IHP News 634 : Kicking Off a Few Crucial Months

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IHP news 634 : Kicking off a few crucial months

( 3 Sept 2021)

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

Dear Colleagues,

Next Monday (6 September), the new flagship report from the Alliance for Health Policy and Systems Research, “Learning health systems: pathways to progress”, will be launched in a webinar. Focus: health systems strengthening through a learning lens. A teaser perhaps: “Learning health systems are those that make the link between past actions, the effectiveness of those actions, and future actions. Learning is a forward-looking and actionable lens through which to view the strengthening of health systems, building on existing frameworks, and linked to the agendas of improved equity, efficiency, resilience, people-centredness, self-reliance and improved quality. The importance of learning is increasingly pronounced in the current context, with the growing focus on the abilities of health systems to respond to pandemics, to transition from foreign aid to domestic funds, and to capitalize on the information revolution to achieve their goals.” Makes sense.

Between you and me, though, given the current state of the world, I also hope for a “learning” global health architecture sooner rather than later, properly taking into account the need to Decolonize & Democratize Global Health, planetary health ( plus “aligning” economic system), the social, commercial & political determinants of health, global tax justice,… you name it. Throwing in some top notch “double-loop” and even “triple-loop learning” . Unfortunately, such a global health architecture isn’t on the horizon yet. Nor are current geopolitics helping much, or some of our European leaders and Pharma CEOs, greatly skilled in ‘smoke & mirrors’ “global solidarity” (borrowing a term from Els Torreele on Twitter). Although at least a few of these seem to believe their own rhetoric.

Anyway. A few crucial months are coming up now. While global health security (& related governance) discussions are gaining momentum in Geneva and elsewhere, on Wednesday, the WHO Hub for Pandemic and Epidemic Intelligence was inaugurated in Berlin. Continuing in our ‘learning mode’, ‘Collaborative intelligence’ seemed the watchword there.

In the run-up to a global Covid summit in conjunction with UNGA (or so we hope - ugh), an urgent call was - again - launched to finally come up with a comprehensive global vaccine plan for the entire world. Last weekend, Devi Sridhar, signalling that charity [read: COVAX] has failed, already summarized what should be done instead, in a Guardian op-ed. Speaking of charity’s rather lousy “track record”, on Tuesday, former co-chairs of the Independent Panel for Pandemic Preparedness and Response called on high-income countries to urgently deliver on their pledged COVID-19 vaccine doses to low- and middle-income countries: instead of 1 billion doses (as advocated by the panel), only 99 million doses donated have been shipped via COVAX — of which 89 million doses to the 97 COVAX AMC countries, by Sept 1. Less than 10 %, in other words. End of last week, the heads of the Multilateral Leaders Taskforce on COVID-19 had already issued a similar call to “finally”

tackle the vaccine inequity crisis in a decisive way. Let’ s hope Biden, Bourla and others pay attention to these various desperate calls. It certainly won’t be for a lack of them.

Enjoy your reading.

Kristof Decoster

More than worth a read. Excerpts:

“The pandemic is no doubt redesigning the international public health order, with new forms of protagonism and significant power grabs, masked by a declared desire for interdependence and collaboration. …. …. The most worrying indication is that the turbulence caused by the pandemic and the public’s disorientation, due to the lack of a truly capable multilateral approach for dealing with it, may lay up the justification for a new twist in global health governance. This would be aimed at pushing through pro-corporate measures, with the good excuse of a revamped health security agenda for future pandemic response. The recently released report of the G20 High Level Independent Panel for Financing Global Commons for Pandemic Preparedness and Response, with its recommendations to establish a Global Health Threats Board and Fund, is a case in point…”

“…The highlight of the last WHO assembly – apart from the decision to greenlight negotiations for a new pandemic treaty and reconvene a special session in November 2021 to this end – is best captured in the WHA post-closure event on 31st May, when the heads of the WHO, the International Monetary Fund (IMF), the World Bank Group (WB) and the World Trade Organization (WTO) jointly announced a new US$ 50 billion plan to align health trade and finance to ending the pandemic and securing a global recovery. The call to action by this unusual quadrilateral grouping …. …. This post-WHA announcement, situated at the eve of the G7 meetings (11-13th June), holds a few perplexing implications. Apart from the rhetoric of engagement, how the new architecture will be translated operationally is not obvious at all; the joint move officially defines the contours of IMF involvement in health, an inconvenient novelty given the already overwhelming role of the World Bank in fostering health financialization…. the quadripartite move is clearly placed – in the geopolitics of health events in the second year of COVID-19 – to lend its support to counterbalancing, and indeed neutralizing, any serious diplomatic endeavor at the TRIPS Council negotiations in Geneva….”

Devex Newswire: Why are local leaders left out of pandemic planning? https://www.devex.com/news/devex-newswire-why-are-local-leaders-left-out-of-pandemic- planning-100690

“Community-based organizations have been critical in the global response to COVID-19. Why aren’t they more involved in public health decision-making? In the last 18 months, countless grassroots leaders and community-based organizations have expanded beyond their typical scope of work and taken on new challenges to help fight the COVID-19 pandemic. In many cases their most valuable asset has been trust, Catherine Cheney reports. But even as CBOs have proven indispensable in reaching vulnerable populations with information about the virus, or with interventions that can prevent its spread, their work tends to go undocumented, unrecognized, and uncompensated, according to a new report from the Aspen Institute’s Communities First Global Collaborative….”

For more, see Devex - How to integrate community leaders into pandemic preparedness

Globalization & Health - When actions do not match aspirations - comparison of the European Union policy claims against what has been negotiated for health services, trade and investment

M Koivusalo et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021- 00739-8

Authors assessed « …to what extent health systems were safeguarded in trade negotiations using the European Union (EU) negotiation proposals for the Transatlantic Trade and Investment Partnership (TTIP) and the negotiated agreement for the EU-Canada Comprehensive Economic and Trade Agreement (CETA).”

Findings: « Our analysis shows that the European Union had sought to secure policy space for publicly funded health services for services chapter, but not for investment and investment protection chapters. In comparison to audiovisual services, exceptions for health services fall short from those on audiovisual services. There is little evidence that the same outcome could have been achieved using other avenues. »

Chatham House (Expert Comment) - New roles for military in health emergency preparedness L Lillywhite et al ; Chatham House;

“New guidance from the WHO outlines how the military and health sectors can work together to be ready for future infectious disease outbreaks.”

BMJ (Opinion) - UN food systems summit leaders must not remain silent on its inadequate rules of engagement with commercial actors M Nisbett, K Buse et al; BMJ;

“The pre-summit to September’s United Nations Food Systems Summit (UNFSS), held in Rome at the end of July 2021, confirmed the fears of a broad range of international actors that the UNFSS model allows for corporate capture of international policy on healthy and sustainable food systems. Coverage in the BBC Food Programme demonstrates that concerns have moved into the mainstream, despite the hopes of many that the UNFSS could still help fix a broken food system….”

“…. The pre-summit programme included sessions with representatives of international food companies and organisations representing tobacco, alcohol, and food industries. This reflects the involvement by the organisers of Davos and other industry representatives in the pre- summit. …. …. Meanwhile, the alternative summit—the People’s counter mobilization to transform corporate food systems—reinforced how the process for the UN food systems summit has failed to ensure authentic inclusion of many unheard voices, despite being referred to by the UN as a “people’s summit.” …”

The authors conclude: “… Ahead of September’s UNFSS, and future summits designed in this vein, we ask other public health actors to support those working from inside the planning process to advocate for a set of meaningful rules of engagement and protective mechanisms from vested interests, for transparency and accountability, and, as a UN summit, bringing the UNFSS back in line with conflicts of interest protocols designed by UN organisations, for example by the World Health Organization (WHO), and other international summits. Member States, with their obligation to respect, protect, and fulfill human rights remain at the heart of the multilateral system, have been disappointingly quiet on this gradual abrogation of their responsibilities to big food, and some even complicit. …”

Annual Health20 Summit ( 1-2 September ) https://h20annualsummit.com/

This meeting took place ahead of the G20 Health Ministers’ meeting (of 5-6 Sept).

“The annual Health20 Summit on 1-2 September 2021, hosted by The G20 Health and Development Partnership, [will] be held virtually this year inviting G20 Policymakers, International Organisations, the Global Health Community, Economists, Civil Society and Academia to join discussions and make concrete recommendations to G20 Health Ministers ahead of their summit about the future of global health crisis management and financing. …. … Under the theme Countdown To 2030 – Turning G20 Health Declarations Into SDG3 Actions and Results, the H20 summit in support of the G20 Presidency of Italy, will discuss what the global community has achieved in managing COVID-19 and compare and analyse existing G20 initiatives to assess how we can leverage the many initiatives and turn them into concrete actions. The “call to action” recommendations following from the H20 summit [will] be shared with G20 Health Ministers ahead of their meeting on 5-6 September 2021….”

Think Global Health - Rethinking Border Management and Global Health Security after the Pandemic Kelley Lee; https://www.thinkglobalhealth.org/article/rethinking-border-management-and-global- health-security-after-pandemic

Well worth a read. “Border measures will be a more complex and controversial challenge for the post-pandemic world.” Among others, on lessons learnt during the Covid-pandemic re border management.

And: “Restoring a multilateral approach to border management must be a key priority in strengthening future pandemic preparedness.”

Links:

• Tweet: “ To enhance #pandemic preparedness in 16 West & Central African countries, the @WorldBank expanded support for the Regional Disease Surveillance Systems Enhancement (REDISSE) Program to strengthen disease surveillance & response: http://wrld.bg/d7PQ50FZLlp

• IJHPM - Financial Assistance for Health Security: Effects of International Financial Assistance on Capacities for Preventing, Detecting, and Responding to Public Health Emergencies (by M Boyce, R Katz et al)

Inauguration of WHO Hub for pandemic and epidemic intelligence (Berlin, 3 Sept) https://www.who.int/initiatives/who-hub-for-pandemic-and-epidemic-intelligence

Official launch. “To better address pandemic and epidemic risks, the WHO Hub for Pandemic and Epidemic Intelligence will strengthen intelligence specifically for pandemics and epidemics by striving for better data, better analytics, and better decisions. Embedded in WHO’s Health Emergencies Programme and building on consultations with hundreds of experts from different disciplines, sectors, and regions, it will leverage WHO’s unique convening power across nearly 200 countries to foster global solutions….”

Check out Q&A and a strategy paper.

