IHP News 585 : There Will Be Hope

IHP news 585 : There will be hope

( 21 August 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,

Last weekend I heard “Jerusalema” for the first time (in a Belgian news bulletin on tv, actually), a catchy song that has already sparked plenty of synchronous dancing around the world and lifted numerous moods, I reckon. Arguably, I’m late to the party, not being South-African nor on TikTok (and more to the point, about as hip as you would expect from a (nearly bald) 47-year old). So far, an ITM version of the dance also didn’t materialize yet, as far as I know, but when it happens, it will be a major “global health event” to cover, for sure ! In any case, the song gives one hope, so it’s perhaps no coincidence that it has not just become a worldwide summer hit now, but also the unofficial anthem of the Covid-19 response, a #safelysocializing one moreover. As long as there is music, there will be hope for this world.

Indeed, whether on Covid-19, the climate and biodiversity emergencies, the grotesque inequity “characterizing” our economic system, or "November", deep down, we have to believe that, like in Hollywood movies, the good will eventually prevail over the bad, or light over darkness. Even if human beings are not particularly good at long term thinking, let alone 7 generations ahead, as argued for in a recent blog by Stuart Gillespie on intergenerational equity. Starting from Roman Krznaric’ latest book, The Good Ancestor: how to think long term in a short-term world, Gillespie referred in his article to the Iroquois concept of ‘seven generation stewardship’, picked up recently also by the Lancet Syndemic Commission report. The concept “urges the current generation to live and work for the benefit of the seventh generation into the future.” As you can tell on a daily basis, neoliberal capitalism is a stunningly effective system to do just that. Cynical remarks aside, however, given the blatant lack of ‘seven generation stewardship’ by most of our current leaders and CEOs, criticism of the younger generation (dubbed by some “generation Covid”), certainly of the dichotomous kind (as in “Young people ‘saints or sinners’ ?” ) feels more than a bit unfair. Can we agree that all of us, not just the young, can be both saints and sinners, depending on the situation or occasion? That’s what it means to be ‘human’, after all. Moreover, that their generation is expected to clean up the planetary (ill-health) mess of the past 7 generations? A bit exaggerated, perhaps, but you get the point. You’d “party till you drop” for less if you were 18 now. And let’s not forget, as a spot-on Guardian op-ed put it this week, “neoliberalism is spreading coronavirus faster than any “reckless teenager” ever could”. Exactly.

When we try to build better in the years to come, seven generation stewardship is what we need. If and when that happens, mankind will at last have more hope. Rich and poor. As well as the generations to come.

Enjoy your reading.

Kristof Decoster

Featured Article

Decolonial thought and African consciousness for socially just health systems: An imaginative space

Lance Louskieter (PhD Candidate, Health Systems and Policy Research Division, School of Public Health and Family Medicine, University of Cape Town, Queer Activist, Decolonial Scholar, Advocate for the decriminalization of sex work in South Africa. Senior Atlantic Fellow for Health Equity at Tekano) and Shehnaz Munshi (HPSR researcher, occupational therapist, Emerging Voice (2018) and Senior Atlantic Fellow for Health Equity at Tekano. Currently she is the Project Manager for the Sheiham Family/Wits program on social determinants of health and health equity, School of Public Health, University of the Witwatersrand. She serves on the steering committee of the People's Health Movement. )

On the 1st and 2nd of October 2020, we plan to host a virtual Africa convening to have a conversation about decoloniality in the broader field of Global Health. The purpose of the convening is for African health scholars and practitioners to build collective capacity to engage in critical decolonial thinking in order to re-imagine socially just African health systems. While the importance of decolonial perspectives for global health has emerged in recent years, many of the discussions and ideas have, so far, been concentrated in well-resourced global north institutions which is once again in line with the colonial project. Decolonizing health in Africa must therefore, necessarily, include African scholars shifting their focus inward to build solidarity across the continent. They must break down the silos and divides that exist across the diverse African contexts, and re-imagine African knowledge and realities as valuable, and the people as legitimate knowledge bearers.

The convening, in early October, which is supported by the HSG Africa regional network, the Atlantic Institute and Tekano, will allow African health scholars to engage authentically and honestly, and make space for difficult conversations about power and hegemonic epistemologies. These conversations are part of a larger initiative, and will therefore make links with the HSR 2020 symposium organized session (track 5), scheduled for Thursday, Nov 12, 2020, titled “What does a socially just health system look like: an imaginative space?”. Stay tuned for that.

In the convening, we intend to build a bridge between the global health and decoloniality communities which, while related, often operate separately. The goal of the convening is for health thinkers and practitioners to learn from decolonial thinkers and practitioners. During the event, we will consider the limitations of (globally) hegemonic epistemologies, and their implications for African health and health systems. Explicit decolonial thinking can facilitate a process of African conscientization - that is, an unthinking/ unlearning/ unravelling of the ’status quo’ in episteme traditions to help us critically reflect on the way we think about the world and the things we do.

Decolonial thought as a segue toward African-centred socially just health systems

In a podcast entitled “Covid-19 and its impact on the Geo-politics of knowledge production”, Prof Sabelo Ndlovy Gatsheni discussed how decolonial thinking enables the politicizing and historicizing of health and health systems challenges in Africa, and enables us to call out the insidious and ubiquitous ways in which coloniality manifests itself in health systems and policies and in African health. This is work of disruptions, shifts and explicit engagement with oppressive power to improve

the lives and re-instil the dignity of African people and places. What are we shifting away from? What the colonial project has predetermined: that African people cannot produce knowledge and that they are not legitimate holders of knowledge. We radically resist narratives of Africa as a ‘dark’ continent and discourses about its people being primitive, and the nuanced and insidious ways in which these ideas persist both in contemporary global relationships and within African institutions of academia, civil society and health systems. Instead, decolonial thinking requires health thinkers and practitioners to explicitly name invisible power that continues to reinforce and perpetuate oppression, marginality and poor material and social conditions of African people. Moreover, the decolonial project calls for African health scholars and practitioners, despite good intentions, to critically reflect and be reflexive on how our training, research and practices perpetuate the very systems of oppression underlying the field of global health and (post-)colonial medicine. We need to move away from stereotypes that exist within ourselves about ourselves, and de-centre “weaknesses” constructed by and through colonialism. A shift away from the white and ‘foreign’ gaze, is an important step. We also need to look to critical social science theories, ideas and strategies that challenge predominant racial, patriarchal, sexist, homo- and trans-phobic conservative, liberal, and neoliberal politics in African settings. Explicitly connecting decolonial thought to a discourse of health in Africa can inform a paradigm shift in health which ignites African consciousness amongst health practitioners and fosters the development of Afrocentric and socially just health systems and policies.

An alternative decolonial Pan-African paradigm that can advance socially just health systems and policies (and the role of HPSR in this)

As Molefi Asante put it, African intellectuality has been undermined for far too long. Against this overall backdrop, the convening will hone in on Health Policy and Systems Research (HPSR) as a progressive field on the continent and its success and possibilities for African-centredness in its knowledge and praxis. The field of HPSR offers us theorisations and empirical work to guide us in engaging with the social, economic and political nature of health systems. Over the past decade, HPSR scholars in Africa have utilised different knowledge and methodological approaches across disciplinary boundaries, with a particular focus on foregrounding the legitimacy of often under- valued social science contributions. HPSR scholars have also increasingly theorised and worked with local actors, including policymakers and civil society who have shaped the nature of HPSR.

In this convening we will explore how the field can go further. Decolonial thought leaders and health thinkers and practitioners will reflect on the possibilities for alternative paradigms of knowledge and for the curating of an African/decolonial archive of health knowledge and praxis to advance socially just health systems on the continent. We seek to engage with the existing knowledge archive in African health and health systems and policy work and reflect on the knowledge contributions from different parts of the world, what Gatsheni calls the “ecology of knowledge”, examining dominant knowledge paradigms and how knowledge is used to assert power and authority. Health scholars and practitioners in Africa will consider critical questions about the knowledge archives we should be drawing on to deepen social justice within health policies and health systems in Africa.

Tools for dismantling the master’s house: An African knowledge paradigm informing praxis

After considering what constitutes an African-centred paradigm for health in Africa, it is only appropriate that we explore the praxis elements of this alternative paradigm. We will interrogate ‘Afrocentric methods’ in research, advocacy, policy making, activism and health systems. We will grapple with what the possibilities are for African consciousness as a foundation for Afrocentric methodologies for praxis. We will ask ourselves: What questions, methods, tools, approaches and strategies are necessary when African people are at the centre? How do our technologies or methodologies reaffirm or reinforce hegemonic paradigms? Audre Lorde offers a powerful caution

when she states, ‘for the master's tools will never dismantle the master's house. They may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change.’ The dismantling of the ‘master’s house’ - that is colonial ideologies and traditions that are imbued within our psyches and entrenched in our systems - only threatens those who still define the master's house as their only source of possibilities, solutions, or support. For Lorde, the tools of resistance and building formed within prevailing practices, structures, and institutions are ultimately unusable for the task of overturning the hegemonic conditions that still prevail. The re-imagining project requires (and forges) different sets of tools. We must therefore be cautious that the technologies of methods, strategies and techniques are not implicated in the very thing they seek to dismantle, that their use does not replicate the same conditions of hegemonic power and decentring of African peoples, though it may take on new guises. When we continue to use the master’s tools, “it means that only the most narrow perimeters of change are possible and allowable” (1984, 110– 11). It is important then that ‘genuine measures of resistance and liberation must come from somewhere else, somewhere “outside,” whether outside of “the canon,” outside of mainstream Academia, outside of modern political institutions, structures, and social processes, or perhaps from outside of history altogether.’ It is our hope that this convening can help us forge (or think about a process of forging) tools to ‘dismantle the master’s house’ so that all that is African can flourish.

A starting point

The convening is a starting point for a political project/process amongst HPSR scholars located in Africa to engage in catalytic, yet difficult conversations and deliberations for developing a language, theories, tools, strategies, approaches, methodologies and research priorities for a decolonial HPSR paradigm/orientation. Through conversation, we aim to advance theories and praxis for decolonising HPSR and to seek strategies for dismantling processes and structures that produce and sustain inequities and injustices in health policies and systems. The convening aims to engage in a process of politicising and historicising HPSR space, critically reflecting on whether we are doing work that transforms unjust political economic and social systems & structural arrangements. We will draw together decolonial theoretical insights and HPSR theories to understand shifts in HPSR for health system change and strategies for transforming African health systems. An important part of this journey will involve ‘re-membering, re-claiming, and re-imagining’ decolonial futures, through reclaiming the origins, histories and realities of African people, politics, systems, institutions and current affairs.

Not only will the deliberations reframe and redirect HPSR towards localised needs and realities, they will also develop a collective mandate amongst African scholars and practitioners within the HPSR community to determine, mobilize and organize an African-centred HPSR to advance equitable and socially just health systems. We intend this as a platform for drawing on collective insights and capacities and building solidarity across diverse African schools, building bridges, harnessing multiple perspectives for a decolonial HSPR orientation, and building strategic partnerships for action.

The urgency of these conversations is greater than ever now that Africa has to cope with the COVID- 19 pandemic, including its massive socio-economic impact. As Arundhati Roy has so aptly said, the pandemic is a portal, a gateway between one world and the next. We see this convening as an important moment to shape history.

More details of the event will be advertised soon.

Highlights of the week

Global tax justice

Forbes - How The OECD Became The World's Tax Leader N A Sarfo (Tax Notes group); https://www.forbes.com/sites/taxnotes/2020/08/11/how-the-oecd- became-the-worlds-tax-leader/#6a68e5fe6628

Interesting historical analysis (of past century and early 21st century). On the key role the OECD plays now in global tax, largely at the expense of the UN.

