IHP News 617 : Back Into the Groove

IHP news 617 : Back into the groove

( 16 April 2021)

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

Dear Colleagues,

More than a year into the pandemic, it’s becoming ever more clear that whoever is not yet an expert in “risk-benefit calculations” better takes a course soon. (And if you suffer from SCT (“Sluggish Cognitive Tempo”, a possible “new mental health disorder” ) you might want to make it a long-term project, with logframe and all )

As we’re already sort of in an economic mood, let’s continue. A while ago, some observers suggested WHO urgently needs a ‘Chief Economist’. Presumably, their underlying rationale was not, ‘now that everything in the world has become a market and for sale (including resource-constrained WHO), we might as well have a “chief economist” to do things properly’ . Still, one might wonder, with recent WHO press releases like “COVAX reaches over 100 “economies” “ (Els Torreele on Twitter: “since when does WHO refer to countries, people, as 'economies'?”), or when reading about Lucy Sullivan’s (rather serious) misgivings around the WHO Foundation (see this Twitter thread for example). By now, the WHO Foundation has pushed back against the criticism, but no doubt good to continue to keep an eye on these business-friendly chaps !

In any case, the WHO Working Group on Sustainable Financing (which met for the first time end of March) has its work cut out, and should probably be inspired by Piketty & UN SG Guterres ‘s strong advocacy for a wealth tax). Let’s quote Piketty in full on this, as it’s really a no brainer indeed: “… a global tax of 2% on fortunes over €10 million would raise … €1,000 billion per year, or 1% of global GDP, which could be allocated to each country in proportion to its population. Setting the threshold at €2 million would raise 2% of global GDP, or even 5% with a highly progressive scale for billionaires. If we stick to the least ambitious option, this would be more than enough to entirely replace all current international public aid, which represents less than 0.2% of world GDP.”

Meanwhile, with downright frightening variants having popped up in a number of countries, and the pandemic once again growing exponentially, leaders and international organisations feel the heat even more on (global) vaccination (equity). Increasingly, observers are also asking profound questions on the global solidarity mechanisms we have in place, like ACT-A (which soon celebrates its 1st anniversary ), including the role of Bill G in these. (PS: As you know, ACT-A has COVAX as one of its pillars - not exactly the incarnation of a ‘People’s vaccine’ so far)

With Easter out of the way (and apparently not caring too much about the start of the Ramadan, and let’s not get into the Kumbh Mela “festivities” in India ☹), the global (health) community got back into its usual “FMP” (“Frantic Meeting Pace”) groove (also something of a disorder, if you ask me), with among others the African CDC virtual vaccine conference, a WTO Vaccine manufacturers’ summit, WHO’s Fair Pricing Forum, the Gavi COVAX AMC Investment Opportunity, Financing for Development Forum, Global Diabetes Summit, … (yeah, we got dizzy too)

Enjoy your reading.

Kristof Decoster

Featured Article

Addressing chronic respiratory diseases and determinants through multisectoral actions

Grace Marie Ku (ITM)

Chronic Respiratory Diseases (CRD) are a leading cause of death and disability worldwide. Just to give you an idea: in 2015, 3·2 million people died from one of the key CRDs, chronic obstructive pulmonary disease (COPD). Many of them occur in sub-Saharan African countries and other LMICs, and figures are on the rise. In addition, CRDs are also a significant cause of loss of productivity and high activity impairment, thus leading to decreased quality of life for many. Sadly, akin to other NCDs, CRDs such as COPD and bronchial asthma are still thought to more commonly occur in high-income countries and largely due to poor lifestyle choices. However, CRD is a typical example of a condition caused by a multitude of social and structural determinants, and these societal and individual determinants are responsible for inequities in health. Lung function is affected by lung size and abnormalities in structure. Unfavourable conditions influence lung (mal)development from foetal life; lung development continues after birth until early adulthood and both immature and mature lungs are susceptible to (further) lung damage throughout one’s lifetime.

Now, imagine this – the situation in a random LMIC:

- There is poor urban planning with high population density and mixing of industrial and residential spaces. - Demand for energy is high and people often resort to power generators burning unclean fossil fuel. - Industrial emissions are poorly regulated. - Old second-hand vehicles and motorcycles lacking in emission-reduction technology abound. - Street hawkers set up their wares by roadsides or weave through the traffic. - Workers are jam-packed in poorly ventilated workplaces and/or work in dust-generating occupations or in mines without personal protective equipment. - Dwellings are poorly ventilated. - Biomass fuel – e.g., animal, yard, forest wastes – is utilised for cooking, heating and as light source in residential and industrial settings. - Women, while taking care of their children, cook food in “dirty” cookstoves for hours. - Nutritious food is difficult to access.

- “Big Food and Drinks” relentlessly promote highly processed, salty and/or sugary foods with artificial additives, and they are often more affordable, readily available and preferred. - “Big tobacco” is waging a war against control and is targeting the youth. - People are chronically stressed. - Prevalence of respiratory tract infections, Pulmonary TB (PTB), HIV, helminth infections is high. - A considerable number of babies are born prematurely and/or have low birthweights. - Health systems have not yet adapted and are unable to fully provide needed services for CRDs.

All of these are common in LMICs. And all of these contribute towards sub-optimal respiratory health and well-being. There are programs in place to address some of the above-mentioned determinants, such as tobacco (FCTC), HIV (90-90-90), PTB (global and national TB programs), etc., although implementation is currently deemed sub-optimal / not reaching targets. There are also attempts to strengthen health care provision for NCDs, but they focus more on diabetes, hypertension, and some cardiovascular diseases. Programs addressing other determinants beyond the health sector remain sporadic and “local”.

Multisectoral action needed

Air quality plays a significant role in the causation and worsening of CRDs; indoor, outdoor, household and industrial pollution – dirty exhausts from vehicles and factories, use of unclean fossil and biomass fuels, utilization of dirty cookstoves, poor waste management, use of incinerators, etc - are significant concerns that could be modified with appropriate action to control emission of noxious and harmful substances.

More rigorous implementation of tobacco control and translation of FCTC commitments into action is needed.

The same goes for adequate social protection, decent work and occupational health and safety.

Appropriate support and capacity strengthening of the health systems response to improve service delivery for CRDs and to address identified risks and promote health and well-being should be foreseen.

Engagement of patients and communities towards recognition of and propagating actions to address CRDs and associated determinants can be done, with special focus on women and children as they are more exposed to biomass smoke, targeted by Big Tobacco, etc.

It is important to note that acting on these challenges would help achieve a number of Sustainable Development Goals (SDGs 3, 5, 7, 8, 11, 12, 13, and 15).

In short, just as it takes a village to raise a child, addressing CRDs and determinants requires multisectoral action. And the time to act was yesterday.

Highlights of the week

The read of the week

Let’s start with an ‘innovation’ : “The read of the week”.

New Republic - How Bill Gates Impeded Global Access to Covid Vaccines A Zaitchik; New Republic;

This one went just viral on social media. Sarah Dalglish summarized it, in a tweet: “The illustration is a bit much - but the story of how Gates positioned the ACT Accelerator / #COVAX over wiser, more equitable alternatives like the @peoplesvaccine is enraging.”

A few excerpts:

“Technically housed within the WHO, the ACT-Accelerator is a Gates operation, top to bottom. It is designed, managed, and staffed largely by Gates organization employees. It embodies Gates’s philanthropic approach to widely anticipated problems posed by intellectual property–hoarding companies able to constrain global production by prioritizing rich countries and inhibiting licensing. Companies partnering with COVAX are allowed to set their own tiered prices. They are subject to almost no transparency requirements and to toothless contractual nods to “equitable access” that have never been enforced. Crucially, the companies retain exclusive rights to their intellectual property. If they stray from the Gates Foundation line on exclusive rights, they are quickly brought to heel. “ “… Gates can hardly disguise his contempt for the growing interest in intellectual property barriers. In recent months, as the debate has shifted from the WHO to the WTO, reporters have drawn testy responses from Gates that harken back to his prickly performances before congressional antitrust hearings a quarter-century ago. ….” “

“… His latest move is to institutionalize the ACT-Accelerator as the central organizing institution in future pandemics. The shortages have made this effort a little awkward, however, and Gates is now forced to reckon with the question of technology transfer. This is an aspect of the equitable access debate that doesn’t concern intellectual property as commonly perceived—as a simple matter of patents and licenses—but access to the components and technical knowledge related to practical manufacture, including biological material and other areas otherwise protected under the category of intellectual property known as trade secrets. The global south and civil society groups have been calling for tech transfer for months—either mandatory tech transfer that could have been written into contracts or through a voluntary mechanism associated with C-TAP—but Gates has predictably arrived on the scene with a more familiar plan in hand. In early March, senior Gates staff joined pharma executives for a “Global C19 Vaccine Supply Chain and Manufacturing Summit” convened by Chatham House in London. The main agenda item: plans for a new arm within the ACT-Accelerator, the Covid Vaccine Capacity Connector, that seeks to address the tech-transfer question within the usual frame of monopoly rights and bilateral licensing. …”

• PS: do combine reading this article with (re-)listening to Chris Elias (Gates Foundation) in a Graduate Global Health institute webinar (from last Wednesday). He did disagree, unexpectedly, on the dominant role of the Gates Foundation in ACT-A, and had some

interesting things to say on how the Gates Foundation stands vs IP, Trips Waiver, C-TAP, whether ACT-A might continue beyond the pandemic, etc. (no need to agree with all he said )

You can read about the webinar also in some detail here: HPW - Patents Are Not Main Roadblock To Expanding Vaccine Production, Says Top Gates Foundation Official

“Patents are not the main roadblock to producing enough coronavirus vaccines for the world – rather the challenge is technology transfer with manufacturers, said a top official at the Bill and Melinda Gates Foundation (BMGF) on Wednesday. His comments joined those of pharma advocates in what seems to be a growing counter-trend to that of civil society advocates who say that IP monopolies are blocking the rapid scale-up of manufacturing. Speaking at an event sponsored by the Geneva Graduate Institute’s Global Health Center, Chris Elias also said that the Foundation is presently working on a number of new tech transfer agreements, to expand vaccine manufacturing in low- and middle-income countries – which have not yet been made public….”

