cause a depletion of important immune cells, recent studies found.”

“…The findings suggest that a popular treatment to tamp down the immune system in severely ill patients may help a few, but could harm many others. The research offers clues about why very few children get sick when they are infected, and hints that a cocktail of drugs may be needed to bring the coronavirus under control, as is the case with H.I.V….”

FT - Coronavirus produces ‘sinister’ tentacles in infected cells https://www.ft.com/content/2690623a-6824-4837-a36d-73519b77aa7a

“Highly unusual structure raises hopes for use of cancer drugs to treat the disease.”

“Scientists have discovered that the virus behind Covid-19 causes the infected cells to grow stringy protruding branches — a highly unusual structure that allows the virus to attack several cells at once. … … The discovery has highlighted a number of drugs that could be deployed against the disease, most of which were previously being developed to treat cancer. Prof Krogan said cancers, HIV, or Sars-Cov-2 were all searching for the “Achilles heel of the cell”. “It totally makes sense there’s an overlap in anticancer drugs and an antiviral effect,” he said. …”

Guardian - Make masks compulsory in public in UK, says virus expert https://www.theguardian.com/world/2020/jun/30/make-masks-compulsory-in-public-says-virus- expert-peter-piot?CMP=share_btn_tw

“Face masks should be compulsory for adults in all public and enclosed spaces, such as shops, according to a leading infectious diseases expert” . Peter Piot, that is.

Piot also weighs in on some other issues related to the Covid-19 pandemic, including faultlines revealed by the pandemic etc.

Quote: “…We need to realise – and it’s sobering – that we are at the beginning of what may be a multi-year type of epidemic.”…”

Plos Med (Editorial) – Will COVID-19 be evidence-based medicine’s nemesis? T Greenhalgh; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003266

“Trisha Greenhalgh asks if during a pandemic evidence-based medicine can deliver the rapid responses needed in public health medicine.”

Concluding: “…In the current fast-moving pandemic, where the cost of inaction is counted in the grim mortality figures announced daily, implementing new policy interventions in the absence of randomized trial evidence has become both a scientific and moral imperative. Whilst it is hard to predict anything in real time, history will one day tell us whether adherence to “evidence-based practice” helped or hindered the public health response to Covid-19—or whether an apparent slackening of standards to accommodate “practice-based evidence” was ultimately a more effective strategy.”

GAVI – First African trial of a COVID-19 vaccine https://www.gavi.org/vaccineswork/first-african-trial-covid-19-vaccine

“With trials in Brazil and the UK already underway, South Africa becomes the first country in the continent to begin a clinical trial of a COVID-19 vaccine.”

GAVI – The latest in the covid- 19 vaccine race https://www.gavi.org/vaccineswork/covid-19-vaccine-race

(update as of 30 June). With also a great map of the vaccines in the pipeline & stage.

“The race is on to find a vaccine to stop the spread of the COVID-19 virus, with countries around the world researching different vaccine technologies that might halt the pandemic. Of the 148 candidate vaccines that researchers are working on, 17 are now in human clinical trials.”

Covid analysis

From various angles.

Lancet Offline: It's time to convene nations to end this pandemic R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31488-4/fulltext

“… COVID-19 is the greatest threat to peace and security since World War 2. Since 1948, there have been ten Emergency Special Sessions of the UN General Assembly—… … Surely this pandemic is serious enough to warrant similar political attention. An Emergency UNGASS can be convened within 24 h when international peace and security are threatened. …”

“…For those of us working in global health, COVID-19 has been devastating, and not only because of the toll of avoidable human loss. This pandemic is dismantling the foundations for protecting and advancing health. The right to health, health equity, and social justice form a trinity of values that animates the daily practice of global health. These values, underpinning first the Millennium Development Goals and, since 2016, the Sustainable Development Goals, have accelerated progress in women's and children's health, the control of epidemic diseases, and health system strengthening. But these achievements are now threatened by COVID-19, a pandemic that has still not reached its peak worldwide. Global health has entered a period of rapid reversal. De-development is the new norm. Yet no plan is in place, or even being proposed, to address this global regression in human health….”

Horton goes on to give some very dire stats of what lies ahead, among others by the Global Fund.

Covid19 Health diaries - Triple Crisis of Private Health 2/3 Owain Williams; https://covid19healthdiaries.com/diary?did=288

Without any doubt, one of the must-reads of the week. Second in series of three blogs.

“… This is the second part of the thread on market failure and the private hospital and healthcare sector, having posted part 1 on the 19th June. This post picks up and examines the details of the triple crisis of market failure in private sector health, particularly in private hospitals during the pandemic. …. … The triple crises of private hospital and healthcare are now widespread across many countries, both north and south, with this piece illustrating just how far-reaching the market failure is by means of country examples drawn from emerging data, press reports, NGO and multilateral opinion pieces and so on….”

Some of our favourite quotes: “…there seems to be a major crisis in legitimacy of the token and illusory public-private partnership model, with market failure exposing the emptiness of calls to harness the private sector for delivery of healthcare or even Universal Health Coverage. …“

“… attempts to sustain the case for the private in health and hospital care are emerging in high- level policy discourses, much centring on the efforts of the International Financial Institutions and the WHO to maintain and legitimise the public-private partnership model that has occupied global health policy for over 10 years….”

And another excerpt: “… It seems that the World Bank and WHO study cited above is accurate in its representation of a huge systemic crisis in private health and hospital care across many LMICs. While clearly significant for the future of that private system after the pandemic, the real immediate

concern is that financial collapse will imperil the ability of countries to respond to COVID and have capacity at the systems level. In Africa and Asia most countries are heavily dependent on the formal private sector which accounts for average of 40% of healthcare in these regions, this figure rising to over 80% in countries such as India, Bangladesh and Nigeria. If the private sector suffers even modest collapse and closures, then capacity will be a problem in the pandemic. …”

The conclusion: “… In conclusion, we have seen a huge financial crisis unfold in private hospital and healthcare in countries where the market model and financialization have been left to run riot over recent decades. COVID is clearly an exceptional crisis, but it has exposed the dangers in weighting health services to profit and business models where elective health has triumphed over essential and universal services. In the next of these threads I will look at the response of the private sector to COVID in a range of countries, above and beyond closure and bankruptcy, as well as the state and multilateral crisis of governance that is centring on the viability of the private in health both within and beyond this pandemic.”

TGH - All Bets Are Off for Measuring Pandemic Preparedness

S Crosby, J Dieleman et al; https://www.thinkglobalhealth.org/article/all-bets-are-measuring- pandemic-preparedness

Absolute must-read: “Three standard measures don't predict how countries fare in COVID-19—so how do we better prepare for the next pandemic?”

One of their explanations: “… Joint External Evaluations, the Global Health Security Index, and measures of universal health coverage are not meant to predict health outcomes but are intended to be tools for identifying gaps in capacity and mobilizing financial and political support to fill those gaps….”

See also this Twitter thread by co-author Tom Bollyky .

“#COVID19 has revealed that we don't yet understand how best to measure countries' capacity to respond effectively to severe pandemic threats…”

Project Syndicate - How Inequality Fuels COVID-19 Deaths

J Sachs; https://www.project-syndicate.org/commentary/inequality-fuels-covid19-mortality-by- jeffrey-d-sachs-2020-06

“High inequality undermines social cohesion, erodes public trust, and deepens political polarization, all of which negatively affect governments’ ability and readiness to respond to crises. This explains why the United States, Brazil, and Mexico account for nearly half of the world's reported deaths since the start of the pandemic.”

Guardian - Covid-19 intensifies elder abuse globally as hospitals prioritise young https://www.theguardian.com/global-development/2020/jun/30/covid-19-intensifies-elder-abuse- globally-as-hospitals-prioritise-young?CMP=twt_a-global-development_b-gdndevelopment

“Older patients turned away or left untreated, while domestic abuse is also rising, leading charity reports.” HelpAgeInternational, that is. “…Discrimination against older people has been on the rise since the pandemic, according to the organisation. It has heard reports from many countries of older people left to die from Covid-19 as younger patients are prioritised – or simply refused treatment amid fears they would infect others….”

Lancet Digital Health (Viewpoint)- Applications of digital technology in COVID-19 pandemic planning and response S Whitelaw; https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30142-4/fulltext

“With high transmissibility and no effective vaccine or therapy, COVID-19 is now a global pandemic. Government-coordinated efforts across the globe have focused on containment and mitigation, with varying degrees of success. Countries that have maintained low COVID-19 per-capita mortality rates appear to share strategies that include early surveillance, testing, contact tracing, and strict quarantine. The scale of coordination and data management required for effective implementation of these strategies has—in most successful countries—relied on adopting digital technology and integrating it into policy and health care. This Viewpoint provides a framework for the application of digital technologies in pandemic management and response, highlighting ways in which successful countries have adopted these technologies for pandemic planning, surveillance, testing, contact tracing, quarantine, and health care.”