“… the role the OECD has taken up speaks to the organization’s powerful tax influence and leads to questions about when, how, and why the OECD became the de facto leader in international tax policy. … … Developments over the years tell a story of an OECD that had first-mover advantage in many aspects of international tax policy, starting in the 1960s when it drafted its highly influential model tax convention. The OECD’s closest policy competitor would be the U.N., but its policy at times has felt reactionary to the OECD’s activity….” “… the continual rejection of an intergovernmental tax body essentially keeps the locus of power with the OECD. …”

And looking ahead to the global OECD-led tax deal: “… As the OECD moves forward on its latest reforms, there are some concerns that the organization will generate solutions that lack the sort of real fundamental change that governments might be expecting….” And: “… Beyond that, it is questionable whether there is a real appetite for the kind of multilateralism necessary to push the OECD’s reform process forward.”

PS: meanwhile, for some of the latest on the current OECD-led tax reform proposals, see Bloomberg - OECD Pillar Two Draft Skips Decision on How to Treat GILTI

Cfr a tweet by Alex Cobham: “Remember when the OECD was briefing that while Pillar One of the new rules might be highly complex and favour OECD members, Pillar Two would make everything great for other countries? Turns out that Pillar Two will be... highly complex, and favour OECD members.”

Debt crisis developing countries

Debt in developing countries has doubled in less than a decade https://www.theguardian.com/world/2020/aug/16/debt-in-developing-countries-has-doubled-in- less-than-a-decade?CMP=Share_iOSApp_Other

“Jubilee Debt Campaign reveals a sharp rise in the number of countries in distress since 2018.”

“Developing nation debt has more than doubled in the past decade and left more than 50 countries facing a repayment crisis, according to a campaign group. Data from the Jubilee Debt Campaign shows that even without taking full account of the impact of the coronavirus pandemic, there has been a sharp jump in the number of poor countries in debt distress since 2018. Debt relief was provided for poor countries at the end of the 1990s and in the mid-2000s, but the JDC said external debt payments as a share of government revenue had more than doubled from 6.7% to 14.3% since 2010 and were at their highest level since 2001….”

Guardian - World Bank: Covid-19 pushes poorer nations 'from recession to depression' https://www.theguardian.com/business/2020/aug/19/world-bank-calls-for-greater-debt-relief-for- poorer-countries-in-wake-of-covid-19

The World Bank president, David Malpass, says a more ambitious debt relief plan is needed.

“The head of the World Bank has called for a more ambitious debt relief plan for poor countries after warning that the Covid-19 recession is turning into a depression in the most challenged parts of the globe. In an interview with the Guardian, David Malpass raised the prospect of the first systematic write-off of debts since the 2005 Gleneagles agreement as he said fresh Bank figures due out next month would show an extra 100 million people had been pushed into poverty by the crisis….”

ISDS threat Covid

Guardian - Global firms expected to sue UK for coronavirus losses https://www.theguardian.com/law/2020/aug/15/global-law-firms-expected-to-sue-uk-for- coronavirus-losses

And not just the UK….

“Governments around the world – including the UK – face a wave of lawsuits from foreign companies who complain that their profits have been hit by the pandemic. Webinars and presentations shared with clients reveal that leading global law firms anticipate governments around the world will soon face claims over their response to the Covid-19 crisis. The actions are being brought under investor state dispute settlement (ISDS) clauses which are embedded in trade and investment agreements and allow foreign investors and firms to sue other countries’ governments….”

Check out the Open letter to governments on ISDS and COVID-19 by a number of international and regional organisations

Global health governance

Devex - US pandemic proposal moving forward despite concerns, aid experts say https://www.devex.com/news/us-pandemic-proposal-moving-forward-despite-concerns-aid- experts-say-97944

“Members of the White House National Security Council met last week to discuss a proposal for a new international pandemic response initiative that has riled U.S. development advocates and global health experts, according to multiple sources with knowledge of the meeting. People familiar with the proposal believe it is moving quickly and expect its backers could seek President Donald Trump’s approval of the initiative as soon as this week. Details about the proposed President’s Response to Outbreaks — or PRO — first emerged in May, when Devex reported that the Department of State was spearheading an effort to consolidate bilateral and multilateral global health security programs under its own authority. …”

“… … The proposed initiatives would see the creation of a new “America’s Response to Outbreaks coordinator” within the State Department, and it has been widely speculated that Deborah Birx, the U.S. global AIDS coordinator who currently also serves as the coronavirus response coordinator, would take on that role….” “…U.S. development advocates are also concerned about the fate of USAID’s programs under such a proposal, with many under the impression that the plan would see significant portions of USAID’s more than $3 billion global health budget shift to the State Department’s authority….”…”

Reuters - Exclusive: Germany, France want more funding, power for WHO as part of sweeping reforms https://uk.reuters.com/article/us-health-coronavirus-who-reform-exclusi/exclusive-germany-france- want-more-funding-power-for-who-as-part-of-sweeping-reforms-idUKKCN25F1TT

Must-read. “Germany and France want to give more money and power to the World Health Organisation after the COVID-19 pandemic underscored long-standing financial and legal weaknesses at the U.N. agency, an internal document seen by Reuters shows. … … The proposed reforms could already be discussed at the WHO in mid-September, three officials familiar with the talks told Reuters, in a fast timeline that would confirm the two European powers’ growing concerns about the organisation, which they also see as excessively subject to external influences….”

“The seven-page document lists 10 reforms aimed at boosting the WHO’s legal powers and funding….”

See also HPW - Germany & France Propose Reforms To Give The WHO More Power, Funding & Oversight

“…The reforms are clearly “pro-WHO,” a diplomat in Geneva familiar with the negotiations told Reuters. One key proposed reform is the creation of an independent expert committee to assess WHO’s operations in emergency situations as they unfold….”

TWN - WHO: Multi-stakeholder governance framework for ACT-Accelerator facilitation council https://www.twn.my/title2/health.info/2020/hi200807.htm

Good analysis on the governance framework for the ACT-Accelerator facilitation council.

“The World Health Organization Secretariat has proposed a multi-stakeholder governance framework for the facilitation council of the Access to COVID-19 Tools Accelerator (ACT- Accelerator). This was presented on 6 August and the Secretariat is currently seeking comments from WHO Member States.;..”

WHO Executive Board in October

The dates for the special session of the WHO Executive Board have been fixed by Dr. Tedros and EB Chair Dr Harsh Vardhan for 5 October 2020 and 6 October 2020.

Emerging Voices evaluation (10 years)

ITM: Emerging Voices is looking for evaluators https://www.itg.be/E/Article/emerging-voices-is-looking-for-evaluators

“After a decade of training Emerging Voices, we are curious to see if the initiative managed to make a change, but also to look forward and analyse how it can remain relevant and innovative for the future.”

Deadline for applications: 11/09. Deadline for questions and clarifications: 28/08.

Spread the word!!

Planetary health

Guardian - Another two years lost to climate inaction, says Greta Thunberg https://www.theguardian.com/environment/2020/aug/19/another-two-years-lost-to-climate- inaction-says-greta-thunberg

“Two years on from Greta Thunberg’s first solo school strike for the climate, she says the world has wasted the time by failing to take the necessary action on the crisis. Thunberg’s strike inspired a global movement, and on Thursday she and other leading school strikers will meet Angela Merkel,

the chancellor of Germany, which holds the rotating presidency of the European council. They will demand a halt to all fossil fuel investments and subsidies and the establishment of annual, binding carbon budgets based on the best science. … … Our demands include halting all fossil fuel investments and subsidies, divesting from fossil fuels, making ecocide an international crime, designing policies that protect workers and the most vulnerable, safeguarding democracy and establishing annual, binding carbon budgets based on the best available science….”

See their Guardian op-ed: After two years of school strikes, the world is still in a state of climate crisis denial.

Project Syndicate - The Need for Debt-for-Climate Swaps

S Akhtar et al ; Project Syndicate;

The authors call for a new global facility that would combine debt relief with investments in sustainability.

Bloomberg - The First Arctic Summer Without Ice Is Coming in Just 15 Years Bloomberg;

“New models convinced a team of scientists to move up projections for the first summer in 130,000 years without sea ice.”

“… By the summer of 2035, it may not be accurate. Scientists estimate that in just 15 years Arctic summer sea-ice could disappear for the first time since primitive humans left Africa. …”

Warming Greenland ice sheet passes point of no return https://news.osu.edu/warming-greenland-ice-sheet-passes-point-of-no-return/

“Even if the climate cools, study finds, glaciers will continue to shrink.”

“Nearly 40 years of satellite data from Greenland shows that glaciers on the island have shrunk so much that even if global warming were to stop today, the ice sheet would continue shrinking.

The finding, published today, Aug. 13, in the journal Communications Earth and Environment, means that Greenland’s glaciers have passed a tipping point of sorts, where the snowfall that replenishes the ice sheet each year cannot keep up with the ice that is flowing into the ocean from glaciers….”

Covid key news and updates

With key WHO messages, global trends, …

Reuters - WHO blasts 'vaccine nationalism' in last-ditch push against hoarding https://uk.reuters.com/article/uk-health-coronavirus-who/who-blasts-vaccine-nationalism-in-last- ditch-push-against-hoarding-idUKKCN25E0AX

Excerpts, among others with an update on COVAX: “Nations that hoard possible COVID-19 vaccines while excluding others will deepen the pandemic, World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus said on Tuesday, issuing a last-ditch call for countries to join a global vaccine pact. The WHO has an Aug. 31 deadline for wealthier nations to join the “COVAX Global Vaccines Facility” for sharing vaccine hopefuls with developing countries. Tedros said he sent a letter to the WHO’s 194 member states, urging participation. …. The global health agency also raised concerns that the pandemic’s spread was being driven now by younger people, many of whom were unaware they were infected, posing a danger to vulnerable groups.”

“Tedros’ push for nations to join COVAX comes as the European Union, Britain, Switzerland and the United States strike deals with companies testing prospective vaccines. Russia and China are also working on vaccines, and the WHO fears national interests could impede global efforts. The European Commission has urged EU states to skirt the WHO-led initiative, citing worries over its cost and speed. … So far, the COVAX facility has attracted interest from 92 poorer countries hoping for voluntary donations and 80 wealthier countries, a number little changed from a month ago, that would finance the scheme, the WHO said. Still, some nations are waiting for the Aug. 31 deadline before making a commitment as the facility’s terms are still being finalised, Bruce Aylward, who leads the WHO’s ACT Accelerator initiative to speed supplies of COVID-19 diagnostics, drugs and vaccines, said.”

… With more than 150 vaccines in development, about two dozen in human studies and a handful in late-stage trials, the WHO said even countries signing bilateral deals boost their odds by joining COVAX. … … COVAX now covers nine vaccine candidates. …”

PS: WHO also spelled out who would get its eventual coronavirus jabs first. See dr. Tedros:

“The allocation of vaccines is proposed to be rolled out in two phases. In phase 1, doses will be allocated proportionally to all participating countries simultaneously to reduce overall risk. In phase 2, consideration will be given to countries’ in relation to threat and vulnerability….”

See also Cidrap News – Tedros also reviewed earlier logistical challenges in rolling out diagnostic tests and personal protective equipment (PPE).

And: “Once a vaccine is available, the WHO's strategic group of advisors will make recommendations, which will likely cover two phases. In phase 1, doses will be allocated proportionally to reduce overall risk, covering about 20% of the population to include high-risk groups in an effort to stabilize health systems and rebuild economies. For phase 2, considerations will be based on a country's threat and vulnerability. Tedros spoke of the interconnectedness of the push to develop and produce vaccines, which he said will require goods and materials from many different countries, which will require elite planning now. "Like an orchestra, we need all instruments to be played in harmony to create music that everyone enjoys," he said.