Africa CDC (virtual) vaccine conference (12-13 April)

Reuters - Africa must expand vaccine production, leaders say https://www.reuters.com/article/us-health-coronavirus-africa-vaccine/africa-must-expand-medical- manufacturing-capacity-south-africas-president-idUSKBN2BZ1DE

(recommended short read) Coverage of the opening day. “Africa must expand vaccine manufacturing to combat the COVID-19 pandemic and future health emergencies, including by forging partnerships to boost expertise and investment, continental leaders and international health officials said on Monday.”

With quotes from Cyril Ramaphosa, John Nkengasong (and the long term aims of Africa CDC), Ngozi Okonjo-Iweala (on WTO goals) and Tedros.

See also Cidrap News – https://www.cidrap.umn.edu/news-perspective/2021/04/who-growing- covid-19-surge-hits-critical-point

“… talks are underway with African leaders to find ways to boost global vaccine manufacturing by ramping up production capacity in Africa. Bruce Aylward, MD, MPH, senior advisor to Tedros, said it will take time to build capacity, but it's clear that the political will among African leaders is there. "This will go quicker than people anticipate," he said….”

HPW - Africa Plots Ambitious Vaccine Targets at Manufacturing Conference https://healthpolicy-watch.news/africa-plots-ambitious-vaccine-targets-at-manufacturing- conference/

Also with coverage of the first day of this conference. “African vaccine producers supply just 1% of the continent’s needs at present – but the plan is to increase this to 60% by 2040, according to John Nkengasong, Director of the Africa Centers for Disease Control (CDC). … There are currently 10 pharmaceutical manufacturing companies on the continent. … By deploying a coordinated regional strategy, Nkengasong said Africa can establish vaccine manufacturing hubs in each of the continent’s five regions — western, central, northern, eastern and southern. If Africa is able to effectively leverage its capabilities, Nkengasong said the continent can vaccinate 60% of its people against COVID-19 by 2022. … By 2040, he said Africa can be fully responsible for the manufacture of vaccines of three emerging diseases including Ebola, Lassa fever and Rift Valley disease; have capacity to manufacture vaccines for unknown global pandemic for up to 60% of its population, and should be able to meet 60% of its routine immunisation….”

… WTO to Prevent ‘Vaccine Hoarding’ “Ngozi Okonjo-Iweala, Director-general of the World Trade Organization (WTO), told the conference that the organisation intends to create a framework to prevent “vaccine hoarding” in future pandemics. …”

Devex - AU launches Partnership for African Vaccine Manufacturing https://www.devex.com/news/au-launches-partnership-for-african-vaccine-manufacturing-99654

“In response to calls from health and economic experts across the continent to increase local capacity to manufacture vaccines to bolster Africa’s health security, the African Union launched the Partnership for African Vaccine Manufacturing on Tuesday. The partnership includes two agreements aimed at boosting the manufacturing of vaccines across the African continent. (resp with CEPI (see below) & the African Export-Import Bank signed an agreement with the African Finance Corporation ).

“The goals of the partnership include a coordinated agenda on vaccine manufacturing for the continent; bolstering of five regional production sites over the next 10 to 15 years; mobilization of financial partnerships; strengthening of regional regulatory systems; increase in technology transfer to manufacturers on the continent; and the development of African universities as premier vaccine research and development hubs….” “… Three countries — South Africa, Senegal, and Rwanda — were identified as potential sites to start exploring building up the capacity to manufacture messenger RNA vaccines …”

See also HPW - New Partnership To Boost Africa’s Vaccine Research, Development And Manufacturing

CEPI and the African Union join forces to boost African vaccine R&D and manufacturing https://africacdc.org/news-item/cepi-and-the-african-union-join-forces-to-boost-african-vaccine-rd- and-manufacturing/

“the Coalition for Epidemic Preparedness Innovations (CEPI) and the African Union Commission have today announced the signing of an memorandum of understanding, which aims to strengthen ties between the organisations and the Africa CDC—a specialised institution of the African Union responsible for the prevention and control of diseases in Africa—to enhance vaccine R&D and manufacturing in Africa….”

PS: at the conference, it’s clear that mRNA vaccines (and how to produce them, hopefully, soon in Africa as well), got much of the limelight. No prizes to be won for why that was the case…

WTO Vaccine Manufacturers Summit (14 April) & WHO Fair Pricing Forum (13-22 April)

Reuters - WTO chief seeks solutions to 'glaring' vaccine inequity, upbeat on IP waiver https://www.reuters.com/article/us-trade-wto-dg/wto-chief-seeks-solutions-to-glaring-vaccine- inequity-upbeat-on-ip-waiver-idUSKBN2BZ2EA

On Monday, Ngozi looked ahead to this WTO meeting on 14 April. “The head of the World Trade Organization said on Monday a meeting this week to tackle “glaring” inequity in COVID-19 vaccine allocation will be attended by major manufacturers and look at solutions such as firing up idle or under-used manufacturing plants in Africa and Asia. … The April 14 meeting will bring together vaccine makers from the United States, China and Russia, ministers from wealthy and developing countries, and banking officials to discuss vaccine export restrictions, scaling up manufacturing and a waiver of intellectual property rights for COVID-19 drugs and shots, she told Reuters. … … Among the possible practical solutions are re-purposing animal vaccine plants to make COVID shots or firing up unused capacity in countries like Bangladesh, Thailand and Senegal by connecting them with financiers like the European Investment Bank or the World Bank’s International Finance Corporation. … The meeting, the first of a series, will also raise the controversial waiver of TRIPS intellectual property rights for COVID-19 drugs on which members are deadlocked, amid opposition from wealthy countries….”

HPW - WHO and World Trade Organization Host Closed Meetings to Tackle Vaccine Access and Prices https://healthpolicy-watch.news/two-key-global-closed-door-meetings-tackle-vaccine-access-and- prices/

“The World Health Organization (WHO) and the World Trade Organization (WTO) both [ are hosting ] key global meetings aimed at improving global access to COVID-19 vaccines and fair medicine prices this week behind closed doors….” “The WHO Fair Pricing Forum started on Tuesday and its stated aim is to activate “additional support for countries to achieve more affordable and fairer access to pharmaceutical products during the COVID-19 pandemic and beyond”. Meanwhile, on Wednesday, the WTO Director General, Ngozi Okonjo-Iweala, will host a meeting on “COVID-19 and Vaccine Equity: What can the WTO Contribute”….”

“The Fair Pricing Forum (FPF), supported by the Ministry of Health of Argentina and running virtually until 22 April, is likely to focus on transparency of medicine prices and production as well “upstream innovation” aimed at widening the manufacturers’ pool. …”

“… Health Policy Watch has seen two discussion papers to be discussed at the Forum, which look at how medicines pricing could be made more “sensitive to health systems’ ability to pay”, and

“incentives for pharmaceutical innovation to achieve fair pricing” respectively. These were developed by two technical working groups formed at the last FPF meeting in South Africa in 2019….”

Reuters - WTO chief lays out global action to increase vaccine access https://www.reuters.com/article/us-trade-wto-vaccines/wto-chief-lays-out-global-action-to- increase-vaccine-access-idUSKBN2C12YU

Coverage of the WTO meeting. “The head of the World Trade Organization laid out a series of actions on Wednesday for countries and drug makers to increase production of coronavirus vaccines and share them more widely and fairly….”

See also WTO - DG Okonjo-Iweala calls for follow-up action after WTO vaccine equity event

“Director-General Ngozi Okonjo-Iweala today (14 April) called on WTO members, vaccine manufacturers and international organizations to act to address trade-related obstacles to the scale- up of COVID-19 vaccine production to save lives, hasten the end of the pandemic and accelerate the global economic recovery. Speaking at the conclusion of the WTO-organized meeting "COVID-19 and Vaccine Equity: What Can the WTO Contribute?", the Director-General said that statements from government ministers, vaccine manufacturers, civil society advocates and leaders of international organizations had identified problems and pointed to potential solutions. "This is a problem of the global commons, and we have to solve it together," she said….

“She expressed hope that the meeting, which included roughly 50 speakers, would serve as the basis for continued dialogue aimed at delivering results in terms of increased vaccine production volumes in the short-term as well as longer-term investments in vaccine production and enhancing the trading system's contribution to pandemic preparedness.” “… The Director-General expressed hope that the ideas raised during the meeting would "contribute to convergence in the TRIPS Council on meaningful results that contribute to the goals we share."…”

HPW – Growing Consensus Emerging At WTO – Strengthen Supply Chain & Tech Transfer To Expand Vaccine Access https://healthpolicy-watch.news/85056-2/

More coverage of the WTO meeting. “A growing consensus seems to be emerging out of this week’s high-level WTO meeting that glaring inequities in access to vaccines can be remedied by strengthening supply chains, avoiding export bans across borders, and ensuring that big pharma voluntarily transfers its vaccine technologies to poorer countries so they can produce their own vaccines...”