CGD (blog) – Healthcare Technologies and COVID-19: Speed is Not Always a Good Thing K Chalkidou et al ; https://www.cgdev.org/blog/healthcare-technologies-and-covid-19-speed-not- always-good-thing

« With a focus on tests, treatments, and a vaccine, we take a look at the emerging global clinical and economic evidence-base underpinning some of these technologies, the mechanisms (mostly global) for financing these commodities, and, finally, the decision-making processes for selecting technologies. This includes identifying the right subpopulations and negotiating a cost-effective tiered price across countries and regions. »

CGD (blog) – Beyond Lockdown—⁠ Sustainable COVID Control for Low-Income Countries Peter Baker, J Konyndyk et al; https://www.cgdev.org/blog/beyond-lockdown-sustainable-covid- control-lmics

“Following precedents applied first in wealthy states, more than 140 countries have applied some form of lockdown restrictions to slow their COVID-19 epidemics, but can control measures be made sustainable in low-income countries?”

“….With lockdown measures proving difficult to sustain, many countries are now relaxing their lockdown measures; 58 of the 115 (50.4 percent) countries with remaining lockdown measures are imminently preparing to begin phasing them out. Wealthier countries have relaxed their policies first, utilising a four-layered strategy of social distancing, shielding of the vulnerable, contact tracing

and public communication. Low-income countries, however, have material differences that change both the feasibility of these strategies and their cost-benefit calculus. In this blog we look at these four layers and assess their feasibility in low-income countries. We recommend that social distancing measures will need to be limited and carefully adapted, focusing on those that are sustainable for 6-12 months and strengthened with hygiene measures. Measures to shield the vulnerable needs to be community driven and piloted to test feasibility. Contact tracing must be adapted to be low cost and scalable, and public communications must focus on building trust with all communities….”

F2P blog - Optimistic or pessimistic about Covid-19? No need to choose By Jordy Vaquer (Open Society Foundations) https://oxfamblogs.org/fp2p/optimistic-or- pessimistic-about-covid-19-no-need-to-choose/

With 4 possible quadrants. Back to (new) normal; Democratic Renewal; Authoritarian winter; Downward Spiral.

Recommended article.

Guardian - Progress on gender equality at risk from Covid-19 jobs crisis, says ILO https://www.theguardian.com/world/2020/jun/30/gender-equality-covid-19-jobs- ilo?CMP=Share_iOSApp_Other

“UN body says pandemic a bigger blow to employment than it previously feared.” “Modest progress in workplace gender equality risks being reversed by the disproportionate impact of the deepening global jobs crisis caused by the Covid-19 pandemic, the International Labour Organisation has said. The Geneva-based ILO said its latest update showed restrictions on activity during the second quarter had led to an even bigger blow to employment than it previously feared, and that women had been hit harder than men….”

ECFR - Europe’s pandemic politics: How the virus has changed the public’s worldview https://www.ecfr.eu/publications/summary/europes_pandemic_politics_how_the_virus_has_chang ed_the_publics_worldview

With focus on European public opinion, but probably also with broader relevance.

“As covid-19 raged, speculation grew that the crisis would restrengthen public support for the state; faith in experts; and both pro- and anti-Europeanism. New research reveals these all to be illusions. Instead, the crisis has revolutionised citizens’ perceptions of global order – scrambling the distinctions between nationalism and globalism. One group – the DIYers – sees a nineteenth- century world of every nation for itself; the New Cold Warriors hear echoes of the twentieth century and look to Trump’s America to defend them from China; the Strategic Sovereigntists foresee a twenty-first-century world of blocs and regions. This last group are the largest and represent a new form of pro-European who believe Europe will need to support its own sovereignty through joint foreign policy, control of external borders, and relocalised production. … … Rather than a ‘Hamilton

moment’ of proto-federalisation, we are instead living through a ‘Milward moment’ of strong nation state identities searching for protection in a dangerous world.”

See also The Guardian on the same report - Europeans' trust in US as world leader collapses during pandemic

NPR - 'I Will Kill You': Health Care Workers Face Rising Attacks Amid COVID-19 Outbreak NPR;

“… According to Insecurity Insight, a research group that documents violence against aid workers, there have been more than 400 reported global incidents of COVID-19-related violence affecting health care workers and facilities since January. Insecurity Insight tracks attacks on health workers, including threats, assault, arrests and detention, kidnappings and conflict-related violence, along with a number of other types of attacks. Its researchers comb through incident reports from the World Health Organization and groups such as the Aid Worker Security Database and Physicians for Human Rights, along with media reports….”

And that’s almost certainly a huge underestimate.

Guardian - 'Evil forces': how Covid-19 paranoia united the wellness industry and rightwing conspiracy theorists https://www.theguardian.com/commentisfree/2020/jun/05/wellness-advocates-used-to-talk- about-bali-trips-and-coconut-oilnow-its-bill-gates-and-5g

On a recent but worrying trend.

Excerpt: “…What was going on? How and why did the largely progressive and left-leaning proponents of wellness merge with rightwing conspiracy theorists and Donald Trump supporters? Such unlikely allegiances were termed “fusion paranoia” in a 1995 New Yorker article by the journalist Michael Kelly, who saw leftwing and rightwing activists coalesce around the anti-war and pro-civil liberties movements that shared common traits of anti-government views and belief in conspiracy theories. Such a tight alliance (or fusion paranoia) between the wellness industry and the far-right would have been unthinkable to me a year ago. But the connection between the alt- right, conspiracy theorists and sections of the wellness community have strengthened and bonded during global lockdowns. The messages of the different groups are remarkably the same: the virus is a cover for a plot of totalitarian proportions, designed to stifle freedom of movement, assembly, speech and – to the horror of some in the wellness industry – enforce a program of mass vaccinations. A popular, multitrillion-dollar sector, the wellness industry’s huge reach and influence has the power to bring people into the conspiracy that previously would not have had any contact with the alt-right….”

Newsweek – Politicizing and Polarizing the Pandemic Pinned America As Global Epicenter https://www.newsweek.com/pandemic-coronavirus-politicizing-polarizing-1513405

Focus on the US but with lessons for many countries in the world.

“… the uptick in COVID-19 cases may, in part, be due to politicization of the pandemic, with a failure to coordinate a unified response across the country. In a study published in Science Advances, a team of political scientists analyzed over 30,000 tweets from members of the U.S. Congress. They found rapid politicization and polarization of the pandemic. "

CGD (blog) - A Framework for Identifying the Sources of Indirect Health Effects of COVID-19

Y-Ling Chi et al ; https://www.cgdev.org/blog/framework-identifying-sources-indirect-health-effects- covid-19#.XvxvZ5TIUKU.twitter

“…In a policy paper released today, we introduce a framework for mapping out these indirect health effects at the country level, and show how it can shape our understanding of how COVID- related policies reverberate across all aspects of health. As we explain here, the framework can help policymakers move to a holistic COVID-19 response that accounts for the impacts of the pandemic and the measures implemented to fight it….”

Devex - How COVID-19 has advanced the case for procurement reform https://www.devex.com/news/how-covid-19-has-advanced-the-case-for-procurement-reform- 97588

“The pandemic put procurement, where 1 in every 3 dollars of public money is spent, in the spotlight, said Gavin Hayman, executive director at the Open Contracting Partnership. … … Hayman said COVID-19 has elevated the issue of procurement to the highest levels of government: “People are asking ‘Why don’t we know?’ for the first time,” he said. “…”

Telegraph - Women more willing to comply with lockdown, Panama's sex- segregation experiment suggests https://www.telegraph.co.uk/global-health/climate-and-people/women-willing-comply-lockdown- panamas-sex-segregation-experiment/

“Males and females were allowed out on alternate days in the Central American country with shops quieter on women-only days. “

“… In response to the Covid-19 pandemic, a small number of countries in Latin America introduced gender or sex-segregated mobility policies. However Panama was the only one to introduce a nationwide policy that held throughout the entirety of the lockdown period and has been seen as a success - the country had just over 30,000 cases and around 1,000 deaths. In what has been

considered one of the most aggressive responses to Covid-19 in Latin America, Panama's lockdown was based on an individual’s sex, as listed on their national identification card or “cedula”. Women were allowed to leave their homes on Mondays, Wednesdays and Fridays whereas men were allowed to go out on Tuesdays, Thursdays and Saturdays….”