See also FT - WHO urges rich countries to join global Covid-19 vaccine facility

“The World Health Organisation has urged wealthier member states to join its Covid-19 vaccine facility by the end of the month, amid fears it may not raise enough money to fund the global inoculation programme. The mechanism, known as Covax, aims to ensure the equitable global distribution of 2bn doses of effective vaccines by the end of 2021 but the initiative has so far failed to build momentum. Tedros Adhanom Ghebreyesus, WHO director-general, said on Tuesday that he had written to all member states calling on them to join Covax by August 31. Under the current plan, high-income countries pay to buy vaccines from the facility, while 92 so-called “funded” countries receive financial assistance….”

“WHO said in July that Gavi had raised close to $600m from participating countries, as well as from the private sector, against an initial target of $2bn. “The deadline is fast approaching and we’re quite concerned that [Covax] might not plug the funding gap,” said Manuel Martin, a policy adviser at Médecins Sans Frontières. Mr Martin said countries had been frustrated and “on edge” about being excluded from the decision-making process and felt the August deadline was too short given the available information about the facility, parts of which are still under discussion. The WHO’s Dr Aylward said some elements of the agreements were indeed still under review, adding that the Covax team had been working through “the barriers to collaborating”, including “issues around price, issues around timing, issues around national expectations”….”

Cidrap News - Nations see COVID-19 spike as they grapple with school reopening https://www.cidrap.umn.edu/news-perspective/2020/08/nations-see-covid-19-spike-they-grapple- school-reopening

(19 August)

“A safe return to school this fall can be managed only at the local level and only if local disease transmission is low, said Mike Ryan, MD, who directs the World Health Organization's (WHO's) health emergencies program… … Global COVID-19 cases are at 22,233,913, including 783,243 deaths, according to the Johns Hopkins University dashboard….”

“… Today, Pope Francis urged wealthy countries not to hoard any potential coronavirus vaccine and to give bailouts to businesses committed to protecting the environment, promoting the common good, and helping the needy and disenfranchised. The announcement follows yesterday's warning from the WHO that vaccine nationalism would worsen the pandemic. "The pandemic is a crisis, and one never exits from a crisis returning to the way it was before,” the pope said. "Either we leave better, or we leave worse. We have to leave better in order to tackle social injustices and environmental degradation."…”

Telegraph - Global coronavirus deaths nearing April record as experts warn against complacency https://www.telegraph.co.uk/global-health/science-and-disease/daily-global-coronavirus-deaths- near-april-record-experts-warn/

“The first peak in fatalities was driven by European nations but now the Americas and southeast Asia are witnessing soaring death rates. Global daily coronavirus fatalities are nearing levels last seen in April in what experts have deemed a “wake up call” as the pandemic continues to circle the world. “

“On April 19 the seven-day average of daily Covid-19 deaths hit a record of 7,465 worldwide. Throughout May and much of June this number consistently fell as Europe, then the epicentre of the

pandemic, grappled to contain the virus. But the pandemic has since accelerated in the Americas and much of Asia and fatalities have surged. According to analysis of data from the European Centre for Disease Control (ECDC) and Our World in Data, the seven-day average on August 18 reached 6,152 . … “

“… according to the latest WHO epidemiological report, it is the Americas that remain at the epicentre of the pandemic - with 53 per cent of all newly confirmed cases and 75 percent of reported deaths detected in the region over the last seven days. ;..” “Elsewhere the pandemic is also accelerating in South East Asia, which accounted for 26 per cent and 19 per cent of new cases and deaths respectively in the last week, according to WHO. Some 85 per cent of these cases and 92 per cent of deaths were reported in India….”

Telegraph - Coronavirus cases in Africa will continue to rise until a vaccine is found, WHO warns https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-cases-africa-will- continue-rise-vaccine-found-warns/

As of late last week, good helicopter view by WHO Afro on the state of affairs in SSA. “But the continent's young population and other factors may mean far less deaths than in other regions, the head of WHO in Africa says.”

HPW - COVID-19: The Sky Hasn’t Fallen Yet In Africa https://healthpolicy-watch.news/covid-19-the-sky-hasnt-fallen-yet-in-africa/

Also a good ‘state of affairs’ read on Africa.

“This week, the Africa Center for Disease Control (Africa CDC) will be launching a continent-wide antibody study to measure the true extent of the COVID-19 pandemic in Africa, where reported coronavirus cases are much lower than initial dire predictions. Africa CDC Director John Nkengasong announced the study at a regular Thursday press briefing. Just a week earlier, the number of confirmed cases of COVID-19 in Africa crossed one million, making Africa the last continent (apart from Oceania) to reach the sobering threshold. While the continent has a number of lessons for the rest of the world regarding handling COVID-19 and pandemics, its comparatively lower testing rate is raising concerns that the official figures from the region do not accurately capture the true extent of pandemic….”

And for the latest update (20 August), see yesterday’s African CDC update (via the Guardian): “Cautious optimism”:

“Average daily cases of coronavirus in Africa fell last week, a “hopeful sign” for the continent’s fight against the disease, the head of the Africa Centres for Disease Control and Prevention (Africa CDC) said. The continent-wide daily average was 10,300 last week, down from 11,000 the week before, Dr John Nkengasong said, adding that officials were greeting the news with “cautious optimism”. He said:…

“Africa had recorded 1,147,369 cases as of Thursday morning, about half of which were in South Africa, which has the fifth-highest total globally. South Africa has seen its number of daily confirmed cases fall from a peak of over 12,000 to an average of 5,000, driving the drop in the continent-wide average but Nkengasong noted that countries in West and Central Africa were showing “similar trends”.

“Nkengasong also announced on Thursday that Africa had crossed the threshold of 10 million Covid-19 tests, suggesting that some progress has been made in addressing the continent’s considerable testing limitations. He acknowledged, though, that testing is still well below what is needed to give a full picture of how the pandemic is progressing on the continent. The Africa CDC announced last week that it would start large-scale antibody testing and that seven countries would participate in the first phase: Liberia, Sierra Leone, Zambia, Zimbabwe, Cameroon, Nigeria and Morocco. Even with limited data, African health officials are increasingly sure that most coronavirus cases are asymptomatic - Nkengasong put the portion at 70 - 80% - and that deaths are relatively low, Nkengasong said…”

AP - WHO: Herd immunity requires effective vaccine AP

(probably in response to a recent NYT article, see below) “The World Health Organization says the planet is nowhere near the amount of coronavirus immunity needed to induce herd immunity, where enough of the population would have antibodies to stop the spread. Herd immunity is typically achieved with vaccination and most scientists estimate at least 70% of the population must have antibodies to prevent an outbreak. But some experts have suggested that even if half the population had immunity, there might be a protective effect. WHO’s emergencies chief Dr. Michael Ryan largely dismissed that theory at a press briefing on Tuesday, saying we should not live “in hope” of achieving herd immunity….”

““As a global population, we are nowhere close to the levels of immunity required to stop this disease transmitting,” he said. “This is not a solution and not a solution we should be looking to.” Most studies conducted to date have suggested only about 10% to 20% of people have antibodies. Dr. Bruce Aylward, a senior adviser to WHO’s director-general, added that any mass immunization campaign with a COVID-19 vaccine would aim to cover far more than 50% of the world’s population….”

NYT – Local Officials in China Hid Coronavirus Dangers From Beijing, U.S. Agencies Find

NYT;

“A new U.S. intelligence report says top officials in Beijing were in the dark in early January on the true dangers of the virus. That could affect U.S. policy on China.”

“Officials in Beijing were kept in the dark for weeks about the potential devastation of the virus by local officials in central China, according to American officials familiar with a new internal report by U.S. intelligence agencies. The report concluded that officials in the city of Wuhan and in Hubei Province, where the outbreak began late last year, tried to hide information from China’s central leadership. The finding is consistent with reporting by news organizations and with assessments by China experts of the country’s opaque governance system….”

Devex - How WhatsApp became the tool of choice for WHO's COVID-19 messaging https://www.devex.com/news/how-whatsapp-became-the-tool-of-choice-for-who-s-covid-19- messaging-97910

“The World Health Organization launched its WHO Health Alert service on messaging platform WhatsApp as a way to reach people where they are with up-to-date information on COVID-19. Many organizations try to share content by drawing people into their channels, said Andy Pattison, manager of digital solutions at WHO. Pattison’s strategy, meanwhile, is to get WHO content onto platforms people are already using. This is part of the reason WHO turned to WhatsApp, which has 2 billion active users. … … WHO is one of a growing number of governments, NGOs, and international agencies that are using WhatsApp as a way to automate one-on-one interactions at scale. … Because of its massive user base and end-to-end encryption, Facebook-owned WhatsApp emerged as the best option for WHO to broadcast COVID-19 information, but a number of challenges stand in the way of it being the perfect solution to keep people informed….”

Reuters - Airlines, airports to push for COVID testing as quarantines hit traffic https://uk.reuters.com/article/uk-health-coronavirus-aviation-testing/airlines-airports-to-push-for- covid-testing-as-quarantines-hit-traffic-idUKKCN25D22S?il=0

“Airlines and airports [will] ask a UN-led task force meeting on Tuesday to recommend countries accept a negative COVID-19 test within 48 hours of travel as an alternative to quarantines that have decimated demand for travel, according to a document seen by Reuters….

““The industry wants the task force to make the recommendation for passengers traveling from countries with high COVID-19 infection rates when it meets on Tuesday to review guidelines for international travel amid the pandemic. “A test prior to departure could reduce the risk of importation by up to 90%, enabling air travel to be opened up between a large number of countries without a quarantine requirement,” said the proposal from Airports Council International (ACI) and airline trade group International Air Transport Association (IATA)….”

Economist - The covid-19 pandemic will be over by the end of 2021, says Bill Gates Economist;

“But millions of deaths are yet to come in poor countries.”

“Millions more are going to die before the covid-19 pandemic is over. That is the stark message of Bill Gates, a co-founder of Microsoft and one of the world’s largest philanthropists via the Bill & Melinda Gates Foundation, in an interview with Zanny Minton Beddoes, The Economist’s editor-in- chief, in early August. Most of these deaths, he said, would be caused not by the disease itself, but by the further strain on health-care systems and economies that were already struggling. … But he offered reasons for hope in the medium term, predicting that by the end of 2021 a reasonably effective vaccine would be in mass production, and a large enough share of the world’s population would be immunised to halt the pandemic in its tracks….”

Guardian - Facebook funnelling readers towards Covid misinformation - study Guardian;

“Websites spreading misinformation about health attracted nearly half a billion views on Facebook in April alone, as the coronavirus pandemic escalated worldwide, a report has found. Facebook had promised to crack down on conspiracy theories and inaccurate news early in the pandemic. But as its executives promised accountability, its algorithm appears to have fuelled traffic to a network of sites sharing dangerous false news, campaign group Avaaz has found….”

“…A relatively small but influential network is responsible for driving huge amounts of traffic to health misinformation sites. Avaaz identified 42 “super-spreader” sites that had 28m followers generating an estimated 800m views….”

And some links:

HPW - WHO Recommends Postponing Visits To The Dentist During The Pandemic

“The World Health Organization recommended postponing routine dental visits in areas with community transmission of COVID-19 in new guidelines released last week. “

More on Covid access to vaccines, medicines, …

WHO – WHO member states briefing (on COVAX) https://apps.who.int/gb/COVID-19/pdf_files/13_08/Member_States_Briefing.pdf

Ppt on COVAX. As of 13 August.

Among the goals, among others: “…To end the acute phase of the pandemic by the end of 2021.”

BMJ Views & Reviews - The rush to create a covid-19 vaccine may do more harm than good Els Torreele; https://www.bmj.com/content/370/bmj.m3209

“The focus on speed risks damaging public confidence in vaccines.” See also her BMJ Opinion of a few weeks ago, with a similar message.