• See WHO - WHO, Germany open hub for pandemic and epidemic intelligence in Berlin • Coverage via the Guardian - WHO opens pandemic intelligence hub to look out for future crises

“ A World Health Organization “pandemic intelligence hub” launched by the UN agency’s director general, Tedros Adhanom Ghebreyesus, and Germany’s Angela Merkel in Berlin on Wednesday will try to help governments identify future pandemics at an earlier stage and improve monitoring of new variant strains of Covid-19. The hub, which will host scientists and policymakers from around the globe on a project-by-project basis, is designed to make it easier for governments to compare notes on emerging infectious diseases and pull in additional relevant information on travel patterns, trade routes or human-animal interactions in agriculture. … The hub will be part-funded by the German government with $100m for the first three years, and will initially operate from a space on Luisenstrasse in central Berlin, leased from the Charité university hospital. It will later move to a permanent campus on Moritzplatz in Kreuzberg district. The hub will have space for up to 120 people, most of whom will not be WHO staff but visiting scientists or policymakers.”

The new director: Dr Chikwe Ihekweazu. Currently the Director-General of Nigeria’s Center for Disease Control. Will serve a dual role as head of the WHO Hub in Berlin, and as Assistant Director- General for Health Emergency Intelligence in Geneva.

• Cfr the Telegraph – “The initiative, launched with Germany, is a key pillar in the WHO’s efforts to stem holes in global pandemic preparedness.”

“…Dr Mike Ryan, head of the WHO’s emergencies programme, added that the hub will be the first of many dotted across every continent, which will create an “unbreakable chain of health protection for all the people on the planet”.”

• Devex - Can the new WHO hub in Berlin build trust for data sharing? “… questions remain as to how it will address issues around transparency and data sharing to prevent future pandemics….. In his remarks, Tedros said the hub will leverage innovations in data science, and make use of artificial intelligence, quantum computing, and other cutting-edge technologies. It is also envisioned to foster “greater sharing of data and information between communities and countries.” But he emphasized the importance of collaboration, noting that “no single institution or nation can do this alone.” “That's why we have coined the term ‘collaborative intelligence’ to sum up our collective mission,” he said. But collaboration requires trust, and a key question is how the hub will be able to build that trust between WHO member states and partners to be open and transparent in sharing information.

Along the same lines: SCMP - WHO starts data-sharing effort to prevent pandemics. Will nations cooperate? “ …experts say the hub’s success will depend on whether countries share disease data….”

Science - In Berlin, a new WHO center aims to keep an eye on emerging diseases

“Ideally, the hub will become the foundation of a new global surveillance architecture for COVID-19 and other pathogens, says Jeremy Farrar, who heads the Wellcome Trust. “This needs to become something akin to the global influenza network,” a collection of centers that track flu viruses. Farrar envisions additional hubs in Asia, Africa, and the Americas that would draw key information from smaller laboratories and data centers…. “

“Some observers worry the hub’s hasty creation highlights a problematic trend. “We’re seeing a ‘hubization’ of the WHO,” says Maike Voss, a global health specialist at the German Institute for International and Security Affairs. “Rich countries are buying new WHO institutions,” she says, pointing to the recent creation of a WHO biobank in Switzerland and a WHO academy in France. She fears the trend could “lead to a legitimacy problem [for WHO] over time.”…”

• PS: (via HPW ) “Dr Tedros, who cut a ribbon with German Chancellor Angela Merkel to inaugurate the hub, credited Merkel with the vision to set up the institution, and later in the event awarded her with the WHO Global Leadership Award in recognition of her “outstanding contribution to global health”.”

• PS: (speech Tedros at Münich Security Conference Breakfast meeting in Berlin) “….Other initiatives include the Universal Health and Preparedness Review – a new mechanism for enhancing national preparedness – and the establishment of the WHO BioHub in Switzerland, for the storage, sharing and analysis of pathogens….”

Politico -WHO, Berlin float sanctions if countries suppress information on pandemics https://www.politico.eu/article/who-berlin-float-sanctions-if-countries-suppress-information-on- pandemics/

“German Health Minister Jens Spahn called for sanctions Wednesday against countries that hide information about future outbreaks. Citing the World Trade Organization’s power to sanction countries for noncompliance, Spahn said “there must be something that follows” if countries fail to live up to commitments under a new pandemic treaty that the World Health Assembly will take up in November. The proposal for sanctions from a major EU country — a not-so-subtle dig at China — marks a major shift in tone as Western governments accuse Beijing of preventing a full investigation into how the novel coronavirus emerged….”

2nd meeting (1-3 September 2021) of the WHO Working Group on Strengthening WHO Preparedness for and Response to Health Emergencies (Geneva) https://apps.who.int/gb/wgpr/e/e_wgpr-2.html

Important forum, in the run-up to the pandemic treaty/IHR/… related WHO meeting in November.

Have a look at the provisional agenda, and some documents.

Quote: “Through a silence procedure that concluded on 30 August 2021, Member States approved the following outcome reports for use as official governing bodies documents…” Including timelines & deliverables, and also Proposed modalities of engagement for relevant stakeholders (which caused some commotion on Twitter).

PS: you also find there the Co-Chairs’ summary report of the first meeting of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (15–16 July 2021)

TWN - WHO: Working Group Bureau questions on pandemic treaty prejudge outcome https://www.twn.my/title2/health.info/2021/hi210901.htm

Analysis. “Leading questions on a proposed pandemic treaty from the Bureau of a World Health Organization (WHO) working group appear to prejudge the outcome of upcoming discussions. The Member States Working Group on Strengthening WHO Preparedness for and Response to Health Emergencies (WGPR) was established by the 74th World Health Assembly (WHA) Resolution WHA74.7 in May this year, and was mandated to assess the benefits of developing a new pandemic treaty under WHA decision (WHA 74(16)). The first meeting of the Working Group was on 15-16 July, with the second currently taking place on 1-3 September at the WHO headquarters in a hybrid mode. The questions concerned compromise the objectivity of the WGPR’s mandate “to prioritise the

assessment of the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response.”…” Read why.

Covax & ACT-A

Independent - High-income countries called on to share COVID-19 vaccines quickly https://theindependentpanel.org/high-income-countries-called-on-to-share-covid-19-vaccines- quickly/

See also the intro this week. “The former Co-Chairs of the Independent Panel on Pandemic Preparedness and Response (IPPPR), Ellen Johnson Sirleaf, former President of Liberia, and Helen Clark, former Prime Minister of New Zealand, have expressed their deep concern at the slow pace of redistribution of COVID-19 vaccines from high income to low-income countries. “The Independent Panel report recommended that high-income countries ensure that at least one billion doses of vaccines available to them were redistributed to 92 low- and middle-income countries by 1 September, and a further one billion doses by mid-2022”, President Sirleaf and Helen Clark said. … … The Co-Chairs noted that, to date, 99 million dose donations have been shipped via COVAX, out of which only 89 million have been shipped to the 92 Advance Market Commitment countries – far short of the one billion doses the Independent Panel has called for. “… …. The 600 million doses which have already been pledged now need to be delivered with urgency”, the Co-Chairs said. The Co- Chairs also noted that there needs to be much more rapid action on increasing vaccine production in low- and middle-income countries.”

PS: Doses pledged to COVAX: https://www.gavi.org/sites/default/files/covid/covax/COVAX-Dose- Donation-Table.pdf (as of 6 August)

Coverage also via Devex – COVID-19 vaccine donations didn’t hit panel recommendation of 1B doses.

GAVI - France donates 10 million doses to Africa through COVAX and AU

GAVI;

“ As part of France’s pledge to donate at least 60 million doses to the world this year, a new arrangement between France and the African Union will see 10 million doses provided through a partnership with COVAX and the Africa Vaccine Acquisition Trust (AVAT)….” AZ & Pfizer doses.

Links:

GAVI - Canada donates doses through COVAX – Nigeria, Kenya and Niger to receive first doses

“Three countries in Africa will receive the first Canadian-donated doses of the AstraZeneca vaccine – Nigeria (801,600 doses), Kenya (459,300) and Niger (100,800) – as part of an overall Canadian pledge of over 40 million doses to COVAX….”

Reuters - U.S. to begin shipping COVID-19 doses to Kenya and Ghana (2 million Moderna doses)

Covid key news

With key trends & WHO messages/initiatives, origins debate, ….

Cidrap News - Global COVID-19 plateau continues as WHO notes another variant https://www.cidrap.umn.edu/news-perspective/2021/09/global-covid-19-plateau-continues-who- notes-another-variant

“The world reported 4.4 million new COVID-19 cases last week, similar to the previous week, as the World Health Organization (WHO) added B1612—now called Mu—as a variant of interest. In its latest weekly snapshot of the pandemic, the WHO noted that cases were down in all of the world's regions except for the Western Pacific, which reported a 7% rise in cases. Globally, the level of deaths also held steady compared with the week before. Countries reporting the most cases last week include the United States, India, Iran, the United Kingdom, and Brazil. Patterns reflect a mixed picture, with some countries reporting notable spikes, including Ethiopia, with a 61% rise, followed by Timor-Leste with 32%, Canada 28%, Guatemala 23%, Sri Lanka 19%, and India 17%....”

Link: Cidrap News - COVID-19 surges in parts of Asia; levels rise in Europe (Aug 30)

WHO Afro – Eight in 10 African countries to miss crucial COVID-19 vaccination goal https://www.afro.who.int/news/eight-10-african-countries-miss-crucial-covid-19-vaccination-goal

“Africa is set to miss the urgent global goal of vaccinating the most vulnerable 10% of every country’s population against COVID-19 by the end of September. Forty-two of Africa’s 54 nations— nearly 80%—are set to miss the target if the current pace of vaccine deliveries and vaccinations hold, new data from the World Health Organization (WHO) shows….”

“…Almost 21 million COVID-19 vaccines arrived in Africa via the COVAX Facility in August, an amount equal to the previous four months combined. With more vaccines expected from COVAX and the African Union by the end of September, we could see enough doses delivered to meet the 10% target. While many African countries have sped up COVID-19 vaccinations as vaccine shipments ramped up in August, 26 countries have used less than half of their COVID-19 vaccines. Over 143 million doses have been received in Africa in total and 39 million people—around just 3% of Africa’s population—are fully vaccinated…”

And via UN News: “Meanwhile, the agency reported that COVID-19 cases are declining slightly in Africa but remain “stubbornly high”. An increase in new cases in Central, East and West Africa,

pushed numbers up to nearly 215,000 for the week ending 29 August. Twenty-five countries, over 45 per cent, are reporting high or fast-rising caseloads, while over 5,500 deaths were reported during the same period. …”

Guardian - US intelligence couldn’t resolve debate over Covid origins – official report https://www.theguardian.com/us-news/2021/aug/27/coronavirus-origin-us-intelligence

Over to the neverending ‘origins saga’ then. From late last week: “The US intelligence community failed to resolve sharp debate within the Biden administration over whether a Chinese laboratory incident was the source of Covid-19, US officials said in a report summary on Friday. The report, issued by the Office of the Director of National Intelligence in response to Joe Biden’s request, said a satisfying answer to the question of how a virus that has killed 4.6 million people worldwide started remained out of reach…..”