“… Using anonymised GPS data from the country between February 15 and May 29, researchers at the London School of Economics found that there was less public movement on women’s days. The study, not yet published, recorded engagement with five major categories: retail and recreation, grocery and pharmacy, transit stations, parks and the workplace. While public mobility was lower on women’s days in all areas compared with men’s, this difference was particularly prevalent in visits to grocery and pharmacy stores - a result that researchers found surprising, and at odds with media accounts from Peru highlighting longer queues outside supermarkets on “female” days.”

“… “We came up with a range of hypotheses for why this might be – is it that women are better at following public health guidance than men? "Is it that actually, going to the grocery store becomes this new desired activity, when there’s nothing else you’re allowed to go out for, and thus represents a new source of bargaining between couples, and the fact that men ‘win’ this bargain reveals the perpetuity of gender norms and the patriarchy,” she told the Telegraph. “

WB (working paper) – COVID-19 Age-Mortality Curves Are Flatter in Developing Countries

G Demombynes; http://documents1.worldbank.org/curated/en/701441593610141326/pdf/COVID- 19-Age-Mortality-Curves-Are-Flatter-in-Developing-Countries.pdf

“A greater share of reported COVID-19 deaths occur at younger ages in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Based on data from 26 countries, people age 70 and older constitute 37 percent of deaths attributed to COVID-19 in LMICs on average, versus 87 percent in HICs. Only part of this difference is accounted for by differences in population age structure. … … It reflects some combination of variation across countries in age patterns of infection rates, fatality rates among those infected, and under-attribution of deaths to COVID-19. The findings highlight that experiences with COVID-19 in wealthy countries may not be generalizable to developing countries”.

“In the rich countries, people ages 70-79 are 12.6 times as likely to die as those ages 50-59. In the low- and middle-income countries, this ratio is 3.5.”

Global Health Research & Policy (Commentary) - The need for COVID-19 research in low- and middle-income countries

M Gupta, D Peters et al ; https://ghrp.biomedcentral.com/articles/10.1186/s41256-020-00159-y

“…In the early months of the pandemic, most reported cases and deaths due to COVID-19 occurred in high-income countries. However, insufficient testing could have led to an underestimation of true infections in many low- and middle-income countries. As confirmed cases increase, the ultimate impact of the pandemic on individuals and communities in low- and middle-income countries is uncertain. We therefore propose research in three broad areas as urgently needed to inform

responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures…”

Lancet Global Health – In the COVID-19 pandemic in Brazil, do brown lives matter?

H Ribeiro et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30314- 4/fulltext

“In The Lancet Global Health, a pioneering study by Pedro Baqui and colleagues confirms in Brazil findings observed in other countries hit hard by COVID-19: that mortality rates from the pandemic differ by geographical region and ethnicity, with disproportionate impact for Black populations and other ethnic minorities. We can discuss these findings in the context of the social protests occurring in the past few months against structural racism and to the slogan “Black lives matter”. However, in this Comment, we go beyond ethnicity, focusing on social and environmental determinants of health for about 50% of Brazilians….”

BMJ GH (blog) - Social media and the spread of COVID-19 in Nigeria E Togun; https://blogs.bmj.com/bmjgh/2020/06/28/social-media-and-the-spread-of-covid-19-in- nigeria/

“This article discusses the influence of social media in the Nigerian COVID-19 pandemic across three broad themes….”

And a link:

BMJ GH (blog) - Mental health, COVID-19 and primary healthcare in Guinea : a tale of stigma and solidarity (by A Sow et al)

Our World in Data in-depth studies

With 3 new in-depth studies by “Our World in Data”.

Emerging COVID-19 success story: Vietnam’s commitment to containment

Emerging COVID-19 success story: Germany’s strong enabling environment

Emerging COVID-19 success story: South Korea learned the lessons of MERS

Covid impact on other global health programs

Immunization economics - Conducting campaigns during the COVID-19 pandemic http://immunizationeconomics.org/recent-activity/2020/5/15/conducting-campaigns-during-the- covid-19-pandemic

With info on the additional operational cost of conducting immunization campaigns during the COVID-19 pandemic.

“With support from the Bill & Melinda Gates Foundation, ThinkWell has estimated the added cost per dose of several potential precautionary measures: personal protective equipment (PPE) for vaccination teams, additional infection prevention and control (IPC) measures at immunization sites, extra staff and supplies to ensure physical distancing and triaging at campaign sites, additional per diems due to potential changes in delivery strategies, and estimates of an increase of other operational cost components (such as additional social mobilization and training). The analysis uses data from 10 studies on the cost of conducting an immunization campaign to model each scenario at a low, medium and high intensity level, as well as the combined effect on the cost per dose.”

“All protective measures and operational changes combined could increase the operational cost of a campaign by 49% in the low scenario up to 154% in the high scenario.”

Lancet Comment - After COVID-19, a future for the world's children? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31481-1/fulltext

By the WHO/UNICEF/Lancet Commissioners. With a number of very sensible ways forward.

“In February, 2020, the WHO–UNICEF–Lancet Commission's report A Future for the World's Children? examined threats facing children—from climate change and related crises of poverty, migration, and malnutrition; commercial marketing of harmful substances; and across all sectors, from unsafe roads and hazardous housing to inadequate education and social protection. The COVID-19 pandemic is exacerbating many of these threats, jeopardising child welfare gains, and causing a global economic crisis in which children will be prime casualties. Yet recovery and adaptation to COVID-19 can be used to build a better world for children and future generations….”

SRHM – Series of Commentaries on SRHR in the era of Covid-19 http://www.srhm.org/sexual-and-reproductive-health-and-rights-in-the-era-of-covid-19/

Do check them out.

GAVI board meeting

Gavi – Short report of latest board meeting https://www.gavi.org/news/media-room/gavi-board-calls-global-access-covid-19-vaccines

Short but recommended read. “Gavi Board shows support for continued work on COVAX Facility: a global, coordinated mechanism designed to ensure rapid and equitable access to safe and efficacious COVID-19 vaccines to as broad a global population as possible; The Board also discussed the role Gavi will play in an expansion in cold chain capacity in developing countries to deploy COVID-19 vaccines, as well as potentially diagnostics and treatments; New flexibilities and measures put in place to help countries deal with unprecedented impact of COVID-19 on immunisation programmes, as well as revised gender policy to guide Gavi’s programmes.”

On the COVAX Facility: “…The COVID-19 Vaccines Global Access Facility (COVAX Facility) aims to pool demand and resources toward securing access to future supply of COVID-19 vaccines. All countries are invited to participate in the COVAX Facility. Gavi is continuing to work closely with stakeholders to complete the design of the Facility, including ways to raise the necessary funding. The Board was encouraged by what has been achieved so far, putting together the building blocks of the Facility, and raised points around equity, risk and financing that will be incorporated into the design, as well as governance that will be finalised in the summer….”

And a link – GAVI - Overview of Covid-19 situation in GAVI-supported countries and GAVI's response.

UNAIDS board meeting

UNAIDS - UNAIDS Board discusses UNAIDS’ work on COVID-19 and HIV and UNAIDS’ next strategy and its transformative agenda https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/june/20 200626_pcb

Good summary of the UNAIDS board meeting. “The 46th meeting of the UNAIDS Programme Coordinating Board (PCB) has concluded in Geneva, Switzerland. The PCB, which met from 23 to 25 June 2020, was held for the very first time as a virtual meeting because of the COVID-19 pandemic. The PCB, chaired by the United States of America, had decided that it would be important to demonstrate that the intergovernmental process can continue to work effectively during the COVID- 19 pandemic. During the meeting, a series of crucial decisions were taken on the future of the HIV response and on the transformation of UNAIDS, while the interconnectedness between the twin pandemics of HIV and COVID-19 was discussed and reflected upon….”

GFF

Wemos – Is it time for a refresh of the Global Financing Facility? https://www.wemos.nl/en/is-it-time-for-a-refresh-of-the-global-financing-facility/

“Wemos critically follows the developments and outcomes of the Global Financing Facility (GFF) for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition. It is currently under the process of a ‘strategy refresh’, planned to be launched around September 2020. With our new fact sheet, we looked into the implications of a potential shift from the GFF’s current structure as a Multi-Donor Trust Fund towards a Financial Intermediary Fund.” (7-pager)

(pre-print S&RM) - Is the Glass Half-Full or Half-Empty? A Content Analysis of Adolescent Sexual and Reproductive Health in Global Financing Facility Country Plans Asha George et al; https://www.researchsquare.com/article/rs-38707/v1

“… As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health. …. We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. …”

Financial crisis PAHO

Lancet Letter - Financial crisis at PAHO in the time of COVID-19: a call for action A King et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31489-6/fulltext

“On May 21, 2020, at a special session of the Executive Committee of the Pan American Health Organization (PAHO), WHO Regional Office for the Americas, Carissa Etienne, Regional Director, declared that due to non-payment of Member States' contributions, PAHO stands on the brink of insolvency. As of April 30, 2020, most of the non-payment is attributable to the USA (67%); however, late payments are outstanding from Brazil, Venezuela, Mexico, Argentina, Colombia, Chile, and others, to a total of US$164·6 million. This includes an unprecedented $63·8 million (57%) of 2019 assessed contributions. This financial crisis could not have occurred at a worse time…”

“…Health security in the western hemisphere would be severely threatened without a functioning PAHO. Reserve funds will be exhausted by September, 2020….” “This is a call to action to countries of the Americas to pay their outstanding contributions and avoid a financial crisis with known and unknown consequences.”