See also a FT Big Read - Why is the ‘anti-vaxxer’ movement growing during a worldwide pandemic?

“Concern in the US that Donald Trump will rush to approve a vaccine before the election is playing into wider safety fears.”

Excerpts:

“… People who worry about vaccines fall broadly into two camps: those who are outright opposed to them, and a far bigger number who are unsure that they are safe. Academics term the latter group “vaccine hesitant”. Concerns about vaccinations vary from country to country, but they are often held by people not normally associated with fringe views or conspiracy theories. Many are highly educated, and they are just as likely to be liberal as conservative …”

“… People who study the phenomenon say that since the coronavirus pandemic started, however, they have begun to find anti-vaccination material being shared among a far wider group of people. … “My researchers have found Facebook groups which have nothing to do with vaccinations suddenly widely sharing misinformation about them,” says Prof Larson. “There is a lot of anger and emotion in the world right now, and the debate around vaccines has been an opportunity for that to bubble up.”

Much of the doubt stems from the breakneck speed at which coronavirus vaccines are being developed. … Anti-vaxxers have also seized on the fact that some developers are using a relatively new technology called messenger RNA that attempts to alter the body’s protein-making machinery.

… the battle to shape public opinion on vaccines will be won or lost online, according to Neil Johnson, a professor of physics at George Washington University. Prof Johnson recently published a paper in the scientific journal Nature concluding that the anti-vaccination movement was winning the online information war because it was organised around smaller “clusters” that were able to infiltrate groups of undecided people. He says the movement has its roots in the anti-vaccination sentiment towards measles jabs that has surfaced in recent years, and which has been blamed for a spate of outbreaks. … … Anti-vaccination groups also have a proliferation of different messages that appeal to different people, notes Prof Johnson, including: safety fears; doubts over whether Covid-19 really poses a risk, especially to young people and children; scepticism over the role of the pharma industry and standard-bearers for vaccinations like Mr Gates; and a general mistrust of science. Even if an undecided person is not swayed by all of these arguments, just one is enough to make them hesitant, he says.

… One question that concerns public health experts is how much the anti-vaccination movement is growing organically, and how much it is being stoked by a small but well-organised and well- funded group of activists. …”

BBC News - Coronavirus: How will the world vaccinate seven billion? https://www.bbc.com/news/health-53741966

Why fridges, vials and polling stations could be key in the distribution of a coronavirus vaccine.

The Conversation - Creating a COVID-19 vaccine is only the first step. It’ll take years to manufacture and distribute

Adam Kamradt-Scott; The Conversation;

“Creating a #COVID vaccine is just the first step. We really need to be investing in manufacturing & supply chains so everyone gets access asap.”

CGD (blog) - Bringing a COVID-19 Vaccine to Market: Where Do We Go from Here? K Chalkidou et al ; https://www.cgdev.org/blog/bringing-covid-19-vaccine-market-where-do-we-go- here

“A lot has been written, including by ourselves, on how best to bring a COVID vaccine (or ideally, several) to market. In this blog, we review the good and the bad about where the world now stands in efforts to bringing a vaccine to market, from the perspective of payers, national governments, and country coalitions, as well as development partners. We also set out some ideas on how best to move forward….”

FT - UK secures another 90m doses of potential Covid-19 vaccines https://www.ft.com/content/1e928cb6-57fb-4384-9c2c-9000c44eacc0

From late last week. “Deals with J&J and Novavax bring country’s total advance orders to 340m doses.”

Médecins Sans Frontières feedback on the European Commission’s roadmap for an Intellectual Property Action Plan (Technical brief) https://www.msfaccess.org/medecins-sans-frontieres-feedback-european-commissions-roadmap- intellectual-property-action-plan

“In July 2020, the European Commission opened a public consultation for feedback to its roadmap for an intellectual property (IP) action plan. In its feedback, Médecins Sans Frontières emphasized that stringent IP enforcement measures and insufficient safeguards threaten or delay the availability of treatments and vaccines and highlighted that IP can act as a barrier to needed medical research and innovation. MSF advises the European Commission to incorporate recommendations for law and policy reform into the IP action plan to ensure access to essential medical tools…”

Bloomberg - Covid Vaccine Turns Into a Shot at Redemption for Britain https://www.bloomberg.com/news/articles/2020-08-18/covid-vaccine-turns-into-a-shot-at- redemption-for-britain

“Finding the Holy Grail in the pandemic has taken on greater significance after a torrid few months. “

“The U.K. is looking for a place in the world as an independent entity and has an opportunity to show real leadership in the vaccine space,” said John Bell, professor of medicine at the University of Oxford, who is working with the government on its vaccine program….”

“There are broadly four main approaches being taken to producing a Covid-19 vaccine. The U.K. strategy is to ensure Britain has enough potential doses from each bucket in the hope that one will be successful, but not to hoard supplies. On the contrary, part of the “Global Britain” brand is to share its success with the world. So far, Bingham’s taskforce has bought a medley of 340 million doses from the four groups after two more deals on Friday. Britain’s desire to respond to the pandemic on its own terms has been clear from the start….”

Politico – The breakthrough that could halt the pandemic, even before a vaccine https://www.politico.com/news/2020/08/14/the-breakthrough-that-could-halt-the-pandemic-even- before-a-vaccine-395179

“Allowing people to test themselves quickly and accurately at home is possible, experts say.”

CGD (blog) - Modelling the Manufacturing Process for COVID-19 Vaccines: Our Approach D Reader et al ; https://www.cgdev.org/blog/modelling-manufacturing-process-covid-19-vaccines- our-approach

“We are developing a system of interconnected models which represent global manufacturing capability from the start of clinical trials to secondary vaccine manufacture; that is, time from first human trials to finished product ready to be shipped.”

And some links:

Reuters - Vietnam to buy Russian COVID-19 vaccine.

Reuters - Russia to begin COVID-19 vaccine trials on 40,000 people next week

“Mass testing of Russia’s first potential COVID-19 vaccine to get domestic regulatory approval will involve more than 40,000 people and will be overseen by a foreign research body when it starts next week, backers of the project said on Thursday. … … Russia has received requests for up to a billion doses of the vaccine from around the world and has capacity to produce 500 million doses per year via manufacturing partnerships, he said. A director at Moscow’s Gamaleya Institute, which developed the vaccine, said 40,000 people would be involved in the mass testing at more than 45 medical centres around Russia. The data is being provided to the World Health Organization (WHO), Dmitriev said, and to several countries that are considering participating in the late-stage trial, including the United Arab Emirates, India, Brazil, Saudi Arabia and the Philippines….”

Covid funding, debt relief, social protection…

Medium - Great expansion — remaining gaps: Social protection in the face of the coronavirus pandemic Oxfam International blog; https://medium.com/@Oxfam/great-expansion-remaining-gaps-social- protection-in-the-face-of-the-coronavirus-pandemic-84c98c935907

Helicopter view of the current expansion of social protection in the world, with also remaining (big) challenges, gaps and flaws.

The piece concludes: “Despite the progress, a lot more needs to be done, both in the design and scope of social protection. Rights-based social protection for all citizens, should be promoted rather than piecemeal ‘safety nets’ approaches. This could be done through universal benefits, like those for all old people and all children, which avoid complex often erroneous systems that decide who is poor and who is not. Behavioral and patronizing conditions on social protection should be lifted for good. Even if we assume, the 1.7 billion people covered now, were among the four billion not covered prior to the new expansion in social protection that still leaves more than two billion uncovered, many of them women. Hence, governments still need to step up. But also more international commitment is necessary: in the form of debt cancellation, as well as in aid, and better coordination of the funds available.”

Covid Science

Telegraph - England and Germany neck-and-neck in race to produce first vaccine https://www.telegraph.co.uk/global-health/science-and-disease/england-germany-neck-neck-race- produce-first-vaccine/

Looks like in Europe at least, we’ll get a re-run of the World Cup Final in 1966. “Experts say the result is too close to call but will be decided by evidence and data, not penalties.”

“The race to produce the first fully licenced vaccine to protect against the new coronavirus may come down to a playoff between teams in England and Germany. Kate Bingham, chair of the UK Vaccine Taskforce, the body in charge of the UK’s vaccine strategy, said on Monday that two groups - one in Oxford and one in Mainz, Germany - were running head to head and may yet see their immunisations approved before the end of December. “I think we have a shot of getting a vaccine this year,” Ms Bingham told Sky News. “There's two potential candidates, one would be the Oxford candidate and the other one is the German vaccine from BioNTech.”…”

Stat - Seven months later, what we know about Covid-19 — and the pressing questions that remain

Stat News;

Recommended analysis. By A Joseph, Helen Branswell et al. “…Here are some of the things we have learned, and some of the pressing questions we still need answered….”

NYT -What if ‘Herd Immunity’ Is Closer Than Scientists Thought? NYT;

“In what may be the world’s most important math puzzle, researchers are trying to figure out how many people in a community must be immune before the coronavirus fades.”

“… To achieve so-called herd immunity — the point at which the virus can no longer spread because there are not enough vulnerable humans — scientists have suggested that perhaps 70 percent of a given population must be immune, through vaccination or because they survived the infection. Now some researchers are wrestling with a hopeful possibility. In interviews with The New York Times, more than a dozen scientists said that the threshold is likely to be much lower: just 50 percent, perhaps even less. If that’s true, then it may be possible to turn back the coronavirus more quickly than once thought. … … … The models also suggest a vaccination strategy: Rather than uniformly vaccinate all groups, governments could identify and immunize those most likely to be exposed in “superspreader” events….”

We’re guessing WHO reacted to this article in a media briefing early this week.

Telegraph - 'No country' has an effective strategy to prevent outbreaks linked to pubs and clubs, experts warn https://www.telegraph.co.uk/global-health/science-and-disease/no-country-has-effective-strategy- prevent-outbreaks-linked-pubs/

“Bars and clubs are among the 'most dangerous' places due to human behaviour, enclosed settings and the difficulty in tracing contacts.”

Science News - How will COVID-19 affect the coming flu season? Scientists struggle for clues https://www.sciencemag.org/news/2020/08/how-will-covid-19-affect-coming-flu-season-scientists- struggle-clues

“Northern Hemisphere prepares for winter with little insight about how the new coronavirus and other respiratory viruses interact.”

It’s not because the Southern Hemisphere has dodged a (flu) bullet that this will necessarily also happen in the North.

Quote: “”Because the Southern Hemisphere has largely been spared, researchers have little evidence about how COVID-19 might influence the course of a flu outbreak. One big concern is coinfection—people getting COVID-19 and flu at once, says Ian Barr, deputy director of the World

Health Organization Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia. “Two or three viruses infecting you are normally worse than one,” he says….”

WP - These are the top coronavirus vaccines to watch https://www.washingtonpost.com/graphics/2020/health/covid-vaccine-update-coronavirus/

As of August 13. “We are tracking 200 experimental vaccines aimed at ending the pandemic, a scientific quest moving at record-breaking speed.” With nice visualization (for vaccines in respective phases).

Standard Media - Scientists still puzzled by low corona deaths in Africa https://www.standardmedia.co.ke/health/article/2001382419/scientists-still-puzzled-by-low- corona-deaths-in-africa

“Although Africa reported its millionth official Covid-19 case last week, it seems to have weathered the pandemic relatively well so far, with fewer than one confirmed case for every thousand people and just 23,000 deaths so far. Yet several antibody surveys suggest far more Africans have been infected with the coronavirus — a discrepancy that is puzzling scientists around the continent. “We do not have an answer,” says immunologist Sophie Uyoga at the Kenya Medical Research Institute- Wellcome Trust Research Programme. After testing more than 3,000 blood donors, Uyoga and colleagues estimated in a preprint last month that one in 20 Kenyans aged 15 to 64 — or 1.6 million people — has antibodies to Sars-CoV-2, an indication of past infection….”