See also Science: COVID-19’s origins still uncertain, U.S. intelligence agencies conclude

“ The first, and most important, takeaway is that the IC is “divided on the most likely origin” of the pandemic coronavirus and that both hypotheses are “plausible.” The National Intelligence Council and the unnamed “IC elements” involved—which could include military agencies, FBI, CIA, and branches of the Department of State—apparently agreed on a few points in their assessment. Chinese officials didn’t “have foreknowledge” of SARS-CoV-2 before an outbreak of the virus arose in Wuhan, China, in December 2019. SARS-CoV-2 probably emerged, they concluded, no later than in November 2019. The agencies also concluded that “the virus was not developed as a biological weapon.”

… “This summary indicates that the IC elements overall were leaning in the direction of a natural origin…”

Nature - US COVID origins report: researchers pleased with scientific approach

Also well worth a read, this analysis by Amy Maxmen.

Including, in the final paragraphs, this tricky question: “… Many researchers welcome the news of a standing scientific committee devoted to origins investigations, saying that it will help future studies to start sooner, when the early events of an outbreak are still fresh in bodies and in minds. However, Thomas Bollyky, director of the global health programme at the Council on Foreign Relations in Washington DC, says, “I think this sort of group would be better outside of the WHO, as a coalition of national scientific academies.”…”

As you know, WHO has launched a call for a scientific advisory group on the origins at WHO.

Reuters - Global policymakers urge more sharing of COVID-19 vaccine

Reuters;

“A group of global policymakers tasked with responding to the COVID-19 health crisis on Friday urged nations with large vaccine stocks to share them with programs that distribute them to lower- income counties. In a joint statement, the Multilateral Leaders Taskforce - which includes the heads of the International Monetary Fund, World Bank Group, World Health Organization and World Trade Organization - said fewer than 2% of adults in most low-income countries were vaccinated, compared with almost 50% in high-income countries. "This crisis of vaccine inequity is driving a dangerous divergence in COVID-19 survival rates and in the global economy," the group said. …. It called on the Group of Seven nations - the United States, Canada, France, Germany, Italy, Japan and the United Kingdom - to "urgently" fulfill their vaccine-sharing pledges, noting that fewer than 10% of pledged doses have been shipped. The group also urged nations to eliminate export restrictions on COVID-19 vaccines….”

• See also UN News – Vaccine inequity causes ‘dangerous divergence’ in COVID survival rates – UN agency heads

“The heads of the International Monetary Fund (IMF), World Bank, World Health Organization (WHO) and World Trade Organization (WTO) met with the leaders of the African Vaccine Acquisition Trust (AVAT), Africa CDC, Gavi and UNICEF to rapidly scale-up vaccines in low- and lower middle- income countries, particularly in Africa….”

• For the detail, see WHO - Joint Statement of the Multilateral Leaders Taskforce on Scaling COVID-19 Tools

Reuters - Coronavirus booster shots 'not a luxury', WHO Europe head says https://www.reuters.com/world/europe/higher-european-covid-19-transmission-rates-deeply- worrying-who-europe-head-2021-08-30/

Interesting (and somewhat strange) point of view from Kluge (WHO Euro). “- A third-dose booster shot of the COVID-19 vaccination is a way to keep the most vulnerable safe and "not a luxury", the World Health Organization said on Monday. … "A third dose of vaccine is not a luxury booster (that is) taken away from someone who is still waiting for a first jab. It's basically a way to keep the most vulnerable safe," Hans Kluge, head of WHO Europe, told a press briefing. "We have to be a little bit careful with the booster shot, because there is not yet enough evidence," he said. "But more and more studies show that a third dose keeps vulnerable people safe, and this is done by more and more countries in our region," he said. Kluge urged European countries with excess vaccines to share them with other countries, particularly those in Eastern Europe and Africa….”

UN News - COVID jabs needed for educators and kids to keep schools open: WHO, UNICEF https://news.un.org/en/story/2021/08/1098712

“As the school year begins for millions of children in Europe and Central Asia, UN health and child experts on Monday issued a series of COVID-19 risk reduction measures to ensure that in-person lessons can go ahead, despite rising infection rates.” … Check out the eight key recommendations to help keep schools open and safe, endorsed by WHO, UNICEF and UNESCO and developed by the WHO European Technical Advisory group for schooling during COVID-19.

HPW - WHO Issues COVID-19 Digital ‘Vaccine Pass’ Guidelines – But Stresses These Should Not be Requirements for Travel https://healthpolicy-watch.news/who-issues-covid-19-digital-vaccine-pass-guidelines/

“Although the World Health Organization (WHO) has issued technical guidelines for the development of digital COVID-19 ‘vaccine certificates’, it has stressed that these should not be a prerequisite for international travel. At the release of the technical guidelines last Friday (27 August), the WHO stated that it “does not support the requirement of proof of COVID-19 vaccination in order to travel”, citing that vaccines were not yet widely available in many countries. “In some situations, however, depending on the risk assessment of the countries concerned, information about vaccination against COVID-19 may be used to reduce requirements for quarantine or testing upon arrival,” it added in a media statement….”

WHO releases new compendium of innovative health technologies for COVID-19 and other priority diseases https://www.who.int/news/item/31-08-2021-who-releases-new-compendium-of-innovative-health- technologies-for-covid-19-and-other-priority-diseases

“To ensure that all countries benefit from health innovation, WHO has compiled a compendium of 24 new technologies that can be used in low-resource settings.”

“… The compendium’s main objective was to select and assess technologies that can have an immediate and future impact on COVID-19 preparedness and response, potentially improve health outcomes and quality of life, and/or offer a solution to an unmet medical need. 15 of these technologies are already commercially available in countries, while the rest are still at the prototype stage. …”

Covid science

Science - Why many scientists say it’s unlikely that SARS-CoV-2 originated from a “lab leak” https://www.science.org/content/article/why-many-scientists-say-unlikely-sars-cov-2-originated- lab-leak

(as of 2 Sept) In-depth report by Jon Cohen.

Guardian - WHO monitoring new coronavirus variant named Mu https://www.theguardian.com/world/2021/sep/01/who-monitoring-new-coronavirus-variant- named-mu

“Health body says Mu, or B.1.621, first identified in Colombia, has been designated as a variant of interest.” Have to say this one sounds like an ancient Chinese philosopher.

Bloomberg - New Covid Variant Found in South Africa Has Concerning Mutations https://www.bloomberg.com/news/articles/2021-08-30/new-covid-variant-found-in-south-africa- has-concerning-mutations

“South African scientists said they identified a new coronavirus variant that has a concerning number of mutations. The so-called C.1.2. variant was first identified in May in the South African provinces of Mpumalanga and Gauteng, where Johannesburg and the capital, Pretoria, are situated, the scientists said in a research paper. It’s since been found in seven other countries in Africa, Oceania, Asia and Europe. The mutations on the virus “are associated with increased transmissibility” and an increased ability to evade antibodies, the scientists said. “It is important to highlight this lineage given its concerning constellation of mutations.”…”

See also Reuters - South Africa detects new coronavirus variant, still studying its mutations

And Reuters - WHO says C.1.2. COVID-19 variant does not seem to be spreading And not a ‘variant of interest’ yet either, for the moment.

As a reminder: WHO - Tracking SARS-CoV-2 variants (last updated on 25 August)

Science - Unethical? Unnecessary? The COVID-19 vaccine booster debate intensifies Unethical? Unnecessary? The COVID-19 vaccine booster debate intensifies

“As United States reveals its plan to offer an extra dose of COVID-19 vaccine, equity and scientific questions abound.”

See also Stat News - The debate over Covid-19 vaccine boosters, what to call them, and whether they’re needed “Some vaccine experts say don’t use the ‘B’ [booster] word. Does it matter?”

Guardian – Delta variant doubles risk of hospitalisation, new study finds https://www.theguardian.com/world/2021/aug/27/delta-covid-variant-doubles-risk-hospitalisation- new-study-finds

See the new study in the Lancet Infectious Diseases.

Links:

• Stat News - Inside Pfizer’s labs, ‘variant hunters’ race to stay ahead of the pandemic’s next twist

Trips Waiver, tech transfer, ….

Fierce Pharma - BioNTech selects Rwanda, Senegal for potential malaria and tuberculosis mRNA vaccine manufacturing https://www.fiercepharma.com/pharma/biontech-selects-rwanda-senegal-for-potential-malaria- and-tuberculosis-mrna-vaccine

“BioNTech hopes it can follow up its global COVID-19 success with the world’s first mRNA vaccines against malaria and tuberculosis. While still under development, the German biotech is already eyeing two African countries to scale up production for the potential shots. BioNTech, in its bid to become a “global immunotherapy powerhouse,” announced that it’s looking to build mRNA manufacturing sites in Rwanda and Senegal to support future production of the two vaccine hopefuls, the company said Friday. The sites would provide “end-to-end vaccine supply solutions on the African continent.” “…. The company has already started evaluating the manufacturing capabilities in each country, BioNTech said. The decision to narrow its search to Senegal and Rwanda came after guidance from the African Union, the Africa CDC and the African Medical Agency, the union’s drug regulator still under formation. The locations of the sites within each country, which have yet to be decided, will eventually co-locate with the WHO’s upcoming vaccine hubs, sites the organization has used against the coronavirus and influenza to transfer manufacturing know-how. …”

Related tweet Els Torreele: “ Smoke and mirrors: Refusing to share proven and desperately needed Covid-19 mRNA vaccine technology today, but making promises for potential future still to be developed malaria and TB vaccines… @BioNTech_Group @vonderleyen. “

MSF Access (Technical brief) – Sharing mRNA vaccine technologies to save lives https://msfaccess.org/sharing-mrna-vaccine-technologies-save-lives

New report from @MSF_access makes the case for increasing vaccine manufacturing capacity (& a People’s vaccine’.