PS: interestingly: Civil Society Call To Revise TRIPS agreement; No Mention Of IP Waiver

“ At the same time, civil society advocates joining the discussions seemed to be steering away from a focus on the IP waiver proposal, instead calling on the WTO to make a series of meaningful technical amendments in the existing TRIPS Agreement – as well as helping low- and middle-income countries to make more effective use of the exceptions contained in the rules….” Check out for example James Love’s recommendations.

Pressure on US Administration is mounting (on Trips waiver and/or kicking off a global manufacturing program) • Meanwhile, Reuters reported on mounting pressure on Washington to back a temporary TRIPS waiver. Let’s hope Joe gives in.

See also FT - Former world leaders call on Biden to suspend Covid-19 vaccine patents

“A group of 175 former world leaders and Nobel laureates is urging the US to take “urgent action” to suspend intellectual property rights for Covid-19 vaccines to help boost global inoculation rates….”

“…The US trade representative’s office said late last month that it was “exploring every avenue” and “evaluating the efficacy” of the proposal to waive so-called Trade-Related Aspects of Intellectual Property Rights. Katherine Tai, US trade representative, told a WTO meeting on vaccine equity on Wednesday that both the government and the private sector would need to do their part to “live up to” the “spirit” of the Trips agreement, which was born out of the HIV crisis….”

• PS: a number of civil society organisations called on the Biden administrationto create an “Operation Warp Speed” for the world with manufacturing hubs on all continents…

“Public Citizen and 65 other global health, development and humanitarian organizations today called on President Joe Biden to announce and implement a global vaccine manufacturing program to end the pandemic and build a globally-distributed vaccine infrastructure for future pandemics….”

The Gavi COVAX AMC Investment Opportunity Launch Event: “One World Protected” (15 April) https://www.gavi.org/gavi-covax-amc-launch-event-april-2021

The title of the event didn’t quite capture the current situation yet (“One World Protected”), but borrowing a phrase from Remco van de Pas & Gorik Ooms, “we are not optimistic but remain hopeful ”.

The virtual event brought together world leaders, the private sector, civil society, and key technical partners to galvanize resources and commitment to the Gavi COVAX Advance Market Commitment (AMC). The event, featuring the Secretary of State and the USAID Administrator on behalf of the United States government, and Gavi Board Chair José Manuel Barroso, took place on April 15.

GAVI press release - Global leaders rally to accelerate access to COVID-19 vaccines for lower-income countries https://www.gavi.org/news/media-room/global-leaders-rally-accelerate-access-covid-19-vaccines- lower-income-countries

“The “One World Protected” Event, hosted today by the United States and Gavi, the Vaccine Alliance, launched a campaign to raise US$ 2 billion for the global fight against COVID-19. The additional funding from donors and countries with MDB support will enable the Gavi COVAX Advance Market Commitment (AMC) to secure 1.8 billion doses of COVID-19 vaccines for 92 lower- income countries by the end of the year. At the event, governments and private sector partners made early pledges worth nearly US$ 400 million and committed to donate millions of COVID-19 vaccine doses to COVAX to benefit the most vulnerable in lower-income economies. The new campaign will culminate in June 2021, at the Gavi COVAX AMC Summit, which will be hosted by Prime Minister Yoshihide Suga of Japan….”

PS: “The campaign will also aim to mobilize $US 1 billion in cost sharing from countries through domestic resource mobilization and the support of multilateral development banks (MDBs).”

“…In addition to financial support, new pledges in support of dose sharing through COVAX were announced at the event. Under this scheme, countries will be able to donate millions of doses of their own COVID19 vaccines to COVAX in an act of global solidarity. As part of this effort, New Zealand committed today that it will donate more than 1.6 million doses of vaccines to COVAX, with a focus on the Pacific region. France welcomed the finalization of a new agreement between COVAX and Team Europe on the provision of doses which will ensure the first French and European donations via COVAX will materialize shortly….”

Tweet Zain Rizvi:

“COVAX held a fundraising event today where everyone got to feel good and state platitudes about equitable access. But in an accompanying document, it also revealed that 93 percent of countries have requested more vaccine doses that it can provide in 2021.”

And via Devex - COVAX Facility seeks an additional $2B for COVID-19 vaccines

“ COVAX has already secured $6.3 billion in pledges for rolling out 1.3 billion doses to these countries this year, with the aim of vaccinating 20% of the people in participating nations. Of these pledged funds, the facility has received about $4 billion, said Marie-Ange Saraka-Yao, managing director of resource mobilization, private sector partnerships, and innovative finance at Gavi, the Vaccine Alliance, during a press conference. …”

“…With additional funds, the facility intends to vaccinate nearly 30% of populations — or about half of all adults in the countries it serves, said Seth Berkley, chief executive officer at Gavi. But right now, the problem is less about money and more about manufacturing capacity, with global supply shortages currently causing delays in delivery….”

IFFIm Returns to Market with US$ 750 Million 5-year Oversubscribed Vaccine Bonds https://iffim.org/press-releases/iffim-returns-market-us-750-million-5-year-oversubscribed-vaccine- bonds

“The International Finance Facility for Immunisation Company (IFFIm) today priced US$ 750 million, 5-year fixed rate Vaccine Bonds that will provide Gavi, the Vaccine Alliance with

immediately available funding to support routine immunisation in lower-income countries, reaching nearly half the world’s children. The issuance, which is IFFIm’s second largest ever, will also accelerate the availability of critical funding for the Gavi COVAX Advance Market Commitment (or AMC). … The Vaccine Bonds are backed by pledges from 10 sovereign donors, including recent new commitments from the United Kingdom and Norway….”

Global Diabetes Summit (14 April)

On Wednesday, WHO launched the Global Diabetes Compact. The launch coincided with the 100th anniversary of the discovery of insulin, a life-saving medicine for people with diabetes.

See WHO - New WHO Global Compact to speed up action to tackle diabetes

Detailed coverage of the launch via HPW - WHO Calls For Expanding Access To Insulin At Launch of Global Diabetes Compact

Also via UN News - New global compact aims to drive down diabetes deaths, boost insulin access

“Increasing access to affordable insulin is among the objectives of the new Global Diabetes Compact, launched on Wednesday by the World Health Organization (WHO), 100 years after the discovery of the life-saving medicine. …”

PS: “…The Compact will also focus on catalyzing progress by setting global coverage targets for diabetes care. A “global price tag” will quantify the costs and benefits of meeting these new targets. The Compact will also advocate for fulfilling the commitment made by governments to include diabetes prevention and treatment into primary health care and as part of universal health coverage packages….”

Lancet Diabetes & Endocrinology - The WHO Global Diabetes Compact: a new initiative to support people living with diabetes D Hunt et al ; https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00111-X/fulltext

“… To act on this urgent and growing epidemic of disease, death, and inadequate patient care, WHO [launched] the Global Diabetes Compact on April 14, 2021. Bringing together partners, the Compact seeks to increase access to treatment and improve outcomes for both type 1 and type 2 diabetes, ensuring everyone can access comprehensive, affordable, and quality care in primary health settings. The Compact will also support the prevention of type 2 diabetes associated with obesity, unhealthy diet, and physical inactivity. In doing so, we want to reduce premature mortality and complications from both type 1 and type 2 diabetes, and slow the rapidly-growing incidence of type 2 diabetes. Through expert discussions and collaboration with key stakeholders, including UN agencies and those with unique lived experiences of diabetes, eight key areas for action have been identified…”

1 year ACT-A

Lancet Editorial - The ACT Accelerator: heading in the right direction? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00835-7/fulltext

“April 24, 2021, marks 1 year since the formation of the Access to COVID-19 Tools Accelerator (ACT-A) partnership. Its mission is to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines, which is central to ending the acute phase of the COVID-19 pandemic. With the pandemic still raging, has ACT-A been successful so far? And what does the future hold?...”

Must-read, obviously.

Conclusion: “On May 21, at the Global Health Summit in Rome, countries and organisations will discuss financing for the global COVID-19 response. ACT-A may be large in scale, but it suffers from the same shortcomings as countless previous global health initiatives. If ACT-A is to deliver on its goals, these weaknesses need to be confronted and overcome. Only then might it find a worthwhile place in the global health architecture, for this pandemic and beyond.”

Global Health Governance & Financing

Global Fund Board Approves Second Term for Executive Director Peter Sands https://www.theglobalfund.org/en/updates/other-updates/2021-04-13-global-fund-board- approves-second-term-for-executive-director-peter-sands/

“The Global Fund Board has approved a decision to extend Peter Sands’ term as Executive Director of the Global Fund for an additional four years, with effect from 1 March 2022.”

Devex - Biden proposes $6.8B boost for US international budget https://www.devex.com/news/biden-proposes-6-8b-boost-for-us-international-budget-99627

“U.S. President Joe Biden released a budget blueprint that would boost U.S. international affairs spending by $6.8 billion next year….”

Among the most notable items included in the budget proposal are:

• $10 billion for global health programs, including $1 billion for global health security.

Tweet Kent Buse: “It is reported that in addition to 10B for global health (and health security) that priorities include support to @WHO @UNFPA @Refugees.”