Cidrap News - COVID-19 cases, deaths may follow weekly pattern https://www.cidrap.umn.edu/news-perspective/2020/08/covid-19-cases-deaths-may-follow- weekly-pattern

“MIT, Boston University, and Harvard Medical School researchers have identified weekly oscillations in the numbers of new daily COVID-19 cases and deaths in several countries that are more pronounced than fluctuations seen with other diseases. In their research letter, published today in JAMA Network Open, the authors describe how they analyzed daily new international coronavirus case and death data from the Worldometer for the United States, Germany, Canada, Italy, Brazil, and the United Kingdom from Feb 29 to Jul 2….”

Science (blog) - Encouraging News About Coronavirus Immunity https://blogs.sciencemag.org/pipeline/archives/2020/08/18/encouraging-news-about-coronavirus- immunity

Summary of a number of recent papers on this topic, by Derek Lowe. “We’ve had some good news on coronavirus immunity recently – good because it gives us some more clarity on the whole situation, and because it suggests that both people who have already recovered from the infection and people who will be getting vaccinated can have good protection….”

Still on immunity, see also Nature - What the immune response to the coronavirus says about the prospects for a vaccine “Viral immunologists say that results so far have been predictable — here’s why that’s good news.”

Reuters - More infectious coronavirus mutation may be 'a good thing', says disease expert https://uk.reuters.com/article/uk-health-coronavirus-mutation/more-infectious-coronavirus- mutation-may-be-a-good-thing-says-disease-expert-idUKKCN25E095?il=0

“An increasingly common mutation of the novel coronavirus found in Europe, North America and parts of Asia may be more infectious but appears less deadly, according to a prominent infectious diseases doctor. Paul Tambyah, senior consultant at Singapore’s National University Hospital and president-elect of the International Society of Infectious Diseases, said evidence suggests the proliferation of the D614G mutation in some parts of the world has coincided with a drop in death rates, suggesting it is less lethal. “Maybe that’s a good thing to have a virus that is more infectious but less deadly,” Tambyah told Reuters….” Wait and see, I guess. The “mutation” story is still rather murky.

Telegraph - Winter resurgence of Covid-19 predicted as experts warn of hard times ahead https://www.telegraph.co.uk/global-health/science-and-disease/new-research-suggests-should- prepare-resurgence-covid-19-across/

With current state of affairs (and hypotheses) on the seasonality of the virus. With some coverage of recent papers.

“Scientists say the virus spreads faster in cold dry air and may peak again when we are huddled inside.”

Stat - Will Covid-19 vaccines be safe for children and pregnant women? The data, so far, are lacking

H Branswell; Stat;

“As potential Covid-19 vaccines speed their way through development, manufacturers and U.S. regulators have largely delayed testing in children and women who are pregnant, raising the possibility that experts will lack critical safety and efficacy data in those populations when there’s a pressing need to inoculate them….”

And some links:

• NYT - Scientists See Signs of Lasting Virus Immunity, Even After Mild Infections

Based on some (not yet peer reviewed) studies.

• HPW - Game-changing COVID-19 Saliva Test Receives Regulatory Approval In The United States. • HPW - COVID-19 May Be Linked To New Onset Type I Diabetes In Children

• And via STAT on a recent study in JAMA: “Although Black people are being infected and hospitalized with Covid-19 at higher rates than white individuals, new research suggests that the mortality rate among hospitalized Black and white patients is comparable. The study, which looked at data from more than 11,200 hospitalized patients in 12 states, suggests access to hospital care may be a major factor in a person's risk of death. …”

Covid-analysis

Telegraph - Saints or sinners: young people and Covid-19 https://www.telegraph.co.uk/global-health/climate-and-people/saints-sinners-young-people-covid- 19/

“Recent virus spikes have been linked to people in their teens and 20s partying - but is criticism of 'generation Covid' unfair?”

Quotes: “… Dr Andy Mycock, reader in politics at Huddersfield University, who collaborated on the Take the Temperature survey with an organisation called Beatfreeks, told the Telegraph that “young people are framed as either being saints or sinners and the Covid-19 story seems to have fallen into that.” He says that the younger generation now feels penalised, with education and employment opportunities diminishing and they are “increasingly resentful of the constraints that have been placed on them”. … Young people have been hit hardest by the fallout of the crisis - a study by the International Labour Organisation found that worldwide a sixth of workers under 30 had lost their jobs in the pandemic. While younger workers are more likely to have received government support through the furlough scheme, long term they are more likely to be affected by any recession….”

BMJ Global Health (Editorial) – Global health and human rights for a postpandemic world R Khosla et al ; https://gh.bmj.com/content/5/8/e003548

“… Global health work continues to pay lip service to human rights in setting global and national development priorities. Yet the structures do not embrace health as a human right, as intrinsic to the capability of individuals to achieve a life they value. In failing to embrace what human rights offer, we lean towards simplistic solutions to otherwise complex global health issues, rooted deeply in social, cultural, religious contexts. COVID-19 is a stark example of this failure, both in the events leading up to the pandemic as well as in the responses. But COVID-19 is not unique in revealing an ecology of sickness and mortality based on social determinants of health. Failing to explicitly address human rights concerns not only continues to jeopardise the response to this pandemic, but the future of global health. The time is now to rethink health as a human right, that

is premised not just on our collective conscience, but our collective responsibility. To rethink global health, we have to start by reimagining health as a ‘global common’….”

BMJ Editorial – The perils of preprints https://www.bmj.com/content/370/bmj.m3111

“Their use and platforms require greater scrutiny.”

TGH - How the Origins of COVID-19 Became Politicized

Yanzhong Huang ; https://www.thinkglobalhealth.org/article/how-origins-covid-19-became- politicized

“Where the coronavirus came from is no longer a scientific question—thanks to narrative spin, agendas, and misinformation.” On both sides, actually: US & China.

Lancet Letter - Sex differential in COVID-19 mortality varies markedly by age S S Bhopal et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31748- 7/fulltext

“The prevailing view is that although the number of male cases is not dissimilar to the number of female cases, men have about twice the risk of death from COVID-19, leading to a range of hypotheses, from lifestyles to differences in chromosomal structure… … We examined the sex ratio through the life course to see if the COVID-19 mortality sex-differential was the same at every age. …” Apparently not.

WEF (blog) - Could this COVID-19 ‘health passport’ be the future of travel and events? D Broom; https://www.weforum.org/agenda/2020/07/covid-19-passport-app-health-travel- covidpass-quarantine-event

Another Big Brother reason to hurry up with that vaccine, if you ask me.

“Rising COVID-19 infection rates pose a threat to global tourism. A new app acts as a health passport for travellers who are virus-free. Using blockchain technology, it provides an encrypted record of test results. Its creators say it could allow healthy travellers to avoid quarantine. The app could also allow sports and entertainment venues to reopen safely, as well as the global conference and exhibition industry.”

The American Journal of Bioethics - Positive Public Health Ethics: Toward Flourishing and Resilient Communities and Individuals JP Ruger ; https://www.tandfonline.com/doi/full/10.1080/15265161.2020.1764145

“The COVID-19 pandemic is a global contagion of unprecedented proportions and health, economic, and social consequences. As with many health problems, its impact is uneven. This article argues the COVID-19 pandemic is a global health injustice due to moral failures of national governments and international organizations to prepare for, prevent and control it. Global and national health communities had a moral obligation to act in accordance with the current state of knowledge of pandemic preparedness. This obligation—a positive duty to develop and implement systems to reduce threats to and safeguard individuals’ and, communities’ abilities to flourish—stems from theories of global health justice and governance. The COVID-19 pandemic revealed and amplified the fragility and deficiencies in our global and domestic health institutions and systems. Moving forward, positive public health ethics is needed to set ethical standards for building and operating robust public health systems for resilient individuals and communities.”

World Development (Viewpoint) - How health inequality affect responses to the COVID-19 pandemic in Sub-Saharan Africa O Okoi et al ; https://www.sciencedirect.com/science/article/pii/S0305750X20301935?dgcid=raven_sd_via_email

“The COVID-19 outbreak has infected millions of people across the world, caused hundreds of thousands of deaths, and collapsed national economies. Recognizing the importance of handwashing in preventing the spread of COVID-19, concerns have arisen about the condition of millions of Africans who lack access to hygiene facilities and clean water services. This paper compiles evidence from the WHO-UNICEF data to show the health disparities that limit the capacity of African countries to effectively address the COVID-19 disease along with recommendations for addressing the challenge.”

Daily Maverick – How well has South Africa done at reducing Covid-19 deaths? https://www.dailymaverick.co.za/article/2020-08-18-how-well-has-south-africa-done-at-reducing- covid-19-deaths/

Very neat analysis on South-Africa (so far).

Bloomberg – Virus Rages in South America With Governments Grasping for Clues Bloomberg;

Helicopter view on current state of affairs in South-America.

“Uruguay, Chile make gains in virus fight, but Brazil hard hit; Hodgepodge policies, poverty complicate efforts to slow spread.”

In a (very much recommended) related read, see this LSE blog - COVID-19 in Latin America: were we doomed from the start? (by R Aguilera).

“Even though different countries responded very differently to the emergence of coronavirus, its impact has been devastating virtually everywhere in Latin America. Underlying factors like labour

informality, compounding health issues, low healthcare spending, multi-generational households, and economic openness have made the region’s experience of the crisis especially grave…”

Lancet - Back to basics: the outbreak response pillars https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31760-8/fulltext

By the GOARN steering committee. In a short letter, they list 7 pillars.

IHP - COVID-19: Charting a sustainable path to response, recovery and resilience in Africa https://www.internationalhealthpolicies.org/featured-article/covid-19-charting-a-sustainable-path- to-response-recovery-and-resilience-in-africa/

By Abiodun Awosusi & Marius Adeniyi. “Africa has had relatively fewer deaths than other parts of the world: the unique conditions on the continent require countries to now chart a path to sustained response, recovery and resilience as the pandemic unfolds….” The authors dwell on diplomacy for access to tools and capital; partnerships for sustainable production; investments in resilient systems for health and wellbeing.

Guardian - Female-led countries handled coronavirus better, study suggests https://www.theguardian.com/world/2020/aug/18/female-led-countries-handled-coronavirus- better-study-jacinda-ardern-angela-merkel

“Countries led by women had “systematically and significantly better” Covid-19 outcomes, research appears to show, locking down earlier and suffering half as many deaths on average as those led by men. The relative early success of leaders such as Germany’s Angela Merkel, New Zealand’s Jacinda Ardern, Denmark’s Mette Frederiksen, Taiwan’s Tsai Ing-wen and Finland’s Sanna Marin has so far attracted many headlines but little academic attention. The analysis of 194 countries, published by the Centre for Economic Policy Research and the World Economic Forum, suggests the difference is real and “may be explained by the proactive and coordinated policy responses” adopted by female leaders….”

I had a look at the paper. Still looking forward to a study that actually tries to control for “populist leadership style”. When the relation then still holds, I’ll believe it. So: to be continued.

Atlantic - Why India’s Pandemic Response Is Tipping Toward Pseudoscience https://www.theatlantic.com/international/archive/2020/08/amitabh-bachchan-india- coronavirus/615310/

In India, “The balance between modern medicine and traditional treatments is shifting in the wrong direction.”

“…Its coronavirus caseload appears to only be worsening, hamstrung by decades of underinvestment in public health, poor medical infrastructure, and, more recently, a troubling official tolerance of pseudoscience, as well as a growing politicization of health care….”