7-pager (27 August). “The World Health Organization (WHO) and many countries are already considering how to scale up mRNA and other vaccine manufacturing with existing vaccine manufacturers (e.g., BioVac and Institut Pasteur Dakar) through initiatives like the WHO COVID-19 mRNA Vaccine Technology Transfer Hub. In addition to existing vaccine manufacturers, quality- assured injectable medicines manufacturers can be another potentially important source to increase mRNA vaccine production capacity, including for vaccine active pharmaceutical ingredients. For example, establishing mRNA vaccine production at an existing manufacturing site in at least one African country could create an annual production capacity of up to 100 million COVID-19 vaccine doses within 10 months in one of the regions most affected by vaccine shortages. Manufacturers, governments and WHO should work to ensure the Hub’s success and utilise the additional production capacity injectable medicines manufacturers could offer to help deliver doses of mRNA vaccines still urgently needed to help protect millions of people from COVID-19.”

Reuters - Vietnam says Cuba to supply COVID-19 vaccine, transfer technology https://www.reuters.com/world/asia-pacific/vietnam-says-cuba-supply-covid-19-vaccine-transfer- technology-2021-08-24/

“ Cuba will supply large quantities of its home-grown COVID-19 vaccine, Abdala, to Vietnam and also transfer the production technology to the Southeast Asian country by the end of the year, the Vietnamese health ministry said on Tuesday….”

Global Policy - Local Production of COVID 19 Vaccines: A Strategy for Action

P G Sampath et al ; https://www.globalpolicyjournal.com/articles/health-and-social-policy/local- production-covid-19-vaccines-strategy-action

“COVID-19 has lent a fresh lease of life to local production initiatives particularly in Africa. In the vaccines sector, several new initiatives have been announced such as the recently announced mRNA hub for COVID-19 vaccines. Focused on creating disseminated manufacturing capacity for current and future pandemic response, these initiatives compete with other supply expansion efforts by private companies and other international organizations. The plethora of initiatives currently underway raise several questions: what is the relationship between building local capacity at the regional level, and expansion of supply capacity of COVID-19 vaccines at the global level? Are we risking over-production of COVID-19 vaccines, and if so, how can we ensure sustainability of current local production initiatives? Building on (a) the structure of the vaccines market, (b) the synergies between COVID-19 and other epidemiological causes, and (c) lessons learnt in vaccines manufacturing in other developing countries, we propose key components of sustainable local production strategies for vaccines that should guide current efforts in the African region….”

Other Covid vaccine access news/analysis/ advocay & other bottlenecks

Advocacy ahead of Global Summit to End COVID-19 by the Covid Collaborative/Pandemic Action Network https://www.covidcollaborative.us/global-covid-19-summit

“A coalition of 80 global leaders and over 25 organizations across corporate, philanthropic, civil society, advocacy, academic, and health sectors have called on world leaders attending the United Nations General Assembly this month to convene a global summit to ignite an urgent global action plan to end the pandemic. The call to action was coordinated by the COVID Collaborative, Duke- Margolis Center for Health Policy, Duke Global Health Innovation Center, Duke Global Health Institute, and the Pandemic Action Network.

“…Therefore, we call on world leaders to convene a global summit during this year’s United Nations General Assembly and commit to actions to make 7 billion doses of high-quality vaccines available before the end of 2021 and an additional 7 billion doses by mid-2022; ensure that every country is ready to implement equitable vaccination programs at scale by the end of this year; and vaccinate

70 percent of the world’s population by mid-2022. People everywhere should also have equitable access to tests, therapies, and other proven interventions so lives can be saved using all COVID-19 tools.”

Devex - COVID-19 vaccine unpredictability complicates country-level planning https://www.devex.com/news/covid-19-vaccine-unpredictability-complicates-country-level- planning-100675

Recommended analysis. Excerpts:

“Many African nations are facing challenges planning for rollouts of COVID-19 vaccines because supplies are unpredictable, according to Dr. John Nkengasong, director at the Africa Centres for Disease Control and Prevention. They are receiving doses in relatively small amounts, often with little warning about when they will arrive or what type of vaccine they will get. “The biggest challenge is predictability on access to vaccines,” he said during a press briefing on Thursday. “There are about six different vaccines out there, they come in all kinds of forms, and they require different conditions to roll them out. How can you plan?”…” “… Over the past week, 13 million doses have been administered across the continent — triple that of the previous week, World Health Organization regional director for Africa Matshidiso Moeti said during a press briefing Thursday. In the month of July, African nations received more doses from COVAX than the months of April to June combined…. But the donations from the facility now flowing to the continent are sporadic and unpredictable, and Nkengasong said some of the donations have “very short” shelf lives. …. … Beyond the doses from COVAX, the African Union made Johnson & Johnson vaccine doses available for purchase to countries, which some started receiving this month. Nkengasong said the schedule around the delivery of these doses is more predictable. He said that some countries have decided they will use the J&J vaccine in hard-to-reach areas because it only requires one dose — a plan countries can make because they’ve been told the type and timeframe of when they will receive the vaccines….”

“… But access to vaccine supplies is not the only problem. Some African countries struggled to roll out vaccines quickly before expiry. In some cases, funding and planning for in-country rollouts have been an afterthought. To ensure the incoming doses are effectively rolled out, WHO asked African countries to conduct self-assessments, examining the challenges they’ve had in rolling out doses. … …. …. During a WHO-convened meeting of the continent’s health ministers last week, Dr. Abdou Salam Gueye, the regional emergency director at WHO Africa, said that of the countries that submitted self-assessments, about one-third did not update national level deployment plans and more than 40% of countries that responded did not update district plans…. …. He added that some countries are not taking advantage of available funding to bankroll their rollouts. This includes Gavi, the Vaccine Alliance’s COVID-19 Vaccine Delivery Support funding, which only about half of the 47 countries in the WHO’s Africa region have applied for….”

Nature Microbiology - 10 Images That Illustrate The Shameful Global Vaccine Inequity

M Pai; https://naturemicrobiologycommunity.nature.com/posts/10-images-that-illustrate-the- shameful-global-vaccine-inequity

Went viral, this one. “This series of 10 images tell the story behind the great vaccine apartheid - the single biggest moral and scientific failure during this global crisis.”

Devex - Deal to send COVID-19 vaccines from South Africa to Europe dismantled https://www.devex.com/news/deal-to-send-covid-19-vaccines-from-south-africa-to-europe- dismantled-101532

“Following criticism over an agreement to ship Johnson & Johnson COVID-19 vaccines partially produced in South Africa to Europe — despite less than 3% of the African continent’s population being fully vaccinated — the deal has been suspended. Doses that have already been sent to Europe will be shipped back to South Africa for distribution among member states of the African Union, said Strive Masiyiwa, special envoy to the AU, at a press conference Thursday. “All the vaccines produced at Aspen will stay in Africa and will be distributed to Africa,” Masiyiwa said. “This issue has been corrected and it has been corrected in a very positive way.”…”

“Because of this, the expected number of J&J doses the AU can ship to countries per month has increased. Countries previously expecting to receive about 10 million doses in September can now look forward to 20 million doses…. … While the AU had previously expected to deliver 50 million doses from the manufacturing facility by the end of the year, they now plan to deliver 70 million….”

FT - Pfizer ramps up its salesforce in battle of vaccine boosters https://www.ft.com/content/7e1c9afc-b7c8-4368-b590-6171f53a2895

“Drugmakers prepare for intense marketing competition to provide annual Covid jab.”

“Pfizer is hiring a new salesforce to promote its Covid-19 vaccine as it gears up to compete with rival pharma groups to offer annual booster shots in the US. The vaccine maker began advertising several positions on LinkedIn last week, including a senior director to lead its US Covid launch and a senior manager for US Covid consumer marketing. The fresh job adverts highlight how Pfizer is preparing for the next phase of the pandemic, which will involve marketing its annual booster shots in order to compete with other drugmakers including Moderna to become the booster vaccine of choice. … … The BioNTech/Pfizer vaccine will be marketed under the brand name Comirnaty, which the companies have said represents a combination of the terms community, Covid, immunity and mRNA. … … Pfizer is likely to market its Covid jab in a variety of ways, including through television, online and social media adverts as well as on billboards….”

People’s Dispatch - Vaccine rollout in North Africa and West Asia: inequities rampant as conflict-hit regions suffer https://peoplesdispatch.org/2021/08/27/vaccine-rollout-in-north-africa-and-west-asia-inequities- rampant-as-conflict-hit-regions-suffer/

“Vaccination rates remain low in West Asia and North Africa even as these regions see an increase in the number of Covid-19 cases. As the health emergency deepens, sluggish vaccination campaigns and extreme disparities within the region remain a challenge…”

Reuters - Germany will offer Africa up to 70 mln COVID-19 vaccine doses, Merkel says

Reuters;

“Germany will make up to 70 million doses of COVID-19 vaccine available to African countries this year, Chancellor Angela Merkel said on Friday, more than doubling a previous pledge to donate 30 million. "Germany will make available not only 30 million doses of vaccines but it will be as much as 70 million doses," Merkel told a news conference after a summit with African leaders on the G20's Compact with Africa initiative….”

See also: African leaders renew calls for vaccine equity at Berlin summit

"The availability as well as the production of the vaccines is linked to the economic wellbeing of the African continent and when we see today that we have vaccinated more than 60% of our population and that it is 2% in Africa, it is of course a dramatic injustice which we which we need to overcome, we talked about that honestly today," Merkel said.”

Related tweet Tahir Amin: "German Chancellor Angela Merkel who has rejected calls to waive vaccines patents said it was a 'dramatic injustice' that Africa's vaccination rates remained low." Covid-19 is a great case study in politicians speaking out of both sides of their mouths.”

Bloomberg – Aspen in talks with J&J to increase Africa vaccine production Bloomberg;

“Aspen is in talks with J&J to increase production of Covid-19 vaccines and evaluate a potential license for Africa’s biggest drugmaker.”

See also Reuters - Aspen eyes Serum Institute model as it seeks licence to make J&J vaccine

UN News - Producing COVID-19 vaccines in Latin America will ease shortages, protect more people https://news.un.org/en/story/2021/09/1098962

“A new platform launched on Wednesday by the Pan American Health Organization (PAHO) will ease severe COVID-19 vaccine shortages and safeguard more people in Latin America and the Caribbean by producing inoculations within the region.”

“PAHO Director Carissa F. Etienne announced the launch of the Regional Platform to Advance the Manufacturing of COVID-19 Vaccines and other Health Technologies in the Americas, describing as an initiative that will “coordinate across sectors – health, science and technology and industry – to strengthen their capacity to produce new technologies”. …. The principle is that manufacture should benefit the entire region, with regional pharmaceutical production and vaccine distribution to all countries by PAHO’s Revolving Fund….”