World Zoonoses Day (July 6)

Lancet Editorial – Zoonoses: beyond the human–animal–environment interface https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31486-0/fulltext

“World Zoonoses Day on July 6 marks the day, in 1885, when a young boy received the first vaccine against rabies—a zoonosis, a disease caused by a pathogen transmitted from animals to humans. Rarely is a World Zoonoses Day so relevant to consider these diseases and their disruption of societies….”

“Sounding the alarm about the risk of zoonotic pandemics has largely been the preserve of a handful of scientists and global health experts. Until now. COVID-19 has coalesced the research community around calls for establishing broad transformational change. This pandemic is a sobering warning against exploiting the natural world without pause, and that zoonoses affect not only health but the whole fabric of society. COVID-19 will not be the last, and perhaps not the worst, zoonotic pandemic. Climate change has shown how an existential threat to human civilisation can galvanise a sense of urgency in a whole-of-society response. Tackling zoonoses needs exactly the same.”

Planetary health

Lancet Letter – Time for WHO to declare climate breakdown a PHEIC? A Harmer, R van de Pas et al; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(20)31289-7/fulltext

I would say it past time already. In fact, I think WHO should declare a “super-PHEIC” or sth like that.

The authors conclude: “By declaring a PHEIC, WHO would protect and respect its mandate, global public health, the planet, and the wellbeing of present and future generations; mobilise political will and funding needed for climate action; and convey a sense of urgency. If ever there was a PHEIC, it is climate breakdown. WHO should declare it as such.”

Guardian - US to join summit on global green recovery from Covid-19 crisis https://www.theguardian.com/environment/2020/jun/29/us-joins-summit-on-global-green- recovery-from-covid-19-crisis

“The US is to join with other major powers including China, India and the EU in formulating plans for a global green recovery from the coronavirus crisis, in the only major international summit on the climate emergency this year. The idea of a green recovery to prevent a dangerous rebound in greenhouse gas emissions to above pre-Covid-19 levels has been gathering steam, but few governments have yet committed to plans. If they fail to do so in the next few months, the economic recovery from the Covid-19 crisis risks locking in high carbon emissions that would lead to climate

catastrophe. Next week, the International Energy Agency (IEA) will host an online summit for the world’s biggest economies as well as developing countries, covering 80% of global emissions. It aims to set out plans for boosting renewable energy, energy efficiency and other emissions-cutting projects that would generate tens of millions of “shovel-ready” green jobs around the world to replace those lost in the pandemic….”

“…The IEA summit on 9 July will be the only major meeting of governments to discuss the climate crisis this year, because the UN Cop26 summit has been postponed to next year due to the pandemic. US participation is crucial, because the White House is pulling out of the Paris agreement, with effect from 4 November, the day after the presidential election….”

See also HPW - Fateful International Energy Agency Meeting Could Set Course For Climate Friendly COVID-19 Recovery… Or Not.

The Monthly - Witnessing the unthinkable J Gergis; https://www.themonthly.com.au/issue/2020/july/1593525600/jo-lle-gergis/witnessing- unthinkable#mtr

By an Australian lead author involved in writing the physical science basis of the “Sixth Assessment Report” of the United Nations’ Intergovernmental Panel on Climate Change (IPCC).

“New climate modelling suggests planetary crisis is coming much sooner than previously thought.”

HPW – Swelling Indian National Opposition As Modi Plans To Expand Coal Mining https://healthpolicy-watch.news/swelling-indian-national-opposition-as-modi-plans-to-expand-coal- mining/

“Prime Minister Narendra’s Modi’s ambitious plan to use coal to power India’s economic revival after his government’s strict lockdowns flattened the wrong curve, bringing economic growth to a halt even as the infection epidemic-curve continued to rise, seems to have run into significant opposition from unexpected quarters. Since the launch of his plan earlier this month, state after Indian state has expressed disagreement with the Centre’s plan to commercially auction coal mines to the private sector, including international players. The latest to join the clamour of opposition by the states of Chhattisgarh, Jharkhand and Maharashtra, where more than half of the 41 mines are located – is the politically powerful chief minister of West Bengal, Mamata Banerjee. Indian environmentalists have also decried a seemingly desperate announcement by the government to auction off 41 Indian coal mines, opening a largely government-controlled sector up to all private investment for the first time ever – and thus greatly accelerating domestic coal production….”

Guardian – Revealed: development banks funding industrial livestock farms around the world https://www.theguardian.com/environment/2020/jul/02/revealed-development-banks-funding- industrial-livestock-farms-around-the-world

“Two of the world’s leading development banks have pumped billions of dollars into the global livestock sector, despite warnings that reducing meat and dairy consumption is essential for tackling the climate crisis. The International Finance Corporation (IFC) – the commercial lending arm of the World Bank – and the European Bank for Reconstruction and Development (EBRD) have provided $2.6bn (£2.1bn) for pig, poultry and beef farming, as well as dairy and meat processing, in the past 10 years….”

SDGs

IISD - SDG Index Measures All Countries’ Progress Since 2015 IISD;

“The Sustainable Development Solutions Network (SDSN) has released the 2020 edition of the Sustainable Development report, focusing on ‘The Sustainable Development Goals and Covid-19.’ The annual report tracks the performance of all UN Member States on the 17 SDGs, measuring the distance remaining to achieve each target. The 2020 report focuses on ‘The Sustainable Development Goals and Covid-19’….”

“The report released on 30 June 2020 was written by lead author Jeffrey Sachs and a team of independent experts working at the SDSN and Bertelsmann Stiftung. It includes the SDG Index along with interactive dashboards to visually represent countries’ performance by SDG. … … Presenting key report findings on 25 June 2020, Guillaume Lafortune, SDSN, said COVID-19 is negatively affecting several Goals: SDG 1 (no poverty); SDG 2 (zero hunger); SDG 3 (good health and wellbeing); SDG 8 (decent work and economic growth); and SDG 10 (reduced inequalities). In other areas, the ultimate effects of the pandemic remain unclear. …”

As a reminder: “The SDSN annual report is one of several SDG assessment reports that are released annually prior to the High-level Political Forum on Sustainable Development (HLPF) meeting, which takes place in July (7-16 July). The UN Secretary-General’s ‘2020 SDG Progress Report‘, which was released in May, identified areas of progress up to the end of 2019 as having included declining global poverty, falling rates of maternal and child mortality, increasing access to electricity, and the development of more national sustainable development policies. “

And a link: IISD Tools Support Policy Makers’ Efforts to Prioritize Multiple Goals

AMR

Stat - Pharma giants to unveil major $1 billion venture to push novel antibiotics https://www.statnews.com/pharmalot/2020/06/29/antibiotics-merck-lilly-pfizer-who/

(gated)

“Amid escalating concerns over antibiotic resistance, several big drug makers are creating a new $1 billion for-profit venture to acquire or invest in small antibiotic companies and their nascent products, according to two people familiar with the plans. The effort will be announced on July 9 by the chief executive officers at Pfizer, Merck, Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Bayer Pharmaceuticals, and Merck KGaA, among others. Also on hand will be government officials from Germany, Sweden, the U.K., and France, as well as representatives from Wellcome Trust and Pew Charitable Trusts…”

SRHR & GBV

UNFPA - Five things you didn’t know about practices that harm girls https://www.unfpa.org/news/five-things-you-didnt-know-about-practices-harm-girls

“Every day, hundreds of thousands of girls around the world are harmed physically or psychologically, with the full knowledge and consent of their families, friends and communities. And without urgent action, the situation is likely to worsen. These are the findings of UNFPA’s flagship 2020 State of World Population report, released today. The report examines the origin and extent of harmful practices around the world, and what must be done to stop them. It identifies 19 harmful practices – ranging from breast ironing to virginity testing – that are considered to be human rights violations. But it focuses on three practices in particular that are widespread and persistent, despite near-universal condemnation: female genital mutilation (FGM), child marriage and son preference. Below are five unexpected, and critical, takeaways from the report….”

BMJ (blog) - Will covid-19 be the catalyst for a “new deal” for the health and wellbeing of women, children and adolescents? Helen Clark (chair of PMNCH Board); BMJ blog;

“This week, I joined online with over 1700 delegates from 120 countries for Lives in the Balance: A covid-19 summit to explore ways of improving and increasing investment in health systems and social protection policies for women, children, and adolescents as the world rebuilds in the wake of the pandemic….”