Guardian - Gordon Brown calls for G7 to act on Covid vaccine ‘apartheid’ https://www.theguardian.com/politics/2021/apr/12/gordon-brown-calls-for-g7-to-act-on-covid- vaccine-apartheid

“Former prime minister says G7 group should commit to global vaccine drive and slams UK’s foreign aid cut.” “…Preventing poor countries suffering from vaccine “apartheid” will require the G7 group of rich nations to commit $30bn (£22bn) a year to a global immunisation drive, Gordon Brown has said. The former Labour prime minister said the UK should use June’s G7 summit in Cornwall to rekindle the moral purpose of the Make Poverty History campaign of 2005, paying for its share of the new fund by reversing the government’s “misguided” cut to the foreign aid budget. …”

See his Guardian op-ed - The G7 must push for global vaccination. Here’s how it could do it

Twitter commotion around WHO Foundation

• Cfr thread Lucy Sullivan (Executive Director @FeedtheTruthinc ) : https://twitter.com/lucymsullivan/status/1380579040285880326

“This is bad. @TheWHO foundation set up to fundraise for @WHO will consider donations "on a case-by-case basis" from corporations with "reputational issues" relating to climate change, poor health, racism, pornography, corruption, and sexual exploitation.” “The WHO Foundation basically put a "for sale" sign on the world's highest health policy-setting body. I wrote about it in this thread … Which is how we ended up with the dance of corporate logos from Big Oil, Big Ag, Big Food, and Big tech on WHO's COVID rapid response fund website. ..” “If @thewhof foundation is going to take money from corporations that pollute the planet, make us sick, and spread disinformation, then the donations should be made anonymously. Absolutely no quid pro quo. “

• Another thread, more specifically related to Nestle: https://twitter.com/lucymsullivan/status/1379930645502251017

“Nestle—a company that pumps the world full of unhealthy, ultra processed food which has made so many people sick and more susceptible to COVID— finally gets the coveted WHO stamp of approval by proxy. All for the low, low price of ???? (Awaiting @thewhof response)”

“It appears that the @thewhof sold the World Health Organization halo to Nestle for the low, low price of $2.15 million.” “It makes sense that @thewhof would emerge as a vehicle for powerful corporations to gain access to the World Health Organization when you look at who’s at the group’s helm—a former pharmaceutical industry executive and McKinsey consultant.”

Devex - Exclusive: WHO Foundation pushes back against criticism over Nestlé donation https://www.devex.com/news/exclusive-who-foundation-pushes-back-against-criticism-over-nestle- donation-99656

As mentioned in the intro, the WHO Foundation pushed back by now. “The WHO Foundation has recently come under fire on social media after some global health advocates learned it received a

$2.1 million donation from multinational food and beverage company Nestlé, which has been accused of violating international marketing codes when it comes to infant milk formulas. But WHO Foundation CEO Anil Soni defended the 2 million Swiss Francs ($2.1 million) donation, telling Devex that receipt of the funds does not imply WHO endorsement of the company’s activities….”

“The foundation has a gift donation policy with its own due diligence and operational procedures, but it also works with the principles set out with the WHO’s Framework of Engagement with Non-State Actors, or FENSA. … … Soni previously told Devex the foundation won’t be accepting gifts from the arms, alcohol, and tobacco industry, categorized as “red” companies by the foundation. … Under the foundation’s guidelines there is also an “orange category” covering “industries with reputational considerations that may need to be assessed on a case-by-case basis” — including those whose contributions negatively impact the Sustainable Development Goals agenda. This includes industries contributing to violence; climate change or environmental degradation; poor health and diet; violence or discrimination toward any particular group; and those alleged to have poor corporate practices, such as on labor rights, child labor, and sexual exploitation and abuse.

Cfr tweet M Pilling: “WHOF operates under same FENSA rules as WHO; Accepting $ =/= endorsement of policies/actions, any more than WHO taking $ from member states = endorsement of their policies/actions.”

WEF - Helen Clark: The lessons we need to learn from COVID-19 https://www.weforum.org/agenda/2021/04/helen-clark-covid-pandemic-preparedness-agenda- dialogues/

“Helen Clark, Co-Chair of Independent Panel for Pandemic Preparedness and Response, explains what we can learn from COVID-19 to prepare for future pandemics. From alert systems to peer reviews, there are multiple recommendations. Internationally coordinated preparation and preparedness will be key.”

WHO – First meeting of the working group on sustainable financing EB/WGSF/1/4 Geneva, 29–31 March 2021 https://apps.who.int/gb/wgsf/pdf_files/wgsf1/WGSF1_4-en.pdf

“This document aims to provide a brief historical overview of WHO budgeting and financing for the consideration of the Working Group on Sustainable Financing, which was established by the Executive Board at its 148th session….”

Do check out also other documents from this first meeting, see Working Group on Sustainable Financing 29-31 March 2021

Certainly including: WHO sustainable financing: Options for the consideration of the Working Group.

Geneva Health Files - WHO’s "Bretton Woods Moment" Dimmed by Member States’ Reluctance To Pay Up More

P Patnaik; Geneva Health Files;

Last Friday’s article in Geneva Health Files:“…In its first meeting during March 29-31, the intergovernmental Sustainable Financing Working Group at WHO, kick-started discussions on finding ways to fund essential functions in a flexible and predictable manner. It has also emerged that sustainable financing is a key objective of the proposed international pandemic treaty. Hence the deliberations of this working group will be crucial in setting the direction on financing and as a consequence, governance. In the early stages of this discussions, member states appear reluctant to pay up more in assessed contributions. “

A few quotes:

“…According to diplomatic sources who were at the meeting, there was a recognition that the current pandemic had resulted in unprecedented economic crisis and health challenges, which need sweeping changes in the way WHO is funded. … Sources drew parallel to the current urgency, similar to the period following the Second World War which saw major policy shifts in monetary systems, and resulted in the creation of the World Bank and the International Monetary Fund. “There was very much a feeling of a ‘Bretton Woods’ moment - the notion that the world faces a situation similar to post-Second War” said one health diplomat in a conversation with Geneva Health Files, on the condition of anonymity. “

“…. The working group’s definition of sustainable financing is “funding that enables WHO to have the robust structures and capacities needed to fulfil its core functions in effective and efficient support of its Member States, including in preventing, detecting, and responding to, disease outbreaks.” In addition, sustainable financing is characterised by predictability, flexibility and of a duration lasting the programme of work. There are four options on the ways forward, according to a document considered by the Working Group. …”

Spotlight - Analysis: The politics and promise behind a proposed pandemic treaty C Tomlinson; https://www.spotlightnsp.co.za/2021/04/13/analysis-the-politics-and-promise-behind- a-proposed-pandemic-treaty/

Must-read analysis. With some interesting hypotheses on ‘why now’, among others….

Foreign Policy – The World Should Treat Pandemics Like It Treats Chemical Weapons N Schwalbe et al ; https://foreignpolicy.com/2021/04/14/pandemic-treaty-who-tedros-china- transparency-inspections-data-covid-19-coronavirus/

“…. To ensure any future pandemic treaty has the teeth to do its job, the international community needs to err on the side of more authority, not less; more independence, not less; more audacity, not less. By elevating the pandemic treaty to the level of the United Nations—the highest level of

authority, one step up from the WHO—it would allow the WHO to focus on its much-needed role of technical support, monitoring, and research….”

Pandemic Action Network - It’s Time to Pandemic-Proof the World: A 2021 Agenda for Action https://pandemicactionnetwork.org/its-time-to-pandemic-proof-the-world-a-2021-agenda-for- action/

“Pandemic Action Network’s 100+ partners urge world leaders to take urgent action in the following areas to bolster the global COVID-19 response, hasten an end to this global crisis, and lay the groundwork for a more pandemic-proof world….” Read what they suggest.

HPW - Italian Authorities Investigating Senior WHO Official Over Suppression Of Report On Italy’s Pandemic Performance; Coverup Extended ‘Higher Up’ Than Imagined https://healthpolicy-watch.news/84862-2/

“Italian prosecutors in the city of Bergamo, the epicentre of the country’s first COVID wave, are reportedly investigating Ranieri Guerra, a senior World Health Organization advisor, for misleading testimony and his role in the suppression of a WHO report into Italy’s coronavirus response “An Unprecedented Challenge“- which contained critical material about the Italian government’s actions in the early days of the pandemic. A series of leaked Whatsapp exchanges between Guerra and Silvio Brusaferro, head of the Italian Institute of Public Health (Istituto Superiore di Sanità) published by the Italian investigative TV series Rai Report, suggest that Guerra pressured WHO to have the report retracted – not only to protect his own reputation as a former Italian Ministry of Health official in charge of prevention, but also to appease other powerful figures such as Brusaferro and the Minister of Health Roberto Speranza. …”

Lancet Viewpoint - Problems with traffic light approaches to public health emergencies of international concern

C Wenham et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00474- 8/fulltext

Another must-read on the caveats of a few potential PHEIC/IHR related reforms. The authors argue in that the real problems of #PHEIC are political, not answered (and maybe worsened) with a more complex, technocratic, diffuse “traffic-light” system.

“… The failure of many states to adequately respond to the COVID-19 PHEIC cannot be ignored. However, introducing a tiered mechanism will not address the main problems with the PHEIC system. These problems are political: pressure not to declare a PHEIC, inadequate response by governments upon a PHEIC declaration, non-compliance with the temporary recommendations by the Director-General following a PHEIC, and insufficient funding to finance preparedness and response domestically and internationally. These political questions are not going to be answered with a more complex, technocratic, and diffuse mechanism. Instead, we need to understand why

many states are not responding to PHEIC declarations or abiding by WHO's recommendations, and why collaboration and assistance for preparedness and response is rarely seen in practice….”