Oxygen crisis

HPW - ‘Code Red’ Oxygen Shortages in 32 Countries; But with Finance Available Countries Need to Step up to Bat https://healthpolicy-watch.news/several-african-countries-face-dire-oxygen-shortages-highlighting- need-for-investment-in-oxygen-infrastructure/

“As some 32 countries worldwide, including seven African nations, face “code red” oxygen shortages, WHO and its partners are in the midst of a major effort to recruit sufficient supplies to meet countries’ urgent needs for life-saving oxygen. But while over US$500 million is now available in funds and finance for oxygen through the Access to COVID-19 Tools (ACT) Accelerator initiative, many African countries at risk of oxygen shortages have yet to apply for available funding to bolster their oxygen supplies – including Algeria, South Africa and the Democratic Republic of Congo. Delays in asking for funding, or asking for the wrong mix of supplies, can make response to oxygen demand surges an even bigger challenge, warned experts at an event Thursday co-organised by Unitaid, Waci Health, and the Every Breath Counts partnership, a coalition of UN agencies, businesses, donors and NGO. They urged countries to fine-tune requests and accelerate their applications to meet the next deadline for financing requests – as well as to fine- tune demands to ensure a faster and more flexible response to shortages – including a “very dire” situation in some African nations….”

“Globally 70 countries are at risk of oxygen shortages. Surges in COVID cases – due in large part to the Delta variant (B.1.617.2) – and hospitalizations are overwhelming health systems and driving up deaths. Among the African countries facing dangerous levels of oxygen shortages are: Ethiopia, Nigeria, Ghana, Benin, Togo, Cote d’Ivoire, and Somalia. Meanwhile, Somalia and nine other African at-risk countries have yet to even apply for funding for oxygen supplies. They include: Algeria, Libya, Mauritania, Guinea, the Democratic Republic of Congo, South Africa, eSwatini, Mozambique, and Botswana….”

“The ACT-Accelerator’s COVID-19 Oxygen Emergency Taskforce, which was launched in February, has mobilised over US$340 million for oxygen-related products in low- and middle-income countries (LMICs) through the Global Fund’s COVID-19 Response Mechanism (C19RM). In addition, some US$182 million has been donated to the therapeutics pillar of UNICEF’s Access to COVID-19 Tools Accelerator Supplies Financing Facility (ACT-A SFF). The finance mechanism is dedicated to the procurement and delivery of therapeutics for LMICs, including oxygen. But while this represents significant progress toward ACT-A’s goal of raising US$1.2 billion for COVID oxygen needs – bottlenecks in the manufacture of oxygen cylinders and long lead times required for the construction of large-scale pressure swing absorption (PSA) oxygen generating plants are delaying the acute deployment of crisis support, officials said. …”

Covid analysis

Economist – The pandemic’s true death toll The pandemic’s true death toll | The Economist

Daily estimate of excess deaths around the world. Now at 15 million… Over three times higher than the official tally.

“Although the official number of deaths caused by covid-19 is now 4.5m, our single best estimate is that the actual toll is 15.2m people. We find that there is a 95% chance that the true value lies between 9.3m and 18.1m additional deaths….”

BMJ GH (blog) - Stigma related to COVID-19 threatens to divide humanity further

S Bandara & R Lencucha; https://blogs.bmj.com/bmjgh/2021/08/29/stigma-related-to-covid-19/

“The long-term threat of stigma related to COVID-19 is two-fold: at the country level, directed towards specific communities, and at the inter-country level , is directed towards countries and regions struggling to control COVID-19….”

They conclude: “A stronger global level action plan focused on building public awareness and increasing political will to address stigma is required….”

International Public Management Journal - Modelling the barriers to multi- stakeholder collaboration for COVID-19 pandemic response: evidence from Sub- Saharan Africa Akenroye et al; IPMJ;

“The aim of this study is to develop a model describing the interactions and interdependence between the obstacles to effective implementation of a collaborative model of pandemic preparedness and response. A comprehensive review of the relevant literature highlighted 15 key variables. The contextual interactions between these barrier variables were identified based on the opinions of experts with COVID-19 pandemic experience and analysed to determine their driving and dependence powers using interpretive structural modelling. The findings indicate that the lack of guidelines and procedures for coordinated actions, differences in organisational culture (working habits) and funding constraints are the most critical barriers to effective multi-stakeholder collaboration. …”

BMJ - Women’s wellbeing and the burden of unpaid work https://www.bmj.com/content/374/bmj.n1972

“Soraya Seedat and Marta Rondon examine how gender inequities in the time allocated to unpaid work, exacerbated by covid-19, are affecting women’s mental health.”

LSE (blog) - Four lessons COVID-19 provides for improving Africa’s social protection systems C Webb; https://blogs.lse.ac.uk/africaatlse/2021/09/01/four-lessons-covid19-pandemic-improving- africa-social-protection-systems-cash-transfer/

“Across Africa, states have adapted or expanded social protection measures in response to the COVID-19 pandemic. These interventions provide valuable policy lessons and political opportunities to reimagine the social contract on the continent.”

Guardian Longread - Covid and the crisis of neoliberalism Adam Tooze; https://www.theguardian.com/news/2021/sep/02/covid-and-the-crisis-of- neoliberalism

“The year 2020 exposed the risks and weaknesses of the market-driven global system like never before. It’s hard to avoid the sense that a turning point has been reached.” From a forthcoming book by Tooze, “Shutdown: How Covid Shook the World’s Economy”.

Polio

CDC (report) – Progress Toward Polio Eradication — Worldwide, January 2019– June 2021

By CDC & WHO authors; CDC;

“Wild poliovirus type 1 (WPV1) remains endemic in Afghanistan and Pakistan. Circulating vaccine- derived poliovirus type 2 (cVDPV2) outbreaks have increased since 2017. From 2019 to 2020, the number of WPV1 cases increased in Afghanistan and decreased in Pakistan and the number of cVDPV2 cases increased and cVDPV2 outbreak countries increased to 32. In Afghanistan, the polio program faces challenges including an inability to reach children in critical areas and increasing political instability. The COVID-19 pandemic continues to limit the quality of immunization activities and poliovirus surveillance. What are the implications for public health practice? The Polio Eradication Strategy for 2022–2026 outlines measures including increased government accountability and wider use of novel, oral poliovirus vaccine type 2 that are needed to eradicate polio.”

UHC & PHC

HSG - New Report: Discussions and debates around primary health care, reaching the unreached, and financial protection during the 6th Global Symposia on Health Systems Research 2020 K Scott et al; HSG;

“HSR2020 provided rich discussions on primary health care that are synthesized in this report, identifying themes, commonalities, and tensions.”

Planetary Health

Guardian - Air pollution is slashing years off the lives of billions, report finds https://www.theguardian.com/environment/2021/sep/01/air-pollution-is-slashing-years-off-the- lives-of-billions-report-finds

“Air pollution is cutting short the lives of billions of people by up to six years, according to a new report, making it a far greater killer than smoking, car crashes or HIV/Aids. Coal burning is the principal culprit, the researchers said, and India is worst affected, with the average citizen dying six years early. China has slashed air pollution in the last seven years, but dirty air is still cutting 2.6 years from its people’s lifespan.”

In the AQLI report, “… M Greenstone and colleagues (university of Chicago) developed the Air Quality Life Index (AQLI), which converts air pollution levels into their impact on life expectancy….”

Cfr Greenstone: “The average global citizen loses 2.2 years of life with today’s levels of air pollution and, if nothing changes, that adds up to 17bn lost years… “What else on the planet is causing people to lose 17bn years of life?” …. The report estimated the number of additional years of life people would gain if air pollution levels in their country were reduced to World Health Organization guidelines. …. In central and west Africa, the impacts of particulate pollution on life expectancy are comparable to HIV/Aids and malaria, but receive far less attention, the report said. …”

UN News - Improving air quality ‘key’ to confronting global environmental crises https://news.un.org/en/story/2021/09/1099042

“With environmental events becoming increasingly interconnected, a new global report on air pollution published by the UN Environment Programme (UNEP) on Thursday underscores that improved air quality is “key to tackling the triple planetary crisis of climate change, biodiversity loss, and pollution and waste”. “Yet, air quality continues to deteriorate despite the increase in laws and regulations seeking to address air pollution”, UNEP chief Inger Andersen said in the foreword to the Global Assessment of Air Pollution Legislation (GAAPL)….”

“…Using Air Quality Guidelines developed by the World Health Organization (WHO), the report examines legal measures for determining whether air quality standards are being met and what procedures exist if they are not. According to the study, 43 per cent of countries lack a legal definition for air pollution and 31 per cent have yet to adopt legally mandated ambient air quality standards (AAQS)….”

Ecological Economics (Commentary) - The green investment paradigm: Another headlong rush N Magelhaes; https://www.sciencedirect.com/science/article/abs/pii/S0921800921002688

“In recent years, a new paradigm has emerged among economists on ecological crises: the green investment paradigm. Its importance in public debates can be explained by the very broad coalition

that supports it. This paradigm represents a new headlong rush that is the consequence of a combination of interrelated theoretical pitfalls. We expose the danger of its hegemony and present some alternative frameworks.”

NCDs

Reuters - Number of people with dementia set to jump 40% to 78 mln by 2030 - WHO

Reuters;

“More than 55 million people worldwide are living with dementia, a neurological disorder that robs them of their memory and costs the world $1.3 trillion a year, the World Health Organization (WHO) said on Thursday. The progressive condition can be caused by stroke, brain injury or Alzheimer's disease. With populations ageing, the number of sufferers is projected to rise to 78 million by 2030 and 139 million by 2050, the WHO said in a report….”

See also WHO - World failing to address dementia challenge

“… In 2019, the global cost of dementia was estimated to be US$ 1.3 trillion. The cost is projected to increase to US$ 1.7 trillion by 2030, or US$ 2.8 trillion if corrected for increases in care costs…. … More support needed, particularly in low- and middle-income countries…”

“only one-quarter of the world’s countries have national policies, strategies or support plans in place….”