“PMNCH consulted widely across its partnership, and has developed a seven-point Call to Action on covid-19, urging governments to strengthen political commitment, policies and financing to support:…”

Lancet Letter – US Global Gag Rule increases unsafe abortion T McGovern; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30921-1/fulltext

“The Trump administration issued the Protecting Life in Global Health Assistance policy in 2017. This policy is an expansion of the Global Gag Rule that blocks US global health assistance to foreign non-governmental organisations that provide, counsel on, refer to, or advocate for abortion services; even if they do so with their own funding and in countries where abortion is legal. Following an additional policy expansion in 2019, foreign organisations that comply with the policy must now

attach it to all subgrants that they give to other foreign organisations, including those that do not involve US global health assistance. Researchers have found three crucial effects of the policy: decreased stakeholder coordination and reduced discussion related to sexual and reproductive health and rights; reduced access to contraception with accompanying increases in unintended pregnancy and induced abortion; and negative outcomes beyond reproductive health, including weakening of health-care system functioning. These consequences are all associated with adverse maternal health outcomes….”

Lancet - Comprehensive sexuality education to address gender-based violence

R Rollston et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31477- X/fulltext

“The COVID-19 pandemic has unmasked underlying inequities. Measures such as lockdown and physical distancing have confined many people to isolated, unsafe places that may increase risk of gender-based violence (GBV). If lockdowns or restricted movement continue for just a year, it is estimated there will be 61 million more cases of GBV than what would have already been expected. In response to this increase, UN Women launched the Shadow Pandemic public awareness campaign in May, 2020. Meanwhile, the UN Secretary-General has called for countries to include GBV prevention as a component of COVID-19 recovery plans….”

“GBV is a multifaceted issue, but the failure to implement comprehensive sexuality education (CSE) internationally puts all people at increased risk of violence. CSE includes developmentally and culturally relevant, science-based, medically accurate information on a wide range of topics, including human development, gender identity, sexual behaviours, communication skills, empathy, and mutual respect. CSE teaches the skills needed to develop healthy relationships and to prevent and not perpetrate violence….”

Lancet Commission on Women and Cancer

Lancet (Comment) – A Lancet Commission on women and cancer O Ginsburg & R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(20)31479-3/fulltext

“…To advance an evidence-based, gendered approach to cancer risk and cancer control, The Lancet Commission on women and cancer will address urgent questions at the intersection of social inequality, cancer risk, and outcomes, and the status of women in society. The Commission will comprise a multidisciplinary and diverse team with expertise in gender studies, human rights, law, economics, sociology, as well as cancer epidemiology, prevention, and treatment. … … We will ask challenging questions about the causes of cancer in women, and “the causes of the causes”, such as the commercial and social determinants of health, that drive the increasing exposures for women to tobacco, alcohol, dietary, and other modifiable risk factors. … The Commission will not, however, be narrowly focused on women's cancers, or solely on the gendered impacts of cancers that affect both women and men. Rather, this Commission will explore the nexus of gender, power, and cancer.”

Black Lives Matter & Decolonize global health

BMJ blog - When Women’s Spaces Don’t Deliver! https://blogs.bmj.com/bmjgh/2020/06/28/when-womens-spaces-dont-deliver/

Hard-hitting and brave blog by Shakira Choonara and Vicci Tallis. Coming back on the ‘Women Deliver’ BLM commotion from recent weeks.

Cfr a tweet by Shakira: “When one of the largest movements of women and girls is marked by claims of racism. What is our collective responsibility as a global community, as youth 'activists'? Or do we wait until the loss of life #GeorgeFloyd occurrences then go to protest?”

And a link:

Guardian - ‘Decolonise and rename’ streets of Uganda and Sudan, activists urge

“Campaigners target statues of slave owners and roads named after imperial armies as protests spread to Africa.”

2020 Triad Statement https://www.who.int/publications/m/item/2020-triad-statement

No, this has nothing to do with the Chinese triads .

“Over 600 government chief nursing and midwifery officers, leaders and representatives of national nursing associations and midwifery associations, together with the International Council of Nurses (ICN), the International Confederation of Midwives (ICM), the World Health Organization (WHO) and key partners, including WHO Collaborating Centers for Nursing and Midwifery, regulators, and the Nursing Now campaign, gathered virtually from more than 145 countries for the 8th ICN-ICM-WHO “Triad Meeting” on 16-18 June 2020….”

“…As a result of the proceedings and deliberations of the meeting, the participants within their respective roles commit to supporting WHO Member States in the development and implementation of the following (10) actions, as relevant to the national and local context:…” Check out what these 10 actions are. Our favourite ones are (3) and (10).

Exemplars in Global health platform

Exemplars in Global Health;

Exemplars in Global Health just launched new findings on national success stories.

“Exemplars in Global Health is a coalition of experts, funders, and collaborators around the globe, supported by Gates Ventures and the Bill & Melinda Gates Foundation, who share the belief that rigorously understanding global health successes can help drive better resource allocation, policy, and implementation decisions. …. … The Exemplars in Global Health platform was created to help decision-makers around the world quickly learn how countries have solved major health and human capital challenges. Our goal is to ensure that our research helps you take action….”

“…With input from in-country and global experts, we analyze countries that have made extraordinary progress in important health outcomes and disseminate the key takeaways. Our hypothesis is that the lessons contained in this growing list of Exemplar narratives will be a resource to leaders committed to improving health and achieving success in their countries….”

So it’s about studying positive outliers and learning from them.

WHO Bulletin (July issue) https://www.who.int/bulletin/volumes/98/7/en/

Do check out first the Editorial - Tackling antimicrobial resistance in the COVID-19 pandemic

H Getahun et al argue that antimicrobial stewardship activities should be integrated into the pandemic response across the broader health system through five measures.

Some papers & reports of the week

HS Governance collaborative - Private sector landscape in mixed health systems: new drafts documents available https://hsgovcollab.org/en/news/private-sector-landscape-mixed-health-systems-new-drafts- documents-available

“…Seven discussion documents have been commissioned by the World Health Organization and recommended by the Advisory Group on the Governance of the Private Sector to support the development of a WHO strategy: Private Sector Utilization: Insights from Standard Survey Data; Measuring the size of the private sector: metrics and recommendations; Engaging the Private Health Sector to Advance Universal Health Coverage: WHO Eastern Mediterranean Region Case Study; Principles for engaging the private sector in universal health coverage; Private sector accountability for service delivery in the context of UHC; International organizations and the engagement of private healthcare providers; Private Health Sector Engagement in the Journey towards Universal Health Coverage: Landscape Analysis.”

Global Health Promotion - Addressing the commercial determinants of health begins with clearer definition and measurement

K Lee et al ; https://journals.sagepub.com/doi/full/10.1177/1757975920931249

Cfr a few tweets:

Luke Allen: “Nice distinction between #CDOH definitions from academics vs @who ; the latter lumps commercial actors in with all non-state actors in most of its texts”

Kent Buse: “ In new editorial @profplum8 & Nick Freudenberg argue that a composite index on commercial determinants of health could help better help target prevention efforts at all levels - and particularly for #NCDs.”

BMC Public Health - Defining the commercial determinants of health: a systematic review C de Lacy-Vawdon et al ; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020- 09126-1

« …This research aims to articulate the CDoH as described in the literature, summarize substantive findings, and assess strengths and limitations of current literature.”

Some of the results & conclusions: “The dynamics constituting CDoH include broad facilitators such as globalization of trade, corporate structures, and regulatory systems, articulation of social and economic power, neoliberal and capitalist ideologies; additional elements include corporate activities such as marketing, corporate political activities, corporate social responsibility, extensive supply chains, harmful products and production, and issues of accessibility. These contribute significantly to worsened global health outcomes. … … Literature describing effects of macro conditions and corporate activities on health could usefully utilize CDoH terminology. Facilitation via revised, consistent and operational definition of CDoH would assist. Social, political, commercial and economic structures and relations of CDoH are under-theorized. Systematic approaches to identifying, describing, and disrupting these are required to improve global health. »

BMJ GH - Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review N Gibbs et al ; https://gh.bmj.com/content/5/6/e002259

Their conclusion: « Overall, OR (Operational Research) for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare. “

HP&P - What happens when performance‐based financing meets free healthcare? Evidence from an interrupted time‐series analysis

N Kuunibe, M de Allegri et al; https://academic.oup.com/heapol/article- abstract/doi/10.1093/heapol/czaa062/5864946?redirectedFrom=fulltext

“In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy….”