“… The problems with PHEIC declarations are not about insufficient gradients of a health emergency. Instead, the tension within this global health security mechanism results from states' refusal to engage in collective action in response to expert advice from an international organisation, particularly when seeing action as against short-term interests: a classic problem in international relations….”

Global Fund - Indonesia, Germany and Global Fund Sign New Debt Swap Agreement to Fight TB https://www.theglobalfund.org/en/news/2021-04-14-indonesia-germany-and-global-fund-sign-new- debt-swap-agreement-to-fight-tb/

“Germany, Indonesia, and the Global Fund to Fight AIDS, Tuberculosis and Malaria today signed a new agreement that will increase support to tuberculosis programs in Indonesia. That will be achieved by converting €50 million of debt owed by Indonesia to Germany into investments in public health programs supported by the Global Fund in Indonesia. This agreement is an example of Debt2Health, an innovative financing mechanism that is designed to increase domestic financing in health by converting debt repayments into lifesaving investments in public health programs. Under individually negotiated ‘debt swap’ agreements, a creditor nation foregoes repayment of a loan when the beneficiary nation agrees to invest all or part of the freed-up resources into a Global Fund-supported program….”

GAO (report) – Global Health Security: USAID and CDC Funding, Activities, and Assessments of Countries' Capacities to Address Infectious Disease Threats before COVID-19 Onset https://www.gao.gov/products/gao-21-359

“…As of March 31, 2020, the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC) had obligated a combined total of more than $1.2 billion and disbursed about $1 billion for global health security (GHS) activities, using funds appropriated in fiscal years 2015 through 2019. USAID and CDC supported activities to help build countries' capacities in 11 technical areas related to addressing infectious disease threats. The obligated funding supported GHS activities in at least 34 countries, including 25 identified as Global Health Security Agenda (GHSA) partner countries….”

CFFP (Briefing) - A Feminist Global Health Policy https://static1.squarespace.com/static/57cd7cd9d482e9784e4ccc34/t/607423b68ba1797240e252b 5/1618224056849/A+Feminist+Global+Health+Policy-2.pdf

“This briefing outlines the interconnection of health policy, peace, and development and provides an overview of existing inequalities in global health, the lasting effects of colonialism and imperialism, and the persisting influence of gender stereotypes on health outcomes. It aims to broaden the

discussion of health within the Feminist Foreign Policy sphere beyond the focus on sexual and reproductive health and rights and also outlines concrete policy recommendations for states and governments.”

Eurodad briefing – ‘Rebuilding better', but better for whom? https://www.eurodad.org/rebuilding_better?utm_campaign=imf_wb_spring_meetings&utm_mediu m=email&utm_source=eurodad

“In March 2020 the World Bank Group pledged to provide US$ 160bn to client countries in the 15 months to June 2021. In this briefing we analyse the Bank's response and ask, given private finance's central role, who is truly benefitting from their Covid-19 response package?...”

One of the findings: “The IFC, with its emphasis on creating markets and mobilising private finance, has a prominent position at all stages of the Covid-19 response….

Covid key news

Key trends, WHO messages, ….

Cidrap News - Global COVID-19 cases, deaths continue steady rise https://www.cidrap.umn.edu/news-perspective/2021/04/global-covid-19-cases-deaths-continue- steady-rise

“As COVID cases rose for the seventh week in a row last week, the biggest jumps were in South Asia and the Middle East, the World Health Organization (WHO) said yesterday in its weekly snapshot of the pandemic. … The countries reporting the biggest increases last week include Iran (cases up 75%), India (70%), Argentina (52%), Turkey (33%), Japan (28%), Bangladesh (26%), and Iraq (22%). … The WHO said global deaths were up for the fourth week in a row and in all regions except for Africa and the Americas. The biggest rise in fatalities—an increase of 189%—came from the Western Pacific region, which the WHO said was driven by a steep fatality rise in the Philippines….”

Cidrap - India, Brazil grapple with massive COVID-19 surges

HPW - Battling ‘supply constraints’, COVAX May Only Deliver 20% Of Vaccine Target By June https://healthpolicy-watch.news/covax-may-only-deliver-20-of-vaccine/

Coverage of the WHO briefing last week on Friday.

“The global vaccine delivery platform, COVAX, might only deliver 20% of its vaccine target by mid- year because of “supply constraints” but it aims to make up the backlog in the second half of the year, according to Dr Seth Berkley, CEO of the global vaccine alliance, Gavi. “Our goal is still to try

to get to 2.3 billion doses by the end of 2021 assuming that there are not any major supply disruptions with any of the manufacturers,” Berkeley told the World Health Organization’s (WHO) biweekly COVID-19 briefing on Friday.

… “What we’re now beginning to see is supply constraints, not just of vaccines, but also of the goods that go into making vaccines: the filters, the bags that are necessary, the mediums,” said Berkley, whose organisation manages COVAX, along with the Coalition for Epidemic Preparedness Innovations (CEPI). … However, Berkley added that he expected donations of surplus doses from high-income countries to be “an important source of vaccines for COVAX in 2021”.” … “Berkley said that there were currently seven vaccine products available, and COVAX hoped that this would be expanded to 10 to 15, but the crucial question was how to expand production….”

“… Meanwhile, the Chinese vaccines, Sinopharm and Sinovac, which applied for WHO emergency use listing in January, “are in the final stages of evaluation”, according to WHO’s Director of medicines Regulation and Prequalification, Rogerio Pinto de Sá Gaspar. WHO’s technical advisory group on vaccines would discuss the application on 26 April, and possibly also at a second meeting in the first week of May when the final decision would be reached, said De Sá Gaspar. “

Reuters - WHO chief laments 'shocking imbalance' in COVID-19 shot distribution

Reuters;

Also Tedros at the same briefing last week on Friday. Not for the first time he called for a more equitable rollout of vaccines.

“There is a “shocking imbalance” in the distribution of COVID-19 vaccines worldwide and most countries do not have anywhere near enough shots to cover health workers and others at high- risk, WHO Director-General Tedros Adhanom Ghebreyesus said on Friday. More than 700 million jabs have been administered worldwide against the disease, but 87% have gone to high income or upper middle-income countries, with low income countries receiving just 0.2%, he said. “On average in high-income countries, almost one in four people has received a COVID-19 vaccine. In low-income countries, it’s one in more than 500,” Tedros told a briefing….

Tedros: “…But only 14 countries were not yet ready to vaccinate their health workers and elderly, said Tedros, who had set Saturday 10 April – the 100th day of 2021 – as the global deadline for this to begin. …”

HPW - WHO Calls For Global ‘Reality Check’ As Cases Surge And Countries Abandon Basics https://healthpolicy-watch.news/who-calls-for-global-reality-check-as-cases-surge-and-countries- abandon-basics/

On Monday’s media briefing.

“The World Health Organization (WHO) has called for a global “reality check” as COVID-19 infections increased by 4.4 million in the past week, with countries and individuals abandoning proven methods to protect themselves….”

“WHO Director General Dr Tedros Adhanom Ghebreyesus blamed “confusion, complacency and inconsistency in public health measures” for the increases, pointing to “several countries in Asia and the Middle East that have seen large increases in cases.” … India, Turkey, Iran, the Philippines and Iraq are driving these regional increases. …”

Quote Aylward on Covax: “Bruce Aylward, WHO’s lead at COVAX, admitted that the “whole vaccine supply situation remains precarious,” and the challenge of managing community was “very difficult one to manage.” India continued to make “tremendous demand” on the supply of AstraZeneca vaccines being produced by the Serum Institute of India. This vaccine is the backbone of COVAX and requires two doses but the interval between doses could be extended to 12 weeks, said Aylward. “Obviously we’d like to make sure that that interval doesn’t go longer than that so we’re doing everything possible to ensure the supply of AstraZeneca’s product in particular because that’s what’s gone out,” said Aylward. …”

On the (new) “Vaccine Manufacturing Task Force” (see also below, Geneva Health Files, for more analysis on this task force):

“The WHO’s Chief Scientist, Soumya Swaminathan, clarified that the Vaccine Manufacturing Task Force being set up under COVAX was focused on the “immediate removal of any obstacles” to vaccine rollout. At present, it was focused on “raw materials and ingredients and the tubings and the plastic, which is getting into short supply,” she said….”

See also Reuters - Coronavirus pandemic 'a long way from over', WHO's Tedros says

“Confusion and complacency in addressing COVID-19 means the pandemic is a long way from over, but it can be brought under control in months with proven public health measures, WHO Director- General Tedros Adhanom Ghebreyesus said on Monday….”

And the Guardian - Covid pandemic still growing exponentially, WHO says

“The global coronavirus pandemic is still growing exponentially, the World Health Organization said on Monday, as it reported 4.4m cases in the last week, the seventh straight week of rising numbers. The latest global figures represent a 9% increase in infections on last week and a 5% rise in deaths. … …. The coronavirus pandemic is at a “critical point” and people need a “reality check” as restrictions are eased, a World Health Organisation (WHO) expert warned. Dr Maria van Kerkhove, head of the WHO’s technical response, told a press conference that vaccinations alone are not enough to combat Covid-19….”

FT - China considers mixing vaccines to bolster efficacy https://www.ft.com/content/c54b02d6-00a0-4b7d-9160-a9353800efd3

From last weekend, causing quite some uproar. “Center for Disease Control makes first public admission that there is a ‘problem’ with local jabs.”