The report: (WHO) Global status report on the public health response to dementia

IJHPM - Public-Private Partnerships With Unhealthy Commodity Industries: Are They Undermining Real Progress in Non-Communicable Disease Prevention? Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases C Rinaldi; https://www.ijhpm.com/article_4112.html?utm_source=dlvr.it&utm_medium=twitter

“Public-private partnerships (PPPs) and whole-of-society approaches are increasingly common in public health promotion and non-communicable disease prevention, despite a lack of evidence in favour of their effectiveness in improving health outcomes. While PPPs may have advantages, they also give industry actors more influence over the design and implementation of public health strategies and interventions. Partnering with unhealthy commodity industries in particular – including the alcohol and ultra-processed food and beverages industries – can pose significant risks to public health due to these industries’ deep-rooted conflicts of interest. In this commentary, I reiterate Suzuki et al.’s message about the importance of assessing and managing conflicts of interest before engaging with non-state actors through PPPs or other forms of engagement.”

Lancet - Polypills with or without aspirin for primary prevention of cardiovascular disease

J Mant et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01913-9/fulltext

Comment re a new Lancet Study – “Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial.”

“Ischaemic heart disease and stroke are the conditions that contribute most to the global burden of disease, as measured by disability-adjusted life-years in people aged 50 years and older, despite many cardiovascular diseases being preventable. Two of the key modifiable risk factors are hypertension and high serum lipid concentrations. There is great interest in simple approaches with wide applicability to address these risk factors, including using fixed-dose combination drug regimens, also known as polypills… evidence is accumulating from randomised controlled trials that polypills can reduce cardiovascular disease, but questions remain with regards to the balance of benefit and harm, the appropriate target population, and which drugs should be included in a polypill….”

Or as Stat News reported, “Polypill’ for high blood pressure gets a boost.” (compared to people who took a single medication, in the study, people in the polypill group had lower BP after a year)

Links:

• WHO Bulletin - Quality of stroke guidelines in low- and middle-income countries: a systematic review

• Plos Med (Perspective) - Understanding how unhealthy food companies influence advertising restrictions Comment linked to a new study in Plos Med - Corporate political activity in the context of unhealthy food advertising restrictions across Transport for London: A qualitative case study.

Decolonize Global Health

An African Reading of the COVID-19 Pandemic and the Stakes of Decolonization Atuire C et al ; https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and- stakes-decolonization

“…In this paper we examine the COVID-19 pandemic in Africa through a decolonization lens. Keeping in mind that there are differences in history, culture, and health systems among the various African countries, we draw on commonalities to explain how the COVID-19 pandemic which from the onset destabilized high-income countries (HICs) has occasioned a disruption of the habitual paradigm of dependence of African countries on foreign donors to assist them in times of health emergencies. We argue that this disruption could be seized as a catalyst in Africa’s process of health and healthcare decolonization. At stake in this process are the lives and livelihoods of millions of people

whose health needs are governed by processes and structures immersed in what we describe as coloniality. Engaging with decolonization has not only become a necessity for survival, but also an occasion to radically transform global health systems at the service of life of all, including the global majority, rather than that of the “haves” over the “have nots”….”

Some other news of the week

Guardian – US supreme court refuses to block radical Texas abortion law https://www.theguardian.com/society/2021/sep/02/us-supreme-court-refuses-to-block-radical- texas-abortion-law

“Court voted 5-4 to deny emergency appeal from abortion providers against law that bans abortions once medical professionals can detect cardiac activity.”

Guardian - Huge decrease in organ transplants as Covid took hold across world https://www.theguardian.com/society/2021/aug/30/huge-decrease-in-organ-transplants-as-covid- took-hold-across-world

“UK and international studies show the impact pandemic has had on health services and patients.” “The number of solid organ transplants fell dramatically around the world between 2019 and 2020, researchers have found, highlighting the widespread impact of the Covid-19 pandemic on health services and patients…. As the pandemic surged, hospitals were forced to delay potentially life-saving organ transplant surgery, because of resources such as intensive care beds being needed for Covid patients and because of concerns including whether it was safe to treat transplant recipients in hospital….”

“… Now an international study, published in the journal Lancet Public Health and presented at the European Society for Organ Transplantation (Esot) congress 2021, has showed the overall number of kidney, liver, lung, and heart transplants from human donors fell by 31% during the first wave of Covid-19 across 22 countries. The overall drop was almost 16% by the end of 2020, with more than 11,200 fewer transplants carried out….”

Some papers & reports of the week

WHO Bulletin (September issue) https://www.ncbi.nlm.nih.gov/pmc/issues/388476/

Start with the Editorial - Strengthening the evidence base for decisions on public health and social measures (by D Enria et al)

“….In June 2021, the World Health Organization launched a new multiyear initiative on measuring the effectiveness and the social, health and economic impact of public health and social measures during health emergencies. The initiative aims at strengthening the global evidence base to provide actionable and evidence-informed guidance on such measures for decision-makers. …. …. Key expected outcomes of the first year include a global evidence review, a global research agenda and a framework to generate, monitor, compare and evaluate research and policies on such measures. As a first step, experts will assess the existing evidence, discuss ethical and methodological challenges when generating knowledge and share lessons learnt from country implementation during a technical consultation in early September 2021. To support this initiative, the Bulletin of the World Health Organization calls for submission of primary studies, secondary analyses and systematic reviews on the effectiveness and broader social, health and economic impact of public health and social measures, to be reviewed on a rolling basis. …”

BMJ GH - Reorienting and rebuilding the health system in war-torn Tigray, Ethiopia https://gh.bmj.com/content/6/8/e007088

Commentary by Azeb G Tesema (EV 2020) et al.

See also a related read, a guest essay in Geneva Health Files - "Health is a strategic frontline target": Guest Essay by Mukesh Kapila on the Tigray Crisis

Including this poignant quote on the “Muted voice of the global health community”:

“My stance on Tigray’s tragedy is shaped by my experiences of confronting genocidal situations in, for example, Rwanda, Darfur, and Srebrenica. These shook me to my personal and professional core. Vowing “never again” means acknowledging that a crime against humanity in one place is a crime against all humanity everywhere, and requires everyone to give voice and act in solidarity. But my greatest disappointment is that this is not happening. The UN’s own political leadership has been non-existent. The hypocrisy of the global health community – many of them my distinguished colleagues from a lifetime of shared values and endeavours – is expressed through their near-silence. They do not hesitate in advocating on vital but “safely” abstract health matters such as COVID-19 inequities or universal health coverage. Yet they are strangely cowardly in taking a stand on immediate existential threats: mass atrocities are also bad for health. In the evil business of crimes against humanity, such silence kills more efficiently than bombs and bullets….”

Globalization & Health - The World Health Organization and the global standardization of medical training, a history

G Weisz et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021- 00733-0

“This article presents a history of efforts by the World Health Organization and its most important ally, the World Federation for Medical Education, to strengthen and standardize international medical education. This aspect of WHO activity has been largely ignored in recent historical and sociological work on that organization and on global health generally…..”

NEJM Fundamentals of Public Health This new Series (see introductory Editorial - Fundamentals of Public Health — A New Perspective Series ) has started.

See: Population Health and Human Rights (by Julio Frenk et al)

PS: Not part of the series, but also a new NEJM perspective - Virchow at 200 and Lown at 100 — Physicians as Activists.

Conflict & Health - Research as usual in humanitarian settings? Equalising power in academic-NGO research partnerships through co-production

M Lokot et al ; https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-021-00399-w

“Research partnerships in conflict-affected and humanitarian settings can reveal complex power hierarchies between academics and NGOs. During the process of research, decision-making may skew in favour of more powerful actors, who often direct the scope of the research, hold the budget and lead the analysis. Co-production is increasingly emerging as a helpful approach that attempts to equalise power dynamics during research. The aim of this paper is to draw attention to the main challenges associated with a “research as usual” approach to research partnerships in humanitarian settings, as power hierarchies may be particularly magnified in these settings….”

“…This paper highlights key challenges with standard research practices in humanitarian settings and identifies seven key principles of co-production that can be helpful in attempting to equalise power dynamics within research partnerships, specifically in conflict-affected and humanitarian settings.”

Development Policy Review - “The SDGs are not God” Policy-makers and the queering of the Sustainable Development Goals in Africa

C Izugbara et al ; https://onlinelibrary.wiley.com/doi/10.1111/dpr.12558

This article explores Togolese, Nigerian, and Ugandan policy-makers’ views and experiences of harnessing SDG-era national policies and programmes to address the exclusion and marginalization of sexual minorities.

Some of the findings: “Policy officials acknowledged the wide range of challenges facing LGBT people in their countries, disapproved of LGBT-privileging SDGs policies, and challenged the notion that LGBT inclusion in SDGs policy-making requires their targeted integration in policies. Policy-makers’ anxieties and apprehension that LGBT-favouring SDGs policies will indicate national support for homosexuality prompted them to equate defence of heteronormative SDGs policy-making with the defence of their countries’ civility and sovereignty. Their efforts to include LGBT people in SDG policies involved a dialectical dance, in which they showed neither vested interest in troubling existing homophobic narratives nor in preserving them using policies and programmes.”

WHO Bulletin - Performance-based incentives on community health worker outcomes, a systematic review

T Gatsden et al ; https://cdn.who.int/media/docs/default-source/bulletin/online- first/blt.20.285218.pdf?sfvrsn=22ccc6ab_5

Review of the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in LMICs.

Conclusion: “Financial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed.”

ILO –World Social Protection Report 2020-2022 https://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/@publ/documents/publication/ wcms_817572.pdf

This World Social Protection Report provides a global overview of recent developments in social protection systems and examines the impact of the COVID-19 pandemic. With 5 key messages.

See ILO : “More than 4 billion people still lack any social protection, ILO report finds.”

“Despite the unprecedented worldwide expansion of social protection during the COVID-19 crisis, more than 4 billion people around the world remain entirely unprotected, a new International Labour Organization (ILO) report says. It finds that the pandemic response was uneven and insufficient, deepening the gap between countries with high and low income levels and failing to afford the much-needed social protection that all human beings deserve. …. “Countries are at a crossroads,” said ILO Director-General, Guy Ryder. “This is a pivotal moment to harness the pandemic response to build a new generation of rights-based social protection systems. …”

Plos Med (Perspective) - Building global health research capacity to address research imperatives following the COVID-19 pandemic P Kilmarx et al; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003753

“…In conclusion, while the COVID-19 pandemic has already taken a devastating global toll on global health and well-being, it has also provided a strong example of the importance of health research capacity as an essential element of pandemic preparedness. The world faces a wide range of health challenges, from chronic diseases and risk factors to emerging global threats. Building research capacity, especially in countries with lower levels, while learning the lessons of COVID-19, must become a higher priority to achieve our current shared global health goals while increasing resilience to address future health threats.”