SS&M - Is it Unfair for the Affluent to Be Able to Purchase “Better” Healthcare? “Existential Standards” and “Institutional Norms” in Healthcare Attitudes across 28 Countries E Immergut et al ; https://www.sciencedirect.com/science/article/pii/S0277953620303658

“Existing research has found that individuals often perceive healthcare inequalities as unfair; yet, there is high variation in unfairness perceptions between countries. This raises the question of whether the institutional context of the healthcare system is associated with what people perceive as just. Using data from the ISSP study and OECD health expenditure data from 2011/13, we explore whether individual attitudes about the unfairness of healthcare inequality – the ability to purchase “better” healthcare for the affluent – vary systematically with a country’s institutional environment: namely, with the prevalence of cost barriers to healthcare access, and with the degree and type of public healthcare financing. Three general findings emerge from the analysis: (1) Higher cost barriers correlate with lower levels of perceived unfairness in healthcare inequality, suggesting those exposed to greater levels of inequality tend to be more accepting of inequality. This finding is consistent with empirical justice theory and the expected relevance of an ‘existential’ standard of justice, stemming from individuals’ proclivities to accept the status quo as just. (2) Further, greater public financing of healthcare correlates with higher perceived unfairness. Drawing on neo-institutionalist theory, this may suggest that greater public financing enshrines access to healthcare as a universal right, and hence provides an ideational framing that delegitimizes unequal opportunities for purchasing better healthcare. (3) Further, higher unfairness perceptions of lower income and educational groups are more strongly associated with greater public financing than those of their respective comparison groups. This may indicate that the normative right to healthcare is of particular importance to the disadvantaged, which could potentially explain the political quiescence on healthcare of lower income and educated persons in societies that lack universal health systems. In sum, this study contributes to the larger debate on the interrelatedness of healthcare institutions and public opinion, and specifically on perceptions of injustice.”

Georgetown Law - The Origins and Future of Global Health Law: Regulation, Security, and Pluralism Sam F Halabi; https://www.law.georgetown.edu/georgetown-law-journal/in-print/volume-108- issue-6-june-2020/the-origins-and-future-of-global-health-law-regulation-security-and-pluralism/

Cfr a tweet: “Prof. Sam F. Halabi (of @MizzouLaw ) traces the origins of global health law and argues that COVID-19 is a dramatic illustration of the movements in global health. “ 48 p.

“…The result of these movements is the future of global health law: regulation, security, and pluralism.”

Global Social Policy - Universal Health Coverage: ensuring migrants and migration are included D Mosca et al ; https://journals.sagepub.com/doi/abs/10.1177/1468018120922228?journalCode=gspa#articleShare Container

With a number of recommendations.

SS&M - Fragmentation by design: universal health coverage policies as governmentality in Senegal P Mladowsky; https://www.sciencedirect.com/science/article/abs/pii/S0277953620303725

« UHC’s role in making citizen subjects and autonomous subjects is underestimated. Making subjects is a key political driver of UHC fragmentation. Interventions that aim to reduce fragmentation overlook this rationality of UHC. Fragmentation may be an inherent feature of UHC. »

Cambridge working paper - Cut Hours, Not People: no work, furlough, short hours and mental health during the COVID-19 pandemic in the UK https://www.sociology.cam.ac.uk/sites/www.sociology.cam.ac.uk/files/v6_covid_paper_ghq- 12_and_employment_20200629_bb.pdf

Via the monthly FT Health newsletter.

This advice should be part of the #Buildingbackbetter” agenda, in our opinion. And not just in the UK.

“…People who have continued to work at least part time during the coronavirus lockdown have far fewer mental health problems than those who have lost their jobs, according to the most comprehensive study of workers across Britain during the pandemic. Research led by academics at Cambridge university argued that employers should share employment more equitably during the recovery, through shorter working weeks to limit unemployment and the associated rise in mental illness….”

Global Social Policy - Focusing on policy coherence to achieve UHC: The social protection floor approach https://journals.sagepub.com/doi/10.1177/1468018120935715

By X Scheil-Adlung. On social protection floors (SPF) as a strategy to address inequities. “Achieving UHC is largely supported and sustained by ensuring policy coherence through SPF strategies.” With Thailand as an example, the author argues.

Lancet Comment – Investing in surgery: a value proposition for African leaders D T Jumbam et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30482- 7/fulltext

“…The need for strengthening surgical care systems is especially urgent in sub-Saharan Africa, where access is strikingly limited, leading to the highest mortality and morbidity from surgically preventable and treatable conditions in the world. Approximately 93% of the population of sub- Saharan Africa lacks access to safe, affordable, and timely surgical care, compared with less than 10% in high-income countries. Despite the immense and growing need for surgical services in sub- Saharan Africa, investments by African public sector leaders to improve surgical systems on the subcontinent have been inadequate….”

“There is a basic ethical responsibility to provide surgical care as a fundamental human right, in keeping with the principles espoused in the Universal Declaration of Human Rights. Additionally, improved access to high-quality surgical care is an essential component of universal health coverage and will contribute to good health and wellbeing, leading to improved human capital— all of which are vital for poverty reduction and economic growth on the continent. … … African leaders have an ethical, social, and economic responsibility to invest in surgical care to increase the individual, societal, and national human capital needed to reap its demographic dividend.”

Some other mainstreams news & blogs of the week

New Internationalist – Broken bonds https://newint.org/features/2020/06/11/covid-19-broken-bonds

Liam Taylor on the World Bank’s waning reputation in pandemic response. Update on the WB’s pandemic bonds.

“… ‘There were plenty of people in the Bank who knew it wouldn’t work,’ says Olga Jonas, an economist at the Harvard Global Health Institute who previously worked on pandemic risk at the Bank. ‘This was meant to be impressive and innovative and flashy, to send a signal that the World Bank is solving something.’ These kinds of ‘exotic financial instruments’ were unnecessary, adds Jonas, because the World Bank can cheaply raise its own money from donor countries and capital markets, such as the $160 billion it expects to deploy in response to the Covid-19 crisis. ‘Public health is a public responsibility so it’s a big mistake to delegate it to private capital,’ she says….”

““‘This instrument is not fit for purpose and seems better designed for the needs of private investors rather than development,’ says Mark Perera of Eurodad, a civil-society network. The World Bank says it will not renew the insurance after the current bonds mature in July. The announcement was made quietly on their website in April, this time without a video.”

Bloomberg – Covid-19 Shows That Scientific Journals Need to Open Up https://www.bloomberg.com/opinion/articles/2020-06-30/covid-19-shows-scientific-journals-like- elsevier-need-to-open-up

“Publishers have had a good 355 years, but change is coming.”

Katri Bertram - Where does our responsibility in global health end? https://katribertram.wordpress.com/2020/06/29/where-does-our-responsibility-in-global-health- end/

Reflection, helping to spur debate on how global health can get to transformative change, at the scale required, and asap.

CGD (blog) - Out of Tragedy Comes Opportunity: How Can Global Health Multilateralism Seize the Moment? J Kaufman et al ; https://www.cgdev.org/blog/out-tragedy-comes-opportunity-how-can-global- health-multilateralism-seize-moment

“Last month, CGD and the Global Fund to Fight AIDS, Tuberculosis, and Malaria convened a high- level discussion, chaired by CGD President Masood Ahmed, to explore some of the rapidly evolving answers to these questions.”

With 3 key takeaways: 1. The true cost of COVID-19 will likely be measured by its impact on other health services.; 2. COVID-19 is both a devastating emergency and momentous opportunity to build a better future for health financing. 3. More health for the money is an essential element of domestic and global health policy.

Global Governance Project (blog) - Threats to the foundations of global health I Kickbusch; https://www.globalgovernanceproject.org/threats-to-the-foundations-of-global-health- 2/

"This is the critical warning: it is essential that major health challenges are taken to the #G7 and #G20, but those institutions must not fall prey to geopolitical posturing and conflicts”.

Some tweets of the week

Kai Kupferschmidt “5 months. 10,000,000 cases. 500,000 dead. When @WHO declared #covid19 a global emergency on 30.1. there were less than 10 thousand confirmed cases. Five months later, the world has passed 10 million confirmed cases. Half a million people have died. Let that sink in.”

Ilona Kickbusch “Health has always been political but never before has #globalhealth been so entangled with and dependent on #geopolitics.”

World Health Summit (on Germany becoming the president of the EU Council from 1 July on)

“Germany has declared strengthening global health as one of the priorities during its Council Presidency. The Role of the #EU in global health is one of the topics at #WHS2020.”

Global health events of the week

Launch of the Global Sustainable Health Equity movement (2 July)

“… On 21 April 2020, the founding members sent an Open Letter to H.E. Mr. António Guterres, Secretary-General of the United Nations. The letter called for a comprehensive, global ethical response to the pandemic, based on the ethical principle of equity to support for the most vulnerable populations worldwide, in addition to voicing strong support for the actions of the UN and WHO’s leadership in combating the COVID-19 pandemic….”