“China’s Center for Disease Control is thinking about mixing vaccines and varying the sequence of doses to boost efficacy. It is the first time a government body has discussed publicly that there are concerns over the effectiveness of Chinese jabs. Gao Fu, the CDC head, told a forum on Saturday

that the agency was “considering how to solve the problem that the efficacy of existing vaccines is not high”, according to local media. … Some of the WeChat social-media posts on Gao’s remarks were swiftly censored, according to Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. …….”

FT – China backtracks on comments questioning efficacy of local vaccines https://www.ft.com/content/5edb16bf-9da1-48c8-bcd0-9f121f86739a

“Top health official says remarks about jabs were ‘taken out of context’.”

“Chinese state media has rushed to defend its locally developed coronavirus vaccines, with a senior health official insisting that he was “misunderstood” when he appeared to question the jabs’ efficacy. … …. But on Sunday, Gao said that his remarks had been “taken out of context” and misunderstood. “After talking about different immunisation strategies, I mentioned the issue of vaccine protection rates and expressed my reflection that we can optimise our administration process,” he told Guancha.com, a Chinese media outlet. “

“… China’s defence of its vaccines coincided with the publication of long-awaited phase 3 trial results and analysis from Sinovac’s Brazilian partners. It marked the first time a detailed breakdown of phase 3 trial data from a Chinese vaccine had been made public. The data, which is yet to be peer-reviewed by independent scientists, is in line with estimations of the vaccine’s performance, with an overall efficacy rate of 50.7 per cent, just above the WHO-recommended cut off. ….” On the study, see also Science News Chinese COVID-19 vaccine maintains protection in variant-plagued Brazil

Guardian - African health workers left without Covid jabs as paltry supplies dwindle https://www.theguardian.com/world/2021/apr/13/african-health-workers-left-without-covid-jabs- as-paltry-supplies-dwindle

“Millions of healthcare workers in sub-Saharan Africa continue to risk their lives to fight Covid-19 as authorities across the continent struggle to obtain and distribute vaccines to frontline medical staff….”

WHO (Interim guidance) - Reducing public health risks associated with the sale of live wild animals of mammalian species in traditional food markets https://www.who.int/publications/i/item/WHO-2019-nCoV-Food-safety-traditional-markets-2021.1

“To reduce the public health risks associated with the sale of live wild animals for food in traditional food markets, WHO, OIE and UNEP have issued guidance on actions that national governments should consider adopting urgently with the aim of making traditional markets safer and recognizing their central role in providing food and livelihoods for large populations. In particular, WHO, OIE and UNEP call on national competent authorities to suspend the trade in live caught wild animals of

mammalian species for food or breeding purposes and close sections of food markets selling live caught wild animals of mammalian species as an emergency measure….”

Coverage via HPW - WHO Make Unprecedented Appeal To Countries: Suspend Sale of Captured Live Wild Mammals In Food Markets “In an unusually bold step for the cautious global health agency, the World Health Organization has called upon countries to suspend the sale of captured live wild mammals in food markets as an emergency measure. The appeal follows on the report by a WHO- convened international team examining the origins of the SARS-CoV2 virus – which found that one of the most likely routes by which the virus may have first infected people may have been through wild food markets, which are an entrenched tradition in parts of China, including Wuhan where the first novel coronavirus case clusters visibly appeared in December 2019….”

NYT - Western Warnings Tarnish Covid Vaccines the World Badly Needs https://www.nytimes.com/2021/04/14/world/europe/western-vaccines-africa-hesitancy.html

“Amid a deep residue of mistrust, American and European cautions on the AstraZeneca and Johnson & Johnson vaccines risk igniting anti-vaccine fervor in the global south….”

“"African health officials have reacted with fury at the breezy reassurances of American and European lawmakers that people denied the AstraZeneca or Johnson & Johnson shots could be given another vaccine. In much of the world, there are no other vaccines."…”

“…The actions of American and European officials reverberated around the world, stoking doubts in poorer countries where a history of colonialism and unethical medical practices have left a legacy of mistrust in vaccines. If the perception takes hold that rich countries are dumping second-rate shots on poorer nations, those suspicions could harden, slowing the worldwide rollout of desperately needed doses….”

“…Amid the clotting concerns, the World Health Organization and African Union have not wavered in recommending the use of the AstraZeneca and Johnson & Johnson’s vaccines….”

Via Politico - The vaccine freeze could become a global chill “Clearly, it makes it extremely complicated for us to strive to achieve our target of immunizing 60 percent of our population” because vaccine distrust may rise, said John Nkengasong, the director of the Africa Centres for Disease Control and Prevention.”

Covid science

Nature Editorial – Funders, now is the time to invest big in COVID drugs https://www.nature.com/articles/d41586-021-00960-w

“Vaccine development has been a resounding success. But the medicine cabinet should have been better stocked.” On what needs to be done to boost antiviral drugs.

“… As reported in a News Feature this week, a number of initiatives are under way to right this wrong. The COVID R&D Alliance, a consortium of more than 20 life-science companies and venture- capital firms from around the world, is aiming to create an organization that will accelerate the development of drugs against coronaviruses. The consortium, which was set up last year, plans to prepare 25 candidate medicines for trials in humans, so that at least some can be ready for larger trials when the next pandemic-causing virus strikes. The COVID R&D Alliance, and another global project called the Rapidly Emerging Antiviral Drug Development Initiative, are in the process of raising funds from industry and governments. The US National Institutes of Health (NIH) is planning to invest heavily in creating drugs to fight SARS-CoV-2. It is essential that the agency is given the funding to make strategic bets in creating drugs for the next pandemic….”

“…. A similar funding vehicle (like for vaccine development) — one based on both the public and private sectors being willing to take risks — must be considered for antiviral drugs….”

See Nature News - The race for antiviral drugs to beat COVID — and the next pandemic .

Guardian – US decision to pause J&J jabs is another blow to global Covid fight S Boseley; https://www.theguardian.com/world/2021/apr/13/us-decision-to-pause-jj-jabs-is- another-blow-to-global-covid-fight

“Analysis: rare side-effects mean that confidence in both the Johnson & Johnson and Oxford/AstraZeneca vaccines is now shaken.” (PS: it’s probably also telling that at the AU vaccine manufacturing summit, most attention went to mRNA vaccines)

“After the extensive probe into what is happening with the Oxford/AstraZeneca vaccine, none of the scientists are very surprised that similar cases involving blood clotting should come to light with J&J’s version. … The two vaccines – and also the Russian Sputnik vaccine – are designed in the same way. … … … The existence of these cases will shake confidence in the Oxford/AstraZeneca and J&J vaccines, but every expert is urging people to understand that the risks of death and harm from Covid for most people far outweigh the risks of blood clots. “

Science News - Concerns over rare clotting disorders halt use of Johnson & Johnson’s COVID-19 vaccine https://www.sciencemag.org/news/2021/04/concerns-over-rare-clotting-disorders-halt-use- johnson-johnson-s-covid-19-vaccine

“Six patients in the United States have symptoms similar to those seen after AstraZeneca immunizations in Europe.”

Science News - Hard choices emerge as link between AstraZeneca vaccine and rare clotting disorder becomes clearer https://www.sciencemag.org/news/2021/04/hard-choices-emerge-link-between-astrazeneca- vaccine-and-rare-clotting-disorder-becomes

Update on the AZ saga as of last weekend.

Science – Vaccines that can protect against many coronaviruses could prevent another pandemic https://www.sciencemag.org/news/2021/04/vaccines-can-protect-against-many-coronaviruses- could-prevent-another-pandemic

State of affairs in the quest for a pan-coronavirus vaccine. “Approaches include tailored nanoparticles, chimeric proteins, virus cocktails.”

Stat - Scientists work toward an elusive dream: a simple pill to treat Covid-19 https://www.statnews.com/2021/04/09/scientists-work-toward-an-elusive-dream-a-simple-pill-to- treat-covid-19/

“The world has vaccines that can prevent most cases of Covid-19. It even has drugs that can help with the most serious symptoms of the disease. Now what it needs is a Tamiflu for SARS-CoV-2….”

Guardian - Is vaccinating against Covid enough? What we can learn from Chile and Israel

Guardian;

“Contrasting lessons from the two countries, both with high rates of inoculation against the virus, show the danger is not past…”

BMJ Editorial - Covid-19 has redefined airborne transmission J W Tang et al; https://www.bmj.com/content/373/bmj.n913

“Improving indoor ventilation and air quality will help us all to stay safe.”

See also a Lancet Comment (by T Greenhalgh et al) - Ten scientific reasons in support of airborne transmission of SARS-CoV-2

Links:

• Washington Post - CDC ramps up scrutiny of rare post-vaccination ‘breakthrough infections’

“As tens of millions of people in the United States reach the coronavirus vaccination finish line, a small fraction have had “breakthrough infections,” testing positive for the virus after being inoculated and in rare cases requiring hospitalization, according to data from state health departments….”

• Reuters - Brazil's P1 coronavirus variant mutating, may become more dangerous: study

“ Brazil’s P1 coronavirus variant, behind a deadly COVID-19 surge in the Latin American country that has raised international alarm, is mutating in ways that could make it better able to evade antibodies, according to scientists studying the virus….”

• FT - Pfizer chief says people will probably require yearly Covid booster shot

“Albert Bourla proposes ‘annual revaccination’ programme to keep virus under control.”