More blogs & mainstream analysis of the week

Health care IT news - Is healthcare too hard for Big Tech firms? https://www.healthcareitnews.com/blog/healthcare-too-hard-big-tech-firms

“With Google Health and Apple both reported to be, respectively, closing down and scaling back their healthcare efforts, it's worth asking just how disruptive consumer technology companies can be in this hugely complex and fragmented industry….”

Some tweets of the week

SoumayeepD (in response to an ESPN tweet: “Name something that 홞홨홣'황 an Olympic sport, but 홛홚홚홡홨 like an Olympic sport”)

“Getting people based in high-income countries to stop writing about decolonising global health.”

Ilona Kickbusch “It has been clear for some time that the US will not support a pandemic treaty and US diplomats are very active to convince others. That is normal health diplomacy. But it is not a given that it will be easier and much quicker to revise the #IHR”.

Tahir Amin “This pandemic is proving what I’ve felt for the last decade. Innovation doesn’t = progress. It has become a code word for markets, monopolies, profit and an excuse to undermine democratic institutions. Anyone looking to re-imagine a new economy needs to address “innovation”.”

Amy Maxmen “The US has tossed out 15 million doses of vaccine (& is stockpiling hundreds of millions more). These 15 million could have protected ALL of the nurses & doctors in Sierra Leone, Guinea and Liberia, where <3% of people are vaccinated.”

Global governance of health

Devex - What's going on between African nations and the EU? https://www.devex.com/news/what-s-going-on-between-african-nations-and-the-eu-100658

“…. More than a 1 ½ year after her trip [i.e. Ursula von der Leyen’s trip to Addis Abeba, AU capital] and despite the commission’s release of a comprehensive strategy for Africa early last year, that partnership [“between equalz] has yet to flourish. A high-level AU-EU summit scheduled for October 2020 has repeatedly been stalled, even as African leaders have strengthened ties with other global powers, particularly China. The COVID-19 pandemic contributed to derailing the European Commission’s efforts, but experts said there may also be a disconnect between the priorities of the two continents, with Europe focused on climate change and migration and Africa determined to end the COVID-19 pandemic and jump-start its economies. There is also a discomfort with Europe’s attempts to dominate the relationship, especially at a moment when other investors are lining up….”

“… The global response to COVID-19 has only exacerbated any divisions. As Europe has charged ahead of much of the rest of the world in securing and administering vaccines, its leaders are at the forefront of blocking the effort spearheaded by South Africa and India within the World Trade Organization to waive intellectual property protections on COVID-19 vaccines and other tools. “How the EU and Africa cooperate on health, on the vaccine rollout in Africa have become really, really key political questions,” said Chloe Teevan, a policy officer in the European External Affairs program at the European Centre for Development Policy Management….”

Project Syndicate - The Case for a Food Systems Stability Board S Dixon-Declève, J Antonio-Campo et al ; https://www.project-syndicate.org/commentary/the- world-needs-a-food-systems-stability-board-by-sandrine-dixson-decleve-et-al-2021-08

« The absence of a Food Systems Stability Board is a notable gap in the global governance architecture needed to bolster sustainability and resilience. By agreeing to launch consultations regarding the creation of such a body, governments could contribute to a better future for hundreds of millions of highly vulnerable people. »

« … A quartet of international meetings – the UN Food Systems Summit in September 2021, the G20 summit in October, the UN climate conference (COP26) in November, and the Nutrition for Growth Summit hosted by the Japanese government in December – offer a rare opportunity to focus international attention on the hunger and food-security crisis, and its links to the changing climate. Each of these gatherings could pave the way for the creation of an FSSB of national governments and international organizations working to address this issue. This could be part of a broader global effort to enhance food governance and achieve – in the words of the government of Indonesia, which will hold the G20 presidency in 2022 – a “just and affordable transition toward net zero.”…”

Devex - Exclusive: Over 200 ex-DFID staffers have left UK's FCDO since merger https://www.devex.com/news/exclusive-over-200-ex-dfid-staffers-have-left-uk-s-fcdo-since-merger- 100686

“The United Kingdom has lost more than 200 development professionals since last year’s merger of the Department for International Development and the Foreign & Commonwealth Office, Devex has learned….”

TGH - Pandemics, Pathological Politics, and International Order D Fidler; https://www.thinkglobalhealth.org/article/pandemics-pathological-politics-and- international-order

David Fidler’s review of "Aftershocks: Pandemic Politics and the End of the Old International Order" (by Kahl & Wright).

• PS: Via Twitter: Matthew Kavanagh will “serve as Special Advisor to Winnie_Byanyima @UNAIDS for the coming year. On temp leave from teaching @Georgetown to support transformative policy & knowledge work of new Global AIDS Strategy.”

UHC

Lancet (Review) – Singapore's health-care system: key features, challenges, and shifts https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00252-X/fulltext

By C C Tan et al.

IJHPM - Health Coverage and Financial Protection in Uganda: A Political Economy Perspective (by some Italian authors).

Planetary health

Politico - HHS unveils office to treat climate change as a health issue https://www.politico.com/news/2021/08/30/hhs-unveils-office-climate-change-507603

“”…The [US] federal health department is creating a new office to address climate change as a public health issue, in an effort to tie growing environmental concerns to the administration’s broader health equity agenda. The Office of Climate Change and Health Equity will take a wide-ranging approach to evaluating the impact that the warming planet is having on people’s health, including initiatives aimed at reducing health providers’ carbon emissions and expanding protections to the most vulnerable populations….”

HPW - Global Campaign That Ended Leaded Petrol Can Provide Lessons for Phasing Out Fossil Fuel – UNEP https://healthpolicy-watch.news/global-campaign-that-ended-leaded-petrol-can-provide-lessons- for-phasing-out-fossil-fuel-unep/

“When Algerian service stations stopped providing leaded petrol last month, this marked the successful end to a global campaign to eliminate this “major threat to human and planetary health”. Celebrating the official end of the use of leaded petrol on Monday, United Nations Secretary-General Antonio Gutteres said that when the global campaign to eliminate the use of tetraethyllead (TEL) as a petrol additive started in 2002, 117 countries were still using TEL. “Today, there are none. Lead in fuel has run out of gas, thanks to the cooperation of governments in developing nations, thousands of businesses, and millions of ordinary people,” said Gutteres in a video message….”

“The UN Environment Programme (UNEP), which led the campaign, said that the same approach to TEL elimination should also be applied to eliminating fossil fuels….”

See also the Guardian – Leaded petrol era ‘officially over’ as Algeria ends pump sales

And the Guardian - Make historic campaign to ban leaded petrol ‘blueprint to phase out coal’, says UN

Guardian - Air pollution linked to more severe mental illness – study https://www.theguardian.com/environment/2021/aug/27/air-pollution-linked-to-more-severe- mental-illness-study

“… research finds small rise in exposure to air pollution leads to higher risk of needing treatment…”. Coverage of a new study published in the British Journal of Psychiatry.

Guardian - Up to half of world’s wild tree species could be at risk of extinction https://www.theguardian.com/environment/2021/sep/01/up-to-half-worlds-wild-tree-species- could-risk-extinction

“Between a third and half of the world’s wild tree species are threatened with extinction, posing a risk of wider ecosystem collapse, the most comprehensive global stocktake to date warns. Forest clearance for farming is by far the biggest cause of the die-off, according to the State of the World’s Trees report, which was released on Wednesday along with a call for urgent action to reverse the decline….”

UN News - Climate and weather related disasters surge five-fold over 50 years, but early warnings save lives - WMO report https://news.un.org/en/story/2021/09/1098662

“Climate change and increasingly extreme weather events, have caused a surge in natural disasters over the past 50 years disproportionately impacting poorer countries, the World Meteorological Organization (WMO) and UN Office for Disaster Risk Reduction (UNDRR) said on Wednesday. According to the agencies' Atlas of Mortality and Economic Losses from Weather, Climate and Water Extremes, from 1970 to 2019, these natural hazards accounted for 50 per cent of all disasters, 45 per cent of all reported deaths and 74 per cent of all reported economic losses. There were more than 11,000 reported disasters attributed to these hazards globally, with just over two million deaths and $3.64 trillion in losses. More than 91 per cent of the deaths occurred in

developing countries. But the news is far from all bad. Thanks to improved early warning systems and disaster management, the number of deaths decreased almost threefold between 1970 and 2019 - falling from 50,000 in the 1970s to less than 20,000 in the 2010s. the report explains….”

Bretton Woods Project - IMF surveillance and climate change transition risks https://www.brettonwoodsproject.org/2021/08/imf-surveillance-and-climate-change-transition- risks/

“New analysis by ActionAid USA and the Bretton Woods Project finds that IMF policy advice has undermined a just energy transition since that Paris Agreement was signed..”

Infectious diseases & NTDs

F1000 research - Non-commercial pharmaceutical R&D: what do neglected diseases suggest about costs and efficiency?

M Viera, S Moon et al ; https://f1000research.com/articles/10-190/v2

“The past two decades have witnessed significant growth in non-commercial research and development (R&D) initiatives, particularly for neglected diseases, but there is limited understanding of the ways in which they compare with commercial R&D. This study analyses costs, timelines, and attrition rates of non-commercial R&D across multiple initiatives and how they compare to commercial R&D….”

Conclusions: “The quantitative data suggest that costs and timelines per candidate per phase were largely in line with (lower-end estimates of) commercial averages. We were unable to draw conclusions on overall efficiency, however, due to insufficient data on attrition rates. Given that non-commercial R&D is a nascent area of research with limited data available, this study contributes to the literature by generating hypotheses for further testing against a larger sample of quantitative data. It also offers a range of explanatory factors for further exploration regarding how non-commercial and commercial R&D may differ in costs and efficiency.”

Reuters - Johnson & Johnson's HIV vaccine fails mid-stage Africa study Reuters;

“Johnson & Johnson (JNJ.N) said on Tuesday its experimental vaccine failed to provide sufficient protection against HIV in sub-Saharan Africa to young women who accounted for a large number of infections last year. The results from the mid-stage study are the latest setback to efforts to develop a vaccine to prevent HIV or human immunodeficiency virus…”

See also Stat News - Johnson & Johnson’s HIV vaccine fails first efficacy trial

PS: the vaccine was based on the same adenovirus design that J&J uses for its COVID-19 vaccine and supported by the Gates Foundation, among others.