Aims of the global launch event:

“1. Highlight the role and importance of sustainable health equity in the response to the pandemic and beyond 2. Reiterate the initiative’s support for the UN and WHO as ethical global leaders to guide the comprehensive response to the pandemic and its aftermath. 3. Launch of the Sustainable Health Equity Movement, by bringing together all entities, organisations, and individuals who endorsed the open letter to the UN.”

HPW - Digital Technologies Will Not Save Us From The COVID-19 Pandemic https://healthpolicy-watch.news/digital-technologies-will-not-save-us-from-the-covid-19-pandemic/

Short report of a webinar from last week. “A slew of new and repurposed public health technology has been rapidly developed in the wake of the COVID-19 pandemic. But in the whirlwind of contact tracing apps, artificial intelligence, and location tracking being used for public health surveillance, old ethical dilemmas have resurfaced around who is actually benefiting from these technologies. “The question remains; will digital technologies save us from the pandemic?” asked Katerini Storeng,

associate professor and deputy director of the Independent Panel on Global Governance for Health, Centre for Development and Environment, University of Oslo. The answer is a resounding, “no” according to a panel of global health policy, governance, and anthropology experts from The New School, University College London, the Center for International Governance Innovation (CIGI), and Simon Fraser University. The panelists were speaking at the third webinar in the Global Pandemics in an Unequal World series, co-hosted by Health Policy Watch, The New School, and The Independent Panel on Global Governance….”

Global governance of health

Devex - Exclusive: DFID seeks cuts of up to 30% on aid projects https://www.devex.com/news/exclusive-dfid-seeks-cuts-of-up-to-30-on-aid-projects-97600

“Aid programs focused on poverty reduction and COVID-19 are among those under threat as the U.K. government is asking its partners to make cuts of up to 30% or more on some programs, Devex has learned. The U.K. aid budget is set to decline as the economy shrinks….”

See also the Guardian - Alarm bells ring over aid spending amid lack of clarity on DfID merger

“NGOs warn of rising uncertainty over programmes to tackle poverty and Covid-19 despite assurances from ministers.”

Reuters - Nigeria's WTO nominee says has 'strong support' from Africa https://www.reuters.com/article/us-trade-wto-nigeria/nigerias-wto-nominee-says-has-strong- support-from-africa-idUSKBN2411AN

“Nigeria’s candidate to head the World Trade Organization (WTO) said she feels “strong support” from Africa and expects African leaders to unite behind one candidate as sources following the race said she is gaining broader backing. Ngozi Okonjo-Iweala, a former finance and foreign minister who has more than 25 years experience at the World Bank, is seeking to replace Brazil’s Roberto Azevedo who announced last month he would step down on Aug. 31, in a surprise move at a critical juncture for the body. Africa has struggled in the past to unite behind one candidate and the Geneva-based watchdog has never been led by someone from the continent before, nor by a woman, and there is broad feeling it is Africa’s turn….”

PCT Invites Public Comments on the Draft Toolkit on Tax Treaty Negotiations https://www.tax-platform.org/news/pct-invites-public-comments-draft-toolkit-tax-treaty- negotiations

“The Platform for Collaboration on Tax (PCT) – a joint initiative of the IMF, OECD, UN and World Bank – is seeking feedback from the public on a draft toolkit designed to help developing countries build capacity in tax treaty negotiations. PCT’s Draft Toolkit on Tax Treaty Negotiations is a joint effort to provide capacity-building support to developing countries on tax treaty negotiations, building on existing guidance, particularly from the UN Manual for the Negotiation of Bilateral Tax Treaties between Developed and Developing Countries (the “UN Manual”). …”

Stat - U.S. withdrawal from WHO threatens to leave it ‘flying blind’ on flu vaccines

Stat News;

Analysis by Helen Branswell. “Twice a year, influenza experts from 10 institutions around the world meet at the World Health Organization’s Geneva headquarters to pore over mounds of data. At the end of the weeklong meetings, they make decisions that affect people around the world: namely, which variants of the flu virus should be used for vaccinations the following season. While the selections don’t always hit the mark — influenza is notoriously hard to predict — it’s the best process health officials have to keep flu vaccines up to date and try to protect people from the annual scourge. Now, with the pending withdrawal of the United States from the WHO, the future of the process — or at least America’s involvement in it — is in question….”

World Development - COVID-19 and the case for global development

J Oldekop et al; https://www.sciencedirect.com/science/article/pii/S0305750X20301704

“COVID-19 accentuates the case for a global, rather than an international, development paradigm. The novel disease is a prime example of a development challenge for all countries, through the failure of public health as a global public good. The COVID-19 pandemic has highlighted the falsity of any assumption that the global North has all the expertise and solutions to tackle global challenges, and has further highlighted the need for multi-directional learning and transformation in all countries towards a more sustainable and equitable world. We illustrate our argument for a global development paradigm by examining the implications of the COVID-19 pandemic across four themes or 'vignettes': global value chains, digitalisation, debt, and climate change. We conclude that development studies must adapt to a very different context from when the field emerged in the mid-20th century.”

Global Fund Appoints New Chief Financial Officer https://www.theglobalfund.org/en/news/2020-06-26-global-fund-appoints-new-chief-financial- officer/

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced the appointment of Adda Faye as Chief Financial Officer. “…Faye brings over 15 years of experience in strategic financial management and a deep understanding of the Global Fund’s financial and administrative functions. Before her selection through a competitive search process, Faye served as the Global Fund’s interim Chief Financial Officer since February 2020….”

Devex - Financial crisis deepens for the development sector https://www.devex.com/news/financial-crisis-deepens-for-the-development-sector-97584

“The financial impact of the coronavirus pandemic on the global development sector is deepening, according to a Devex survey, with more professionals reporting funding cuts and job losses….”

UHC

ABC - Amid pandemic, Trump administration asks Supreme Court to overturn Obamacare

ABC

Bigot @ work.

“In the midst of a pandemic and without an alternative health plan of its own, the Trump administration formally called on the U.S. Supreme Court to completely strike down the Affordable Care Act. The administration makes the case in a legal brief filed late Thursday in the case brought by 20 Republican-led states that want to completely invalidate the law. The justices will hear oral arguments as soon as October, which is just weeks before the general election….”

Planetary health

Guardian - $10bn of precious metals dumped each year in electronic waste, says UN https://www.theguardian.com/environment/2020/jul/02/10bn-precious-metals-dumped-each-year- electronic-waste-un-toxic-e-waste-polluting

“At least $10bn (£7.9bn) worth of gold, platinum and other precious metals are dumped every year in the growing mountain of electronic waste that is polluting the planet, according to a new UN report. A record 54m tonnes of “e-waste” was generated worldwide in 2019, up 21% in five years, the UN’s Global E-waste Monitor report found. The 2019 figure is equivalent to 7.3kg for every man, woman and child on Earth, though use is concentrated in richer nations. The amount of e-waste is rising three times faster than the world’s population, and only 17% of it was recycled in 2019….”

Globalization & Health - ‘Calibrating to scale: a framework for humanitarian health organizations to anticipate, prevent, prepare for and manage climate-related health risks’

P N Schwerdtle et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992- 020-00582-3

“…By bringing together authors from two historically disparate fields - climate change and health, and humanitarian assistance – this paper aims to increase the capacity of humanitarian organizations to protect health in an unstable climate by presenting an adapted framework. We adapted the WHO operational framework for climate-resilient health systems for humanitarian organizations and present concrete case studies to demonstrate how the framework can be implemented. Rather than suggest a re-design of humanitarian operations we recommend the application of a climate-lens to humanitarian activities, or what is also referred to as mainstreaming climate and health concerns into policies and programs. The framework serves as a starting point to encourage further dialogue, and to strengthen collaboration within, between, and beyond humanitarian organizations.”

Review of Political Economy - Policies for Equality Under Low or No Growth: A Model Inspired by Piketty

T Hartley et al ; https://www.tandfonline.com/doi/full/10.1080/09538259.2020.1769293

“GDP growth is declining in industrial economies, and there is increasing evidence that growth may be environmentally unsustainable. If growth falls below returns to wealth then inequalities increase, as Thomas Piketty recently showed. This poses a challenge to managing slow and/or negative growth. Here, we examine policies that have been proposed to solve the problem of increasing

income inequality in slow- or non-growing economies, including redistribution, taxation, and employment reforms. We construct a simple model, expanding Piketty’s recent work, to evaluate the parameter ranges within which these different policies can be effective. Our analysis leads to two main findings. First, except in the case of complete wealth equality, any strategy to prevent increasing income inequality must reduce returns to wealth below the rate of growth. Second, several strategies may prevent an increase in income inequality during periods of low growth and may slow rising inequality, but not prevent it, in non-growing economies.”