Evidence & Policy - Making evidence and policy in public health emergencies: lessons from COVID-19 for adaptive evidence-making and intervention

K Lancaster et al; https://www.ingentaconnect.com/content/tpp/ep/pre-prints/content- evidpold2000018

Key messages: “COVID-19 necessitates new ways of thinking about emergent evidence-making. Emergencies open up questions about what constitutes ‘evidence-enough’ for rapid decisions in- the-now. Rapid assessment and outbreak science models offer indications of how evidence-making might be done differently. Adaptive evidence-making is needed not only during emergencies but also for intervening in the everyday.”

BMJ Global Health - Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements https://gh.bmj.com/content/5/8/e003042

“With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns….”

Conclusions: “Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered….”

Covid-impact on other global health programmes

Millions of women lose contraceptives, abortions in COVID-19 https://www.clickondetroit.com/news/world/2020/08/19/baby-boom-ahead-as-covid-19-kept- millions-of-women-from-care/

“… Several months into the pandemic, many women now have second-trimester pregnancies because they could not find care in time. Across 37 countries, nearly 2 million fewer women received services between January and June than in the same period last year, Marie Stopes International

says in a new report — 1.3 million in India alone. The organization expects 900,000 unintended pregnancies worldwide as a result, along with 1.5 million unsafe abortions and more than 3,000 maternal deaths. Those numbers “will likely be greatly amplified” if services falter elsewhere in Latin America, Africa and Asia, Marie Stopes’ director of global evidence, Kathryn Church, has said. The World Health Organization this month said two-thirds of 103 countries surveyed between mid-May and early July reported disruptions to family planning and contraception services. The U.N. Population Fund warns of up to 7 million unintended pregnancies worldwide….”

See also the Telegraph - Pandemic could trigger a ‘baby boom’ as millions of women lose access to contraception and abortion

And the MSI report: https://www.mariestopes.org/media/3849/resilience-adaptation-and- action.pdf

Action for Global Health (Briefing note) – Indirect impacts of Covid-19 on other essential health services https://actionforglobalhealth.org.uk/news-%26-views/f/indirect-impacts-of-covid-19-on-other- essential-health-services

On key trends on the ground; examples of actual impacts being measured; Priorities for action to reduce negative indirect impacts and protect the most vulnerable, …

INCB, WHO and UNODC statement on access to internationally controlled medicines during COVID-19 pandemic https://www.who.int/news-room/detail/14-08-2020-incb-who-and-unodc-statement-on-access-to- internationally-controlled-medicines-during-covid-19-pandemic

(14 August) “The International Narcotics Control Board (INCB), the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) call on governments to ensure that the procurement and supply of controlled medicines in countries meet the needs of patients, both those who have COVID-19 and those who require internationally controlled medicines for other medical conditions….”

Science News - Scientists worried the pandemic would cause malaria deaths to soar. So far, it hasn’t happened https://www.sciencemag.org/news/2020/08/scientists-worried-pandemic-would-cause-malaria- deaths-soar-so-far-it-hasnt-happened

“Countries averted disaster by resuming suspended bed net distribution campaigns.” Benin for example.

UN News - Children have ‘nowhere to turn’, as COVID-19 hits protection, social services, reports UNICEF https://news.un.org/en/story/2020/08/1070412

“Disruptions to services for preventing and responding to violence in the home , due to the global pandemic, has left children in more than 100 countries vulnerable to exploitation and abuse, a UN Children’s Fund (UNICEF) survey has found. The UN agency’s 'Socio-economic Impact Survey of COVID-19 Response' revealed that 104 countries out of 136 responding, reported interruptions or suspensions of services such as case management, referral services and home visits by child welfare and social workers, to children and women at risk of abuse. Violence prevention programmes, children’s access to child welfare authorities, and national helpline services have also been affected, as countries adopted measures to prevent and contain COVID-19, according to UNICEF….”

And a link:

WB (blog) - Killer # 2: Disrupted health services during COVID-19

Covid-19 resources

IDS - Responding to Covid-19 – the social dynamics https://www.ids.ac.uk/news/responding-to-covid-19-the-social-dynamics/

“The global pandemic Covid-19 is impacting the lives of people in many and varied ways. Together with partners worldwide, IDS researchers are providing critical evidence and analysis that are shaping the spread of the virus and must inform immediate responses. We are collaborating across disciplines and sectors to understand the longer-term impacts of the pandemic on development globally, and the transformations needed to support the recovery and rebuild more equitable and sustainable societies and economies. This page brings these resources together for those working to understand and shape responses to the virus, as well as longer-term development implications….”

World Humanitarian Day (19 August)

WHO - World Humanitarian Day 2020: A tribute to aid workers on the front lines https://www.who.int/news-room/detail/19-08-2020-world-humanitarian-day-2020-a-tribute-to-aid- workers-on-the-front-lines

“Last year was the most violent on record for humanitarians, with 483 attacked, 125 killed, 234 wounded and 124 kidnapped. The UN condemns all attacks on humanitarians.”

“… According to Humanitarian Outcomes’ Aid Worker Security Database, major attacks against humanitarians last year surpassed all previous years on record. A total of 483 relief workers were attacked, 125 killed, 234 wounded and 124 kidnapped in 277 separate incidents. This is an 18 per

cent increase in the number of victims compared to 2018. … … A surge in attacks against health workers was recorded in 2019, including strikes against medics in Syria and shootings of Ebola workers in the Democratic Republic of the Congo (DRC). … … Most of the attacks occurred in Syria, followed by South Sudan, DRC, Afghanistan and the Central African Republic. Mali and Yemen both saw a doubling of major attacks from the previous year. The UN condemns these attacks, and it calls for accountability for perpetrators and justice for survivors. Relief workers cannot be a target….”

Guardian - Syria deadliest place to be an aid worker, amid global 30% rise in attacks – report https://www.theguardian.com/global-development/2020/aug/19/syria-is-deadliest-place-to-be-an- aid-worker-amid-global-30-rise-in-attacks

Good coverage.

Global Financing Facility

SRHM (Commentary) - The Global Financing Facility at five: time for a change? L Seidelmann et al ; https://www.tandfonline.com/doi/pdf/10.1080/26410397.2020.1795446

Must-read analysis. “… After five years of implementation in a high variety of country contexts, a “Strategy Refresh” and a governance reform of the GFF Investors Group have been announced. We find it timely to take stock of how the GFF has been operating at global and country level, how it has been governed and whether it has achieved its objectives. We will first present the GFF governance model including recent developments, and then focus on aspects of two strong GFF promises: increasing domestic resource mobilisation for health, and strengthening health systems. We base the following commentary on observations in GFF countries – such as the Democratic Republic of the Congo (DRC), Kenya, Malawi, Mozambique, Tanzania and Uganda…”

SRHR

SRHR (Review article) - The inclusion of sexual and reproductive health services within universal health care through intentional design G Appleford et al ; https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1799589

“In this paper, we argue that how sexual and reproductive health (SRH) services are included in UHC and health financing matters, and that this has implications for universality and equity. This is a matter of rights, given the differential health risks that women face, including unwanted pregnancy. How traditional vertical SRH services are compensated under UHC also matters and should balance incentives for efficiency with incentives for appropriate provision using the rights- based approach to user-centred care so that risks of sub-optimal outcomes are mitigated. This suggests that as UHC benefits packages are designed, there is need for the SRH community to advocate for more than simple “SRH inclusion”. This paper describes a practical approach to

integrate quality of SRH care within the UHC agenda using a framework called the “5Ps”. The framework emphasises a “systems” and “design” lens as important steps to quality. The framework can be applied at different scales, from the health system to the individual user level. It also pays attention to how financing and resource policies intended to promote UHC may support or undermine the respect, protection and fulfilment of SRH and rights. The framework was originally developed with a specific emphasis on quality provision of family planning. In this paper, we have extended it to cover other SRH services.”

Decolonize Global Health

The Republic - (Purse) Strings Attached: From dependency to decolonization in global health P Akugizibwe; https://republic.com.ng/august-september-2020/purse-strings-attached/

Recommended. “COVID-19 is reminding us that global health has long operated a model in which Africans are treated as subjects of a quasi-philanthropic complex that, in turn, feeds one of the largest industries in the world.”

BMJ Global Health - Decolonising Global (Public) Health: from Western universalism to Global pluriversalities Clara Affun-Adegbulu et al ; https://gh.bmj.com/content/5/8/e002947

“There is emerging consensus about the need to decolonise Global Health. This is evidenced by the proliferation of seminars, conferences and publications in recent times. In many cases, however, the focus and scope of these decolonial efforts tend to be on the Global South and on representation (diversity and equality), practice and the (re)production of knowledge. Yet decolonisation is not ‘merely about altering the content but also the term on which we are having the conversation’. In our opinion, a critical reflection about the very concept of Global Health is indispensable to true decolonisation. Global (Public) Health, as currently conceptualised, is based on and inextricably linked to the Eurocentric conception of the (hu)man. Global (Public) Health, thus, inevitably (re)produces the processes of othering and dehumanisation which are inherent to this conceptualisation of the (hu)man. For Global (Public) Health to become truly decolonised, decolonisation must occur at both the epistemic and ontological levels. This requires acknowledging that there are many ways of being and doing, unlearning the universality of being and actively engaging with pluriversalities of being.”

Katri Bertram (blog) - What’s next for diversity? Next crisis? Next issue, next group? https://katribertram.wordpress.com/2020/08/19/whats-next-for-diversity/

“…Just as in global health, where our community seems to move from disease to disease, in the diversity discussion we seem to be moving from one population that needs to be included to another. Women! Youth! Global South! Black people! … … There must be some better way to advance the

diversity and inclusion agenda. In a way that looks at more diverse facets and variables, instead of fixating on one aspect….”

And Katri wonders whether “As a white, Northern, elite-educated person, am I part of the problem or solution in #internationaldevelopment and #globalhealth?”

And a link:

Guardian - I've seen first-hand the toxic racism in international women's rights groups.

The Lancet on the upcoming US presidential elections

Lancet Editorial - Trump versus Biden: a fight for the health of a nation https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31786-4/fulltext

Concluding: “If logic and justice prevail in the next presidential administration, universal health coverage, a fairer society, stronger health institutions, more energetic global engagement, and a robust research agenda will be the foundations for America's renewal. We all have a stake in America's success.”

Lancet Global Health – September issue https://www.thelancet.com/journals/langlo/issue/current

Do start with the Editorial - Water and sanitation in a post-COVID world

“Like many such events, this year's World Water Week (Aug 24–28) conference will now be taking place virtually. Convened by the Stockholm International Water Institute, the meeting gathers scientists, business leaders, and policy makers, as well as civil society, to engage on one of the world's most pressing set of challenges….”

The challenge of achieving water security is here to stay. “…Yet could the COVID-19 pandemic mark a step change in the urgency with which the international community addresses these challenges? In a Comment published in this month's issue, Adeladza Amegah notes the “tremendous” improvement in access to handwashing facilities in many African countries, with “handwashing stations noticeably increasing in community centres, schools, markets, bus terminals, lorry stations, and other public spaces”. Moreover, “some African governments, as part of their COVID-19 response plans, took urgent steps to make clean water accessible to all communities by drilling boreholes and mobilising water tankers to supply water.” He urges national and local governments to find the fiscal space to continue these practices and sustain the promotion of handwashing post-COVID. 2 years into the International Decade for Water Action, the complexity

of governance of this abundant yet paradoxically increasingly scarce resource cannot be underestimated. But if ever there was a moment to seize upon the small gains prompted by a global event, the moment is now.”

Do check out the other papers and Comments though, eg Oxygen availability in sub-Saharan African countries: a call for data to inform service delivery.