Covid vaccine access

Reuters - Brazil, Mexico, Philippines among those due to get Pfizer shots from COVAX in Q2 - statement https://www.reuters.com/article/health-coronavirus-vaccines-covax/brazil-mexico-philippines- among-those-due-to-get-pfizer-shots-from-covax-in-q2-statement-idUSL8N2M11PE

On the release of the Q2 allocation round. “Some 14.1 million doses of the Pfizer BioNTech COVID- 19 vaccine have been allocated to 47 countries and economies for delivery in the second quarter of this year, the GAVI vaccine alliance said on Monday. Brazil, Colombia, Mexico, the Philippines, South Africa, and Ukraine are set to be among the main recipients of the Pfizer vaccine between April and June, according to GAVI’s table “based on current knowledge of COVID-19 vaccine supply availability”….”

Geneva Health Files - The COVAX Manufacturing Task Force Geneva Health Files;

In-depth analysis of the ‘COVAX manufacturing task force’. In the words of Tedros: “WHO and our partners have established a COVAX manufacturing taskforce, to increase supply in the short term, but also to build a platform for sustainable vaccine manufacturing to support regional health security….”

“…At the press briefing (April 9), Gavi’s Berkley had said, “There is a COVAX manufacturing task force that is looking at technology transfer and how to expand production, but right now one of the worries is limitations in supplies.”…”

“Top WHO official, Sowmya Swaminathan, Chief Scientist of the organization, told us that WHO is working with CEPI, Gavi and UNICEF on the taskforce. The immediate goals of the taskforce will be to address shortages of raw materials needed to manufacture vaccines and also to work with countries to ensure that there are no export restrictions on these materials. The medium term goal will be expand the manufacturing of approved vaccines. The idea is to encourage more manufacturers to strike voluntary licensing deals (She cited the AstraZeneca model). She also added that there is a “close link” between the C-TAP and the manufacturing taskforce. C-TAP will work closely with the Medicines Patent Pool to enable licensing arrangements between manufacturers.

The goal is to ensure that “additional doses produced will have to go through COVAX to ensure equitable distribution.” The long-term goal of the taskforce is to expand basic manufacturing capacities in Africa, for example, including by working on investments, business plans for sustainability and technology transfer to service not only the production of COVID-19 vaccines but also other diseases….”

Friends of the Earth International & Transnational Institute (report) - COVAX: A global multistakeholder group that poses political and health risks to developing countries and multilateralism H Gleckmann; https://www.foei.org/features/covax-covid19-vaccine

“… This report concentrates on the political and economic repercussions on the global South and how COVID and the multistakeholder structure of COVAX is driving a transformation of global governance. … … Probably no other commercial product has been produced that in its first years expects to have the entire world as its consumer base. COVAX as a multistakeholder body provides a gathering spot for business interests which otherwise may not be allowed to jointly plan marketing, productions, investments, and distribution in what is for them a major evolving vaccine global market. There is significant potential for commercial self-interest to be injected inappropriately into Covax decisions….”

Reuters - World Bank, Gavi urge countries with excess COVID-19 vaccines to release them

Reuters;

“World Bank President David Malpass and José Manuel Barroso, chair of the Gavi vaccine alliance, on Monday discussed the importance of countries with excess COVID-19 vaccine supplies releasing them as soon as possible, the World Bank said. Malpass expressed his desire to work closely with Gavi on a 2022 strategy, including helping expand vaccine production capacity for developing countries, the bank said in a statement. The two officials also discussed the need for more transparency by countries, suppliers and development partners on vaccine contracts, and regarding national export and supply commitments and requirements, the bank said….”

The Conversation - The global approach to vaccine equity is failing: additional steps that would help E Hannah, S Harman et al; https://theconversation.com/the-global-approach-to-vaccine-equity-is- failing-additional-steps-that-would-help-158711

“… Efforts to address vaccine equity have focused on multilateral solutions such as the COVAX scheme and the suspension of intellectual property rights through the World Trade Organisation (WTO). These initiatives differ in approach. But each is committed to pursuing solutions through global institutions. Based on our work in global health and world trade governance, we question whether vaccine equity can be addressed via global institutions alone. To secure universal access to vaccines, states must take up the fight by using the existing rules to their advantage. These include: Issuing compulsory licences to produce their own vaccines; Setting up bilateral agreements with those states that have production capacity; Building vaccine blocks to negotiate and supply

vaccines to territories; Being prepared to disrupt power relations within supply chains by breaking confidentiality clauses in contracts and publishing what pharmaceutical companies want them to pay – or at least leak these contracts….”

Quote: “…When states are challenged on vaccine hoarding, priority deals, and bilateral price negotiations, they often point to COVAX as evidence of commitment to vaccine equity. Our criticism of COVAX is more than that it is just charity: COVAX is serving as a smokescreen to cover up vaccine nationalism….”

Development Today - UK buys 500,000 Pfizer vaccine doses from COVAX for domestic use https://www.development-today.com/archive/dt-2021/dt-3--2021/uk-buys-500-000-pfizer-vaccine- doses-from-covax-for-domestic-use

“The United Kingdom and Norway have taken opposite approaches to the rich-country window of the COVAX vaccine facility. The UK government has bought 539,000 doses of Pfizer’s COVID19 vaccine from COVAX for use at home. Norway was offered 700,000 doses by COVAX last year but decided to transfer them to developing countries.”

As for Denmark, see Reuters - WHO says Denmark looking to share AstraZeneca vaccines after halting shots

HPW - Many Africans May Not Receive Their Second COVID-19 Vaccine Doses Anytime Soon, Africa CDC Warns https://healthpolicy-watch.news/second-africa-vaccination/

“The Africa CDC has expressed concerns over the disruption of the COVID-19 vaccination drive in Africa saying it was preventing many Africans who have received the first dose of the Oxford/AstraZeneca vaccine may not be able to receive the second dose 12 weeks after the first dose as recommended in the vaccination guideline….”

GFO – Covid-19 vaccination in Africa: from hope to reality https://www.aidspan.org/en/c/article/5553

“With the roll-out of the COVAX Facility giving low-income countries access to COVID-19 vaccines, developing countries, particularly in Africa, face many financial, logistical and programming challenges in accessing the vaccine doses they require. This article outlines these challenges, as well as African countries' individual strategies and the collective ones adopted by the African Union to find solutions.”

TWN - Attempts to slow down discussions on TRIPS waiver at WTO https://www.twn.my/title2/health.info/2021/hi210401.htm

“Notwithstanding the growing calls by many developing countries for text- based negotiations on the proposed TRIPS waiver, the new chair of the TRIPS Council, Ambassador Dagfinn Sorli from Norway, appears to be slowing down the five-month-old talks by asking the proponents of the waiver to prove all over again how intellectual property rights (IPRs) remain a barrier in scaling-up production of vaccines, said people familiar with the development. … Ideally, the chair ought to have started the text-based negotiations on the TRIPS waiver, as being demanded by many developing countries at the WTO and supported by over 400 international civil society groups and several prominent US Congressmen. During the 10-11 March TRIPS Council meeting, the 58 co- sponsors of the TRIPS Waiver proposal, the ACP (Africa, Caribbean, and Pacific) and other developing countries called for text-based discussions as the way to move forward with the discussions, without being tied up in a continuous evidentiary loop.

“… More recently it has emerged that Norway may actually be a fierce critic of the TRIPS waiver proposal alongside the US, the European Union, the United Kingdom, Japan, Australia, Canada, Switzerland and Singapore. … …. The [Norwegian] prime minister’s response points to the Access to the COVID-19 Tools Accelerator (ACT-A) and its vaccine pillar Covax as a mechanism to achieve “the rapid development, scaling up of production and equitable distribution of Covid-19 vaccines, therapeutics and diagnostics”. The ACT-A Facilitation Council is co-chaired by Norway and South Africa….”

And link: TWN - WTO-TRIPS waiver: “Third Way” Set to Reinforce Status Quo?

Analysis from last Monday, ahead of the WTO meeting on 14 April.

Thomson Reuters - Calls to tackle vaccine hesitancy as African Union drops AstraZeneca https://news.trust.org/item/20210409172034-tdapu/

From last weekend. “Wariness about taking AstraZeneca's COVID-19 vaccine in Africa could be compounded by the African Union's decision to halt plans to procure the shot, health experts said on Friday, calling for public awareness programmes to fight misinformation. The African Union (AU) said its announcement was not related to recent findings by European and British medicine regulators that there are possible links between the vaccine and extremely rare blood clots, but rather a case of diversifying options. Still, experts said the timing of Thursday's announcement could fuel vaccine hesitancy….”

CSIS (brief) – The Time Is Now for U.S. Global Leadership on Covid-19 Vaccines J S Morrison et al ; https://www.csis.org/analysis/time-now-us-global-leadership-covid-19-vaccines

Pleading for a four-part U.S. diplomatic strategy that will: Bring order to the Covid-19 vaccine marketplace; Expand global Covid-19 vaccine supply, including by enhancing manufacturing capacity; Build local Covid-19 vaccine distribution capacity; and Strengthen global demand for Covid-19 vaccines.

World Bank (policy research WP) – How to End the COVID-19 Pandemic by March 2022 WB;

“ How can the world reach herd immunity against COVID-19 before the second anniversary of the pandemic, or March 2022? A study of vaccine demand and supply answers this question. A target of vaccinating 60 percent of the population in each country by March 2022 is likely sufficient to achieve worldwide herd immunity under a baseline scenario with limited mutation. Achieving this target appears feasible given stated production capacity of vaccine manufacturers and the pace of current and historical vaccination campaigns. Considering existing pre-purchase contracts for vaccines, achieving this target requires addressing a procurement gap of just 350 million vaccine courses in low- and middle-income countries. Immediate additional donor funding of about $4 billion or in-kind donations of excess orders by high-income countries would be sufficient to close this gap….”