WEF (blog) – Locusts are putting 5 million people at risk of starvation – and that’s without COVID-19 https://www.weforum.org/agenda/2020/06/locusts-africa-hunger-famine-covid-19

“Locust outbreak could leave nearly 5 million people in Africa facing starvation. The crisis comes on top of food insecurity already exacerbated by COVID-19….”

Infectious diseases & NTDs

Science News - Swine flu strain with human pandemic potential increasingly found in Chinese pigs https://www.sciencemag.org/news/2020/06/swine-flu-strain-human-pandemic-potential- increasingly-found-chinese-pigs

“New study spotlights influenza virus that could wreak havoc if it adapts to humans.”

See also the Guardian - New swine flu with pandemic potential identified by China researchers

“G4 strain has already infected 10% of industry’s workers in China but no evidence yet that it can be passed from human to human.”

And see also Reuters - WHO says "we cannot let our guard down" after China pigs study

“The World Health Organization (WHO) will “read carefully” a Chinese study on a new flu virus found in pigs, a spokesman said on Tuesday, saying the findings underscored the importance of influenza surveillance during the COVID-19 pandemic….”

And HPW - Swine Flu Variant Circulating In China Not A New Virus, Says WHO Experts.

“…A swine flu variant, G4 EA H1N1, that captured headlines on Tuesday for its ‘pandemic potential’ has been monitored by WHO and health authorities since 2011, WHO Health Emergencies Executive

Director Mike Ryan said Wednesday, attempting to ease fears that a pandemic flu strain could appear on top of this year’s deadly COVID-19 pandemic. “It’s important I think to reassure people that this is not a new virus. This is a virus that is under surveillance,” said Ryan, in response to a query from Bloomberg News….”

MedicalXpress - New strain fears as fresh Ebola outbreak emerges https://medicalxpress.com/news/2020-06-strain-fresh-ebola-outbreak-emerges.html

“Scientists fear a new Ebola strain might emerge in the Democratic Republic of Congo if two versions of the disease mix together to form a new, potentially deadlier version….”

PS: in related (and more encouraging) news (via tweet Helen Branswell (STAT) – “ The world now has a 2nd #Ebola Zaire vaccine. The European Commission has approved J&J's 2-dose vaccine, using human safety & immunogenicity data bolstered by effectiveness data from animal studies.”

WHO - WHO urges countries to expand access to rapid molecular tests for the detection of TB and drug-resistant TB https://www.who.int/news-room/detail/30-06-2020-who-urges-countries-to-expand-access-to- rapid-molecular-tests-for-the-detection-of-tb-and-drug-resistant-tb

“The World Health Organization (WHO) is urging countries to expand access to rapid molecular tests for the detection of TB and drug-resistant TB in updated consolidated guidelines, released today. The guidelines are accompanied by an operational handbook to facilitate rapid implementation and roll out of rapid molecular tests by national TB programmes, ministries of health and technical partners….”

UN News - ‘Major breakthrough’ in fight against diseases spread by mosquitos https://news.un.org/en/story/2020/06/1067202

“The UN nuclear agency (IAEA) has announced a major breakthrough in the bid to scale up technology designed to suppress disease-carrying mosquitos, and bring dengue, yellow fever and Zika under control. A study has shown that the use of a specialized drone, developed by IAEA and partners, to release tens of thousands of male mosquitoes, sterilized by using radiation, is effective: many of the sterilized males mate with females, who then produce no offspring, reducing the mosquito population over time….”

NCDs

Newsflash on NCDs (29 June 2020) https://mailchi.mp/ace1e5d41f8c/who-newsflash-on-ncds-29-june-2020

Newsletter curated by WHO's Department for Noncommunicable Diseases #NextGenNCDs

BMJ collection – Food for thought 2020 https://www.bmj.com/Food4Thought20

“How do we maintain a healthy diet? The question is simple, the answer is long, and one which many of us clearly get wrong. We know nutrition is one of the key drivers of chronic disease; yet there is great controversy as to what constitutes a healthy diet and how we should encourage individuals to eat well. In 2018, The BMJ and Swiss Re Institute worked together to publish a landmark series of articles on the science and politics of nutrition. Building on this success, The BMJ and Swiss Re Institute have come together once again to explore how nutrition can lead to better health outcomes and greater societal resilience against disease.”

Big Alcohol Lobbies Against Alcohol Taxation https://movendi.ngo/news/2020/06/29/big-alcohol-lobbies-against-alcohol-taxation/

“Big Alcohol is asking for special treatment by lobbying against alcohol taxation with the excuse of overcoming the COVID-19 setback. The alcohol industry lobby in Australia is pushing for a halt of automatic CPI-linked increases for alcohol for at least 12 months….”

We reckon this is not just an issue in Australia…

BMJ Analysis - Public health response to ultra-processed food and drinks

J Adams et al ; https://www.bmj.com/content/369/bmj.m2391

“Growing evidence confirms a link between consumption of ultra-processed food and drinks and noncommunicable diseases. Jean Adams and colleagues explore the implications for public health action.”

Sexual & Reproductive / maternal, neonatal & child health

IJHPM - Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review

A Banke-Thomas et al; https://www.ijhpm.com/article_3841.html

“Cost is a major barrier to maternal health service utilisation for many women in low- and middle- income countries (LMICs). However, comparable evidence of the available cost data in these countries is limited. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings….”

Miscellaneous

Devex - UN enlists 10,000 digital volunteers to fight COVID-19 misinformation https://www.devex.com/news/un-enlists-10-000-digital-volunteers-to-fight-covid-19- misinformation-97615

“The United Nations is mounting a response to counter misinformation on COVID-19, which is spreading faster than the disease itself, according to Melissa Fleming, under-secretary-general of global communications….”

New Yorker - The Lancet Editor’s Wild Ride Through the Coronavirus Pandemic https://www.newyorker.com/news/letter-from-the-uk/the-lancet-editors-wild-ride-through-the- coronavirus-pandemic

On Horton’s trajectory, lately, in the UK, but also linking back to the past of the Lancet.

Covid-19 Health System response monitor https://analysis.covid19healthsystem.org/index.php/2020/06/25/how-are-countries-compensating- health-professionals-for-income-losses-and-extra-expenses-due-to-covid-19/

New analysis: “How are countries compensating health professionals for income losses and extra expenses due to COVID-19? “

Fyi – “The COVID-19 Health Systems Response Monitor (HSRM) collects and organizes information on how countries’ health systems are responding to the crisis. It currently includes information for most of the countries in the WHO European Region, including all EU Member States, and is updated regularly.”

Devex - 'Radical transformation': COVID-19 shows urgency for food systems policy shifts https://www.devex.com/news/radical-transformation-covid-19-shows-urgency-for-food-systems- policy-shifts-97579

“A dramatic shift in global policy governing food systems is needed if the world is to sustainably feed a growing population during and after the COVID-19 pandemic and achieve the SDGs, according to a new report by an independent arm of the Food and Agriculture Organization. The Committee on World Food Security’s High Level Panel of Experts found that policymakers must adopt new food security and nutrition frameworks to ensure people have access to sufficient, nutritious food to eliminate hunger, achieve food security and improved nutrition, and promote sustainable agriculture….”

On Think tanks (report) - COVID-19: First survey results https://onthinktanks.org/series/covid-19-first-survey-results/

“The first On Think Tanks (OTT) survey on the impact of COVID-19 on think tanks was carried out between 7 April and 25 May 2020. It was a short pilot survey intended to provide us with a rapid assessment of how think tanks have been affected by the pandemic, and how they have responded in the early months of the crisis….”

Science (news) - Just 50% of Americans plan to get a COVID-19 vaccine. Here’s how to win over the rest https://www.sciencemag.org/news/2020/06/just-50-americans-plan-get-covid-19-vaccine-here-s- how-win-over-rest

“To stop the pandemic, the world’s public health experts must win the coming “story war” over vaccine misinformation.”

BBC News – Covid-19: China pushes traditional remedies amid outbreak https://www.bbc.com/news/world-asia-53094603

“As scientists race to develop a vaccine for Covid-19, Beijing has been championing traditional Chinese medicine (TCM) as a way to treat the disease. A recent white paper released by the Chinese government claimed that 92% of the country's Covid-19 cases were treated in some way with it….”

Research

Globalization & Health - A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region

H Naal et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020- 00585-0

“This is the first systematic review of GHCB initiatives among LMICs in the MENA region.”

Health Information Management Journal - Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

K Hoxha et al ; https://journals.sagepub.com/eprint/HZGDD9USDRC8RCUH76BP/full

“Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness. This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges….”