Devex - Ebola case reported in Côte d'Ivoire was false positive, WHO says https://www.devex.com/news/ebola-case-reported-in-cote-d-ivoire-was-false-positive-who-says- 100692

“The World Health Organization on Tuesday walked back its declaration of an Ebola outbreak in Côte d'Ivoire after an additional laboratory examined the patient’s samples and found no evidence of the virus. … … the Institut Pasteur in Lyon, France, took a second look at the samples and found she tested negative for Ebola. “Further analysis on the cause of her illness is ongoing,” according to WHO….”

And on WHO’s “no regrets policy”: “No regrets: Guinea declared an end to a four-month-long Ebola outbreak in June. After the supposed case in Côte d'Ivoire was announced in mid-August, 5,000 vaccines were transferred from Guinea to Côte d'Ivoire for use by health workers, first responders, and those who had been in contact with the woman. WHO also released $500,000 from its Contingency Fund for Emergencies. The agency calls this its “no-regrets” policy, in which it launches into response mode “before all the dimensions and consequences of an emergency or outbreak are known with the aim of saving as many lives as possible.”

Links:

The Conversation - The first human case of Marburg virus in West Africa is no surprise: here’s why

Global Health Research & Policy - A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa

NCDs

Global Health Action - Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders

M Dhimal et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1963069

“Nepal adopted the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (MSAP) in 2014. Implementation of the plan has been challenging, with limited participation from non-health sectors. The overall aim of the study was to gain the perspectives of key stakeholders involved in the Nepal MSAP on the barriers and facilitators to its implementation, through the participation of relevant sectors in the plan….”

And via Stat News: Salt substitute gains traction in new large [NEJM] study

“…. We … know low-salt diets and potassium supplements can lower blood pressure. Until now, there was no gold-standard evidence for trying a salt substitute that replaces part of the sodium chloride with potassium chloride. A large, randomized clinical trial tested the salt substitute in about 21,000 people in rural China with poorly controlled blood pressure who had a history of stroke or were 60 or older. After five years, people who took the salt substitute had significantly lower rates of cardiovascular disease or death compared to people who used regular salt, with no apparent serious side effects. “Wider effectiveness is hard to predict” beyond China, an editorial notes….”

Links:

SS&M - Global collective action in mental health financing: Allocation of development assistance for mental health in 142 countries, 2000–2015 (by V Iemmi)

Lancet Oncology - The UK's contribution to cancer control in low-income and middle-income countries

From the Lancet Oncology Series - Global cancer control networks “In this Series, Danielle Rodin and colleagues and Susannah Stanway and colleagues outline the rationale and impetus behind the development of national global cancer control networks in Canada and the UK, respectively, to create a formal structure and coordinated strategy for collaboration with LMICs in global cancer control….”

Sexual & Reproductive / maternal, neonatal & child health

Lancet Global Health (Comment) - Empowering women through expanded contraceptive access in Nigeria and Zambia https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00388-0/fulltext

Comment linked to a new Lancet GH study - What’s needed to improve safety and quality of abortion care: reflections from WHO/HRP Multi-Country Study on Abortion across the sub-Saharan Africa and Latin America and Caribbean regions

“The addition of the hormonal intrauterine device to the product catalogue of the US Agency for International Development is a game changer that will allow millions more women in low-income and middle-income countries (LMICs) to have access to a highly effective, long-acting reversible contraceptive method, albeit two to three decades after their counterparts in Europe and the USA. Already, the International Contraceptive Access Foundation in Nigeria and the Expanding Effective Contraceptive Options project in Zambia have been working with partners to introduce the hormonal intrauterine device in both private and public sector outlets, as well as mobile outreach systems. However, given the high unmet need and growing demand for modern contraception in both countries, these efforts have just scratched the surface. …. … research on long-acting reversible contraceptives in LMICs remains scarce, and hence the study by Aurélie Brunie and colleagues reported in The Lancet Global Health is a valuable contribution, given the drive to scale up hormonal intrauterine device use….”

ODI - Intersectionality as a Framework for Understanding Adolescent Vulnerabilities in Low and Middle Income Countries: Expanding Our Commitment to Leave No One Behind S Baird et al ; https://odi.org/en/publications/intersectionality-as-a-framework-for-understanding- adolescent-vulnerabilities-in-low-and-middle-income-countries-expanding-our-commitment-to-leave- no-one-behind/

“…. To understand how these disadvantages—and adolescents’ abilities to respond to them— intersect to shape opportunities and outcomes, this Special Issue draws on the Gender and Adolescence: Global Evidence conceptual framework which accounts for gender roles and norms, family, community and political economy contexts in shaping adolescents’ capabilities. Implicitly critiquing a focus within youth studies on individual agency, the articles advance our understanding of how adolescents’ marginalisation is shaped by their experiences, social identities and the contexts in which they are growing up. An analytical framework foregrounding intersectionality and collective capabilities offers a means to politicise these findings and challenge uncritical academic celebration of individual agency as the means to address structural problems….”

Link:

• IJHPM - Individual and Contextual Factors Associated With Maternal and Child Health Essential Health Services Indicators: A Multilevel Analysis of Universal Health Coverage in 58 Low & Middle-Income Countries

Access to medicines

Plos One - Public investments in the development of GeneXpert molecular diagnostic technology D Gotham et al ; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256883

Cfr tweet: “The public sector invested >$250m developing underlying tech & @CepheidNews 's GeneXpert platform+assay Their key role stands in contrast to the lack of public sector ability to secure affordable pricing/maintenance agreements. "

EUI Working paper - Public lies and public goods: ten lessons from when patents and pandemics meet. P Drahos; https://cadmus.eui.eu/bitstream/handle/1814/71560/EUI_WorkingPaper_Law_2021_5.pdf?sequ ence=1&isAllowed=y

« The paper examines three decades of the history of patents and pandemics that begins with the HIV/AIDS pandemic and TRIPS. This history demonstrates that the patent system is itself a huge source of risk when it comes to managing the risks of pandemics. From this history ten core lessons

are extracted. The central message of the paper is that developing countries will have to focus on collaborations among themselves with the aim of building a wide base of rich manufacturing experience in the production of medicines and therapies. They can expect no priority of treatment under the present patent-mediated response to pandemic.”

Human resources for health

WHO - Global strategic directions for nursing and midwifery 2021-2025 https://apps.who.int/iris/bitstream/handle/10665/344562/9789240033863-eng.pdf

“The Global strategic directions for nursing and midwifery (SDNM) 2021-2025 presents evidence- based practices and an interrelated set of policy priorities that can help countries to ensure that midwives and nurses optimally contribute to achieving universal health coverage (UHC) and other population health goals. The SDNM comprises four policy focus areas: education, jobs, leadership, and service delivery. Each area has a “strategic direction” articulating a goal for the five-year period, and includes between two and four policy priorities…..”

Human Resources for Health - Interventions for health workforce retention in rural and remote areas: a systematic review

D Russell et al ; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021- 00643-7?utm_source=dlvr.it&utm_medium=twitter

Focus on HICs in this article.

Extra Covid section

Vox - Should vaccinated people worry about long Covid? https://www.vox.com/22632695/long-covid-19-vaccines-delta-variant-pandemic

Check it out.

Devex - Deep dive: Is COVID-19 vaccine equity a pipe dream? https://www.devex.com/news/deep-dive-is-covid-19-vaccine-equity-a-pipe-dream-100588

Neat overview of the state of affairs on various vaccine equity fronts, as of late last week.

BMJ GH - Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles

V Haldane et al ; https://gh.bmj.com/content/6/8/e006406

“….This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs)….” “….Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.”

Guardian - Covid’s toxic divides could shape Europe for years, study says https://www.theguardian.com/world/2021/sep/01/covid-toxic-divides-could-shape-europe-years- study

“Radically different experiences of the Covid-19 pandemic have created toxic geographical, generational and societal divides across Europe that could shape the continent’s politics for years to come, according to a study. Research by the European Council on Foreign Relations based on polling in 12 EU states shows a “tale of two pandemics and two Europes”, with the past 18 months taking a vastly different toll on regions, age groups and individuals in the bloc…..”

Lancet Infectious Diseases - Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study

Lancet;

Vaccination reduces risk of long Covid, even after breakthrough infection. Some of the early evidence on this important issue. “People who are fully vaccinated against Covid-19 appear to have a much lower likelihood of developing long Covid than unvaccinated people even when they contract the coronavirus…”

BMJ GH (Commentary) – The economics of improving global infectious disease surveillance

L de Vries et al ; https://gh.bmj.com/content/6/9/e006597

“ Additional investments in infectious disease surveillance are preferably based on sound economic evaluations considering the specific characteristics of infectious disease surveillance, however, a framework for cost-effectiveness analyses capturing the specific characteristics is yet non-existent….”

Links:

• Telegraph - Red tape keeps Covid vaccine out of reach for nearly 4m undocumented migrants across Europe

• FT – GSK hopes for vaccine success as new shot enters late-stage trial

Miscellaneous

Economist - African swine fever is spreading rapidly in China, again https://www.economist.com/china/2021/08/28/african-swine-fever-is-spreading-rapidly-in-china- again

“The country has kept covid-19 in check, but its pigs are dying in droves.”

CGD - The Challenge of Reallocating SDRs: A Primer https://www.cgdev.org/publication/challenge-reallocating-sdrs-primer

By M Plant.

Devex - The WASH sector's biggest enemy? Corruption. https://www.devex.com/news/the-wash-sector-s-biggest-enemy-corruption-100663

“Cities must address corruption and integrity failures if they’re to achieve the Sustainable Development Goal 6 on clean water and sanitation for all. That’s the message coming from the new Water Integrity Global Outlook 2021. … As it stands, over 14% of the urban population lacks access to safe drinking water and 38% doesn’t have safely managed sanitation. According to the report — which was produced by WIN — efforts to reduce those numbers are being jeopardized by the mismanagement of WASH project funding, inflated water prices, kickbacks, and sextortion. In fact, the report estimates that between 6% and 26% of total WASH expenditure is lost to corruption on a yearly basis. If the annual cost to meet SDG 6 sits at $114 billion that means a loss of between $6.8 billion and $30 billion…”

For more on World Water Week 2021, see also Devex - 3 takeaways from World Water Week 2021.

Nature - Drowning in the literature? These smart software tools can help Nature;

“ Search engines that highlight key papers are keeping scientists up to date.”

Nature - India’s DNA COVID vaccine is a world first – more are coming https://www.nature.com/articles/d41586-021-02385-x

“The ZyCoV-D vaccine heralds a wave of DNA vaccines for various diseases that are undergoing clinical trials around the world.”

Links:

• Critical Public Health - ‘Open’ relationships: reflections on the role of the journal in the contemporary scholarly publishing landscape