Papers & reports of the week

Globalization & Health - An overview of the commercial determinants of health M Mialon ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00607-x

“… the aim of the present review was to provide an overview of the commercial determinants of health, through a review of the literature on this subject…. The commercial determinants of health cover three areas. First, they relate to unhealthy commodities that are contributing to ill-health. Secondly, they include business, market and political practices that are harmful to health and used to sell these commodities and secure a favourable policy environment. Finally, they include the global drivers of ill-health, such as market-driven economies and globalisation, that have facilitated the use of such harmful practices….”

BMJ Global Health (Analysis) - Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy? R Lencucha et al ; https://gh.bmj.com/content/5/8/e002246

On a possible window of opportunity: “Tobacco, unhealthy food and alcohol-producing industries remain highly influential in economic sectors of government. The influence of these industries is largely conditioned by models of economic growth that have historically neglected social goods such as health and the environment. Recent shifts have occurred in approaches to economic policy that reflect a need to address sustainability, health and social well-being. These shifts provide an important opportunity for public health to work with the economic sectors of government to redress the harms of these unhealthy commodity-producing industries.”

Annals of Global Health (Editorial) - A Mechanism for Reviewing Investments in Health Research Capacity Strengthening in Low- and Middle-Income Countries Annals of Global Health

« More than 40 agencies that fund health research capacity strengthening in low- and middle- income countries (LMICs) participate in the ESSENCE Health Research initiative, which has established a mechanism for reviewing and coordinating their funding. Taken together, the expected outcomes of implementation of the review mechanism are increases in the efficiency and equity in health research capacity strengthening activities with decreased duplication of efforts. The overall goal is increased support of research on national health priorities as well as improved pandemic preparedness in LMICs, and, eventually, fewer countries with very limited research capacity. «

Public Health - Public health and political science: challenges and opportunities for a productive partnership P Fafard et al ; https://www.sciencedirect.com/science/article/pii/S0033350620302997

At last we found a ‘partnership’ we can live with . “Public health is inherently political. Public health and political science studies typically unfold in parallel. Opportunities exist for a productive ‘public health political science’ partnership. We need shared understandings of concepts such as evidence, politics, and policymaking. A deeper mutual engagement will benefit work in both fields.”

African Women’s Development Fund - Women and Noncommunicable Diseases in Africa: Mapping the scale, actors, and extent of rights-based work to address the impact of NCDs on African women J Riha; https://awdf.org/wp-content/uploads/Women-and-NCDs-in-Africa.pdf

80 p. “… AWDF commissioned a future trends analysis titled, Futures Africa: Trends for Women by 2030 (AWDF 2017). This report indicated that non-communicable diseases (NCDs) are rapidly growing in terms of the burden of disease and soon becoming the leading causes of death in many countries across Africa (AWDF 2017). Focusing on this often neglected trend and the potential opportunities to support women-led initiatives in NCD response, AWDF wants to understand: What is the scale and what are the key gendered concerns around NCDs and women in Africa? Who are the key actors responding to the rise in NCDs in Africa? How are these actors responding and are gender, equity and rights being considered in these responses? What are the opportunities and challenges for African women’s organisations around engagement with NCD prevention and control and what are the ways to support greater engagement on links between NCDs and women’s rights?...”

Blogs and other news of the week

CGD (blog) - Emigration Rises Along with Economic Development. Aid Agencies Should Face This, but Not Fear It M Clemens; https://www.cgdev.org/blog/emigration-rises-along-economic-development-aid- agencies-should-face-not-fear-it#disqus_thread

Summary blog of two new papers, also adding some paragraphs on how development aid should deal with this reality. “Within low-income countries, richer people are more likely to emigrate. And as low-income countries economically grow, people are more likely to emigrate.”

“I released two major research papers that document and explore the empirical relationship between rising incomes within, and emigration from, low-income countries. One of these papers studies households within low-income countries… The other paper looks at the national level over the past 200 years. …”

Clemens concludes: “… we should not use a fear of migration as a reason to keep poor countries poor. The emigration life cycle doesn’t imply that aid shouldn’t exist, but that the repurposing of

development assistance as a way to stop migration has always been a political project with little hope of generalized real-world success. … “ Instead, ” development assistance should engage with human mobility; not to deter it, but to shape it for mutual benefit. It should seek to address the shocks that spur increased emigration, like conflict, violence, climate change, and economic collapse. It should work to reduce smuggling and trafficking, making journeys safer and cheaper. And it should support new legal immigration pathways like asylum, refugee resettlement, family reunification, and work visas. Indeed, strengthening those pathways requires development assistance, because they require migrant origin countries to work in partnership with migrant destination countries.”

Global Policy - “Gender Equality as Smart Economics”: Questioning the Assumptions behind the Claim https://www.globalpolicyjournal.com/blog/20/08/2020/gender-equality-smart-economics- questioning-assumptions-behind-claim

“Cecilia Berlanga Alessio Robles deconstructs the claims that “Gender Equality as Smart Economics”.”

HSG - Ending the rhetoric: funding research and addressing health challenges in Africa Martin Amogre Ayanore & UHAS-HSG 2020 Convening Team; https://healthsystemsglobal.org/news/ending-the-rhetoric-funding-research-and-addressing-health- challenges-in-africa/

“April 2021 marks twenty years since the Abuja declaration by African Governments to commit 15 per cent of GDP to health. In addition, during the African Union heads of state summit in 2006, a continental agreement was reached to commit 1 per cent of GDP to fund national research priorities. However, nearly two decades on, targets for research and development (R&D) and investments in the health sector remain unmet. In contributing to renewed calls for African Governments to honour their pledges for R&D and greater investments in the health sector, University of Health and Allied Sciences (UHAS), Ghana, with support from Health Systems Global (HSG) organised a virtual convening on 29th and 30th July, 2020. The aim was to respond to the HSR2020 sub-themes of “engaging political forces” and “social, economic and environmental forces” and to galvanize support from political, social, economic, academic, and policy actors in Ghana and across the continent of Africa to end the rhetoric of national funding for research and act now to protect Africa’s future. Over 80 participants took part in the two-day event. …”

IISD - Africa Leads the Way: Working Across the SDGs for Health Equity IISD;

“Providing Universal Health Coverage goes far beyond achieving SDG 3 (good health and well-being), and is equally a metric of success for countless other SDGs, from life on land (SDG 15) to gender equality (SDG 5). The Access Challenge and Harvard Global Health Institute recently launched a report highlighting the collaborations necessary to achieve UHC by drawing the connection between food, water, and air, and human health….”

“…The Access Challenge and Harvard Global Health Institute recently launched the report ‘Africa Leads the Way: Harnessing Multi-sectoral Collaboration to Achieve Universal Health Coverage,’ which highlights the collaborations necessary to achieve UHC by drawing the connection between food, water, and air, and human health….”

HSG (blog) - Are we doing enough for the mental well-being of Community Health Workers during COVID-19? https://healthsystemsglobal.org/news/are-we-doing-enough-for-the-mental-well-being-of- community-health-workers-during-covid-19/

Based on a recent survey in 23 countries. First published on The George Institute for Global Health.

Among the results: “…Fifty-seven percent of organisations involved in the survey noticed mental health signs and symptoms such as anxiety, depression and stress among CHWs during the COVID-19 pandemic.”

Vice - Celebrated Rwanda-Based Nonprofit Faces Harrowing Misconduct Accusations

Vice

“The director was accused of harassment, discrimination, anti-Semitism, and financial impropriety— and stayed on a year after his backers among the great and good were told.”

“The Sustainable Development Goals Center for Africa launched in 2016 to tremendous fanfare. Boasting a board featuring nine African presidents, Jeffrey Sachs, Aliko Dangote (Africa’s richest man), and other prominent philanthropists and development leaders, the Center was supposed to eschew international development norms and finally show what an organization by Africa, for Africa, and in Africa could do. It was founded, according to the organization’s website, to support “governments, civil society, businesses and academic institutions in achieving the Sustainable Development Goals (SDGs) in Africa.” The board is chaired by Dangote and Rwandan President Paul Kagame, and the organization’s website claims partnerships with U.N. Women, the U.N. Economic Commission for Africa, and international development agencies from Japan and South Korea, among others. Dr. Belay Begashaw, the founding director of the Columbia Global Centers for Africa and former director of the Millennium Development Goals Center for Eastern and Southern Africa, was tapped for the director-general role by Sachs. With Begashaw’s credentials, the board’s fame, and the organization’s virtuous mission, there was no doubt the SDGCA would excel….”

Katri Bertram - What do different types of partnerships mean for impact? https://pfipartners.org/2020/08/18/types-of-partnerships/

In this blog, Katri Bertram outlines four different types of partnerships (in international development): logo partnerships, technical partnerships, funding partnerships, and organizational partnerships. Not all types of partnerships provide the basis to collaborate in a way that drives impact. Key lessons are summarised at the end of this blog.

Some tweets of the week

Priti Patnaik

“The goal is to get to some populations in all countries, and not all people only in some countries - @WHO top official explains vaccine allocation in plain terms.”

WHO “About 170 countries, or 70% of the world's population, have expressed interest in the #COVAX facility, but we will only know how many have signed up by late August when the terms of agreement of this 'global solution' are concretized, said @WHO 's Bruce Aylward.”

Yanzhong Huang “Sinopharm plans to launch its COVID vaccine in Dec, and claims that two doses (priced below $142) will have 100% protection rate (1st dose, 97%). https://finance.sina.com.cn/stock/zqgd/2020- 08-18/doc-iivhvpwy1754036.shtml”

Kent Buse

Referring to a key message from a Guardian op-ed :

“‘#Neoliberalism hasn’t just undermined the quality of specific sectors ... but, by undermining the centrality of secure jobs that come with sick leave, career leave and annual leave, it has undermined the foundations of the modern welfare state...’”

Tom Frieden “Estimated cost of recent epidemics/pandemics: SARS (2003) - $40 billion H5N1 (2006) - $40 billion H1N1 (2009) - $45 billion Ebola (2014) - $55 billion COVID-19 (2020) - $8.8 TRILLION Investing in public health preparedness is FAR cheaper than the economic impact of a pandemic.”

Global health events

Coming up - 1st International Conference on Public Health in Africa (May 2021, Addis) https://africacdc.org/event/1st-international-conference-on-public-health-in-africa/

“The First International Conference on Public Health in Africa, organized by Africa CDC, will focus on COVID-19 in Africa: one year later and allow a review of lessons learned from the COVID-19 pandemic and opportunities to re-evaluate the new normal in public health practice in Africa….”

Global governance of health

Devex - What would Biden's foreign aid policy look like? https://www.devex.com/news/what-would-biden-s-foreign-aid-policy-look-like-97930

In-depth analysis. “A Joe Biden administration in the U.S. would "bring aid back to the center of our foreign policy," according to a campaign adviser. Here's a look at what Biden's foreign assistance policy could look like if he is elected president.”

“Joe Biden, the Democratic nominee for U.S. president, would have a different approach to foreign aid — one that would prioritize development, look to multilateral partnerships, and focus on a series of issues that have not seen as much attention during the President Donald Trump administration, according to experts and campaign documents….”

“not seen much attention’ must sure be the understatement of the century.

PS: as for how Biden plans to tackle Covid-19 in the US, if he’s elected, see Stat - Ramped-up testing and daily briefings: Inside Biden’s plan to take over a tumultuous Covid-19 response.

Africa Confidential - Governments reject UN report slamming rights abuses during pandemic https://www.africa-confidential.com/article- preview/id/13059/Governments_reject_UN_report_slamming_rights_abuses_during_pandemic

(gated) “Diplomatic spat as outraged African officials hold up publication in bid to amend its findings.”

“As Winnie Byanyima celebrates her first anniversary as Executive Director of UNAIDS, storm clouds circle her campaigning style. For her supporters, she has brought a breath of fresh-air into the UN's guarded pronouncements on any matter remotely political. For her opponents, including Uganda's President Yoweri Museveni, she continues to take the stance of the civil society activist instead of adapting to international protocols.”