And some links:

• Reuters - WHO expects decision on emergency listing for Chinese vaccines soon

• Reuters - India approves Russia's 'Sputnik V' COVID-19 vaccine: Economic Times • HPW - India Set To Become Major Manufacturing Hub Of Sputnik V COVID Vaccine – Regulatory Approval Comes As COVID Cases Spike • Reuters - India, swamped by COVID-19 surge, fast-tracks approval of foreign vaccines

“ India is to fast-track emergency approvals for COVID-19 vaccines that have been authorised by Western countries and Japan, paving the way for possible imports of Pfizer, Johnson & Johnson, and Moderna shots….”

• Devex - In Brief: Lift export barriers to boost global vaccine supply, Moderna says

“The key to expanding supplies of Moderna’s COVID-19 vaccine globally is removing U.S. export barriers, according to Stéphane Bancel, the company’s chief executive officer….”

Covid analysis

BMJ GH - Giving hope a sporting chance: COVID-19 as a beneficial epidemic?

R van de Pas & G Ooms; https://gh.bmj.com/content/6/4/e005784

“Sociologist Abram de Swaan wrote in the 1990s about a ‘Project for a Beneficial Epidemic’.

Could the COVID-19 pandemic prod ‘concerted action by the wealthy countries to eradicate the conditions of poverty that caused the spread of a disease on a world scale?’ COVID-19 seems likely to become an endemic, and governments will need to switch from emergency measures to policies

that are economically and socially sustainable. We are not optimistic, but we remain hopeful, that the COVID-19 pandemic prompts states to effectively take international responsibility and collective action.”

Pre-print - The World Mortality Dataset: Tracking excess mortality across countries during the COVID-19 pandemic https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v2

Cfr tweet A Glassman: “These authors estimate abt 3.3 million excess deaths in 79 countries (about 1 mill more than official C19 deaths) - must read paper but excess deaths are explained by C19 but also health system failures and pandemic recession effects.”

BMJ - Covid-19: a disaster five years in the making https://www.bmj.com/content/373/bmj.n657

Interesting article, but debatable. “The covid-19 pandemic is not a one-off extraordinary event but the culmination of a five year unravelling of progress in global health, writes Peter Hotez.”

World Health Day 2031: Looking back on the pandemic from the future https://www.graduateinstitute.ch/communications/news/world-health-day-2031-looking-back- pandemic-future

One of my favourite blogs of the week. A tad dystopian, though (except the final paragraphs).“Vinh- Kim Nguyen, Co-director of the Global Health Centre and Professor, and Ilona Kickbusch, founding Director and Chair of the Global Health Centre, glimpse into the future, taking stock of a world where global cooperation is a necessary remedy to tackle COVID. “

PBS - Grim view of global future painted in U.S. intelligence report https://www.pbs.org/newshour/health/grim-view-of-global-future-painted-in-u-s-intelligence- report

Also pretty dystopian, this one. Cfr tweet: “The #covid19 pandemic is the “most significant, singular global #disruption since World War II, with health, economic, political, and security implications that will ripple for years to come.” - too many policy makers do not realise or communicate this ! “

Guardian - Covid-status certificates could lead to deliberate infections, scientists warn https://www.theguardian.com/world/2021/apr/11/covid-status-certificates-could-lead-to- deliberate-infections-scientists-warn

“Covid-status certificates – to allow those who have been vaccinated, recovered from the virus or have tested negative to attend an event or holiday abroad – could do harm as well as good, UK government science advisers have warned. While they could encourage some people to get vaccinated, the scientists say others may deliberately go out to get infected, in order to test positive for antibodies and get a certificate enabling them to mix more freely. They say certificates, like vaccine passports, may also encourage people to behave as though they are no longer at risk, discarding masks and ignoring social distancing. The paper, which has not yet been peer reviewed, was written by a group of eight psychologists and behavioural scientists, all but one of whom take part in the government advisory body on the pandemic known as Scientific Pandemic Insights Group on Behaviours (SPI-B)….”

Global Fund Observer – The impact of Covid-19 on health systems in the developing world

S N Laing & A Whiteside; https://www.aidspan.org/en/c/article/5543

“The biggest health challenge of the 21st century, COVID-19, is making itself felt in every country around the world; and will continue to do so for some time. This article, the third in our series on the impact of the coronavirus on various spheres of life, looks at the ramifications of the pandemic for already fragile and under-resourced health systems in the developing world.”

WEF - When will life return to 'pre-COVID normal'? https://www.weforum.org/agenda/2021/04/normal-pre-covid-post-pandemic/

“A majority of people expect life to return to something like 'normal' within the next 12 months, according to a new World Economic Forum-Ipsos survey. There are large differences between countries on this, though. The pandemic has also impacted people's emotional and mental health.”

BMJ Editorial - Reconsider this summer’s Olympic and Paralympic games K Shimizu, D Sridhar et al ; https://www.bmj.com/content/373/bmj.n962

“Serious questions remain about managing the games safely.”

Scroll- India played down new mutant Covid strains to avoid panic – but this may have backfired https://scroll.in/article/992172/india-played-down-new-mutant-covid-strains-to-avoid-panic-but- this-may-have-backfired

“Some amount of panic may have actually helped reinforce Covid-appropriate behaviour, say experts.”

“… One of the factors propelling the second wave is the emergence of a new, fast-spreading Indian variant of the virus. It is being called a “double mutant” variant because it has two mutations. It has been found in 61% of samples put through genome sequencing in Maharashtra, the worst hit state in India, as the Indian Express reported on April 14, strengthening suspicions that the current surge is

powered by a more transmissible strain. … Labelled B.1.617, the double mutant variant was first detected in India, but has been now found in eight countries, with 70% of samples containing the mutations originating from India. …”

Guardian - Oxford/AstraZeneca Covid vaccine research ‘was 97% publicly funded’ https://www.theguardian.com/science/2021/apr/15/oxfordastrazeneca-covid-vaccine-research-was- 97-publicly-funded

Probably no surprise for the readers of this newsletter.

Link:

BMJ GH (Analysis) - COVID-19 response: mitigating negative impacts on other areas of health

“Vertical’ responses focused primarily on preventing and containing COVID-19 have been implemented in countries around the world with negative consequences for other health services, people’s access to and use of them, and associated health outcomes, especially in low-income and middle-income countries (LMICs). ‘Lockdowns’ and restrictive measures, especially, have complicated service provision and access, and disrupted key supply chains. Such interventions, alongside more traditional public health measures, interact with baseline health, health system, and social and economic vulnerabilities in LMICs to compound negative impacts. This analysis, based on a rapid evidence assessment by the Social Science in Humanitarian Action Platform in mid-2020, highlights the drivers and evidence of these impacts, emphasises the additional vulnerabilities experienced by marginalised social groups, and provides insight for governments, agencies, organisations and communities to implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 in the context of and alongside other disease burdens….”

Covid impact on other global health programs & causes

Global Fund - New Global Fund Report Shows Massive Disruption to Health Care Caused by COVID-19 in Africa and Asia https://www.theglobalfund.org/en/news/2021-04-13-new-global-fund-report-shows-massive- disruption-to-health-care-caused-by-covid-19-in-africa-and-asia/

“A new report by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows COVID-19 has massively disrupted health systems and health service delivery for HIV, TB and malaria in low- and middle-income countries in Africa and Asia in 2020. The report highlights the urgent need to scale up the adaptive measures that health facilities adopted to continue the fight against HIV, TB, malaria, to ramp up delivery of critical supplies for the COVID-19 response, and prevent health care systems and community responses from collapse. Through programmatic spot-checks recording information from 502 health facilities in 32 countries in Africa and Asia between April and September 2020, the Global Fund has assembled a snapshot of the extent of the disruption to health services for HIV, TB and malaria, and of how health facilities have responded….”

AMR

FT – WHO sounds alarm on drug-resistant bacteria https://www.ft.com/content/f04275a3-5095-4f9e-a711-6fe7d59216dc

“The World Health Organization has warned none of the antibiotics currently being developed against antimicrobial resistance are enough to tackle drug-resistant bacteria that are expected to kill millions by 2050. In a report published on Thursday, the WHO said that none of the 43 such drugs in the pipeline addressed the 13 most dangerous superbugs it had identified….”

Malaria

Lancet Infectious Diseases – Association of Plasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: an open- label, single-arm, multicentre, therapeutic efficacy study https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00142-0/fulltext

Via the press release: The Lancet Infectious Diseases: First clinical evidence of drug-resistant malaria mutations gaining foothold in Africa, Rwandan study suggests

• Study finds for the first time, in Africa, that mutations are associated with delayed clearance of the parasite among children with malaria treated with common Artemisinin- based combination therapies (ACTs). • While drug efficacy remains high so far, authors call for increased monitoring in the region.

New data provide the first clinical evidence that drug-resistant mutations in the malaria parasite Plasmodium falciparum may be gaining a foothold in Africa. The study, conducted in Rwanda, is published in The Lancet Infectious Diseases journal and finds for the first time that the mutations are associated with delayed parasite clearance, as was first shown in South-East Asia when artemisinin- resistance started to emerge. The study also finds that the mutations are more prevalent than previous studies have reported, indicating likely transmission of the mutations, and raising concern about further geographical spread of resistance. “

Related Comment in Lancet Infectious Diseases - Has artemisinin resistance emerged in