Chatham House - Debunking the Myth of ‘Debt-trap Diplomacy’: How Recipient Countries Shape China’s Belt and Road Initiative Chatham House;

New paper. “China is often said to be pursuing ‘debt-trap diplomacy’: luring poor, developing countries into agreeing unsustainable loans to pursue infrastructure projects so that, when they experience financial difficulty, Beijing can seize the asset, thereby extending its strategic or military reach. This paper demonstrates that the evidence for such views is limited.”

Guardian - DfID scheme accused of 'putting UK aid in pockets of wealthy companies' https://www.theguardian.com/global-development/2020/aug/14/dfid-scheme-accused-of-putting- uk-aid-in-pockets-of-wealthy-companies?CMP=twt_a-global-development_b-gdndevelopment

“£6.85m programme places emphasis on benefit to businesses rather than protecting workers in the developing world, say critics.”

Devex - How WHO is engaging Big Tech to fight COVID-19 https://www.devex.com/news/how-who-is-engaging-big-tech-to-fight-covid-19-97854

(gated) “Silicon Valley companies met with the World Health Organization to share ideas on addressing COVID-19 before it became a pandemic. Andy Pattison, WHO manager of digital solutions, discusses how the agency approaches these tech partnerships and where they stand now.”

UHC

WHO Guidance - Diagnosis-related groups (DRG): A Question & Answer guide on case-based classification and payment systems https://www.who.int/publications/i/item/diagnosis-related-groups-(drg)-a-question-answer-guide- on-case-based-classification-and-payment-systems

New WHO guidance. “The guide explores key policy questions related to the preparations, design and implementation of case-based classification and payment systems, with a particular focus on diagnosis-related groups (DRGs).”

HP&P - Cross-border medical travels from Cambodia: pathways to care, associated costs and equity implications

M Liverani et al ; https://academic.oup.com/heapol/advance-article- abstract/doi/10.1093/heapol/czaa061/5892998?redirectedFrom=fulltext

“In low- and middle-income countries, patients may travel abroad to seek better health services or treatments that are not available at home, especially in regions where great disparities exist between the standard of care in neighbouring countries. While awareness of South–South medical travels has increased, only a few studies investigated this phenomenon in depth from the perspective of sending countries. This article aims to contribute to these studies by reporting findings from a qualitative study of medical travels from Cambodia and associated costs….” “Data collection primarily involved interviews with Cambodian patients returning from Thailand and Vietnam, conducted in 2017 in the capital Phnom Penh and two provinces, and interviews with key informants in the local health sector. The research findings show that medical travels from Cambodia are driven and shaped by an interplay of socio-economic, cultural and health system factors at different levels, from the effects of regional trade liberalization to perceptions about the

quality of care and the pressure of relatives and other advisers in local communities. Furthermore, there is a diversity of medical travels from Cambodia, ranging from first class travels to international hospitals in Bangkok and cross-border ‘medical tourism’ to perilous overland journeys of poor patients, who regularly resort to borrowing or liquidating assets to cover costs….”

Planetary health

Guardian - China's billion dollar pig plan met with loathing by Argentinians https://www.theguardian.com/global-development/2020/aug/14/chinas-billion-dollar-pig-plan-met- with-loathing-by-argentinians

“A government-sponsored plan to turbocharge Argentina’s hog industry with Chinese capital is generating unprecedented resistance among its supposed beneficiaries – the Argentinian general public….”

Vox - A simpler, more useful way to tax carbon https://www.vox.com/energy-and-environment/2020/8/17/21370732/carbon-tax-simple-useful- nt2nz

“A new proposal for how carbon taxes can play well with other policies.”

“The latest issue of the journal Nature Climate Change contains a study that attempts to sketch out a new approach to pricing carbon … … Rather than the conventional method of determining a carbon price, which involves wildly uncertain far-future climate projections from scientists and a whole range of social value judgments from economists, they advocate for a more modest approach, with prices tied to short-term goals and arrived at through democratic deliberation….”

Guardian - Atlantic ocean plastic more than 10 times previous estimates https://www.theguardian.com/environment/2020/aug/18/atlantic-ocean-plastic-more-than-10- times-previous-estimates

“More than 10 times as much plastic has been found in the Atlantic ocean than previously estimated to be there, showing the world’s plastic problem is likely to be much greater than realised….”

Infectious Diseases and NTDs

CNN - 750 million genetically engineered mosquitoes approved for release in Florida Keys https://edition.cnn.com/2020/08/19/health/gmo-mosquitoes-approved-florida-scn- wellness/index.html

“A plan to release over 750 million genetically modified mosquitoes into the Florida Keys in 2021 and 2022 received final approval from local authorities, against the objection of many local residents and a coalition of environmental advocacy groups. The proposal had already won state and federal approval….”

AMR

Nature News - The antibiotic paradox: why companies can’t afford to create life- saving drugs https://www.nature.com/articles/d41586-020-02418-x

“Paratek Pharmaceuticals successfully brought a new antibiotic to the market. So why is the company’s long-term survival in question?”

NCDs

SS&M - How are frames generated? Insights from the industry lobby against the sugar tax in Ireland.

N Campbell et al ; https://www.sciencedirect.com/science/article/abs/pii/S0277953620304342?via%3Dihub

« Sugar is undergoing a major framing contest. The process of generating a frame is as relevant as what is pictured inside it. Four framing mechanisms are used by industry against sugar taxation – dichotomizing, contesting, equating and cropping. Visibilizing the process of framing exposes meaning mechanisms across contexts, domains and issues….”

Reuters – PepsiCo hires WTO chief Azevedo as trade body's leadership void drags on https://www.reuters.com/article/us-trade-wto-azevedo/pepsico-hires-wto-chief-azevedo-as-trade- bodys-leadership-void-drags-on-idUSKCN25F21B

Tss tss. “Departing World Trade Organization Director General Roberto Azevedo will join PepsiCo Inc (PEP.O) as chief corporate affairs officer, the soft drink and snack foods giant said on Wednesday as the WTO remains far from deciding on a successor. PepsiCo said in a statement that Azevedo will oversee its public policy, government affairs and communications efforts in a newly created role that works with governments, international organizations and other stakeholders. He will also join PepsiCo’s executive committee.”

Sexual & Reproductive / maternal, neonatal & child health

Devex - Swedish aid: A focus on maternal health https://www.devex.com/news/swedish-aid-a-focus-on-maternal-health-96885

(gated) « Sexual and reproductive health and rights form a major portion of Sweden's health aid. Devex explores Swedish aid data to learn more about its maternal health funding priorities. »

Guardian – Selective abortion in India could lead to 6.8m fewer girls being born by 2030 https://www.theguardian.com/global-development/2020/aug/21/selective-abortion-in-india-could- lead-to-68m-fewer-girls-being-born-by-2030?CMP=twt_a-global-development_b-gdndevelopment

“An estimated 6.8 million fewer female births will be recorded across India by 2030 because of the persistent use of selective abortions, researchers estimate. Academics from King Abdullah University of Science and Technology in Saudi Arabia projected the sex ratio at birth in 29 Indian states and union territories, covering almost the entire population, taking into account each state’s desired sex ratio at birth and the population’s fertility rates. The cultural preference for a son was found to be highest in 17 states in the north of the country, with the most populous state of Uttar Pradesh showing the highest deficit in female births….”

Human resources for health

BMJ GH - Panacea or pitfall? The introduction of community health extension workers in Uganda David Musoke et al ; https://gh.bmj.com/content/5/8/e002445

“The Uganda Ministry of Health is planning to introduce new Community Health Extension Workers (CHEWs) who would be institutionalised, paid a monthly allowance, and work closely with existing Village Health Teams (VHTs) who are community volunteers. The introduction of CHEWs is likely to have several benefits to the country’s health system, including availability of another health cadre offering majorly preventive and selected curative services, and supporting the work of VHTs including supervision. But there are foreseeable concerns that could affect the CHEW programme. Just like VHTs, CHEWs would require support systems: performance management, regular refresher trainings, supervision from health practitioners, and availability of necessities and supplies. Given that two CHEWs would be employed per parish (the sub-counties of Uganda are divided into parishes, which are further divided into villages) in comparison with four VHTs per village, VHTs would remain crucial in supporting the community health system. However, there is a likelihood that with the introduction of CHEWs, VHTs would be further neglected hence affecting community health outcomes. Hence, there is need for a holistic approach to introduce and adequately support the CHEWs. Even with the introduction of CHEWs, deliberate effort to strengthen the existing VHT programme is necessary to improve community health.”

Miscellaneous

Economist - The pandemic is affecting elections around the world https://www.economist.com/graphic-detail/2020/08/17/the-pandemic-is-affecting-elections- around-the-world

“The list of impacted countries includes both full democracies and authoritarian regimes.”

“… According to the International Institute for Democracy and Electoral Assistance, a Swedish intergovernmental organisation, at least 70 countries and territories have rescheduled elections since mid-February; this includes 25 nationwide elections or referendums. Data from the latest edition of the Democracy Index from The Economist Intelligence Unit, our sister company, shows that such suspensions have been carried out across the spectrum, from bona fide democracies to authoritarian states….”

BMJ Analysis - Face coverings for covid-19: from medical intervention to social practice https://www.bmj.com/content/370/bmj.m3021

“Helene-Mari van der Westhuizen and colleagues argue that face coverings should be considered not as medical equipment but as a social practice informed by norms and expectations.”

“Face coverings used by the public are now widely recommended as source control during the covid- 19 pandemic; The dominant narrative driving policy has viewed face coverings as a medical intervention and evaluated their effectiveness from an infection control perspective; Face coverings are also a social practice and carry a range of meanings in different settings; Policies to encourage uptake should reflect the complex and contested sociocultural meanings of covering the face and draw on these to promote their use.”

Economist – Nicholas Christakis on fighting covid-19 by truly understanding the virus Economist;

Concluding paragraph: “ The distinctive characteristics of the virus behind covid-19 mean it will inexorably infect a large percentage of the world before the pandemic has run its course—an epidemiological parameter known as the “attack rate.” For SARS, the attack rate was infinitesimal: only 8,422 people out of a global population of 6.3bn in 2003, just 0.00013%. For covid-19, at least 40% of the world’s 7.6bn people will probably become infected, with millions of deaths.”

Lancet World Report – COVID-19 and readjusting clinical trials https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31787-6/fulltext

“The COVID-19 pandemic has disrupted clinical trials worldwide, with long-lasting effects on medical science. Aaron van Dorn reports.”

Emerging Voices

Global Health Promotion - Towards a better integration of social sciences in arbovirus research and decision-making: an experience from scientific collaboration between Cuban and Quebec institutions M Carabali (EV 2010) et al; https://journals.sagepub.com/doi/full/10.1177/1757975920943859

“In 2017, the Institute of Tropical Medicine Pedro Kourí, University of Montreal Public Health Research Institute, and McGill University joined efforts to provide scenarios for scientific exchange and knowledge dissemination about the social science contribution on arboviral research. This commentary describes the scientific collaboration between Cuban and Canadian (Quebec) institutions, illustrating the need and opportunities to facilitate research and effective decision- making processes for arboviral prevention and control, going beyond traditional biomedical aspects. We organized a set of scientific activities within three international events conducted in Cuba between 2017 and 2018. Given the collaborating institutions’ expertise and the knowledge gaps in arboviral research, we selected three main thematic areas: social determinants and equity, community-based interventions and use of evidence for decision-making. The partnership shows that interdisciplinary collaboration and the use and integration of quantitative and qualitative methods from the social sciences is essential to face the current challenges in arbovirus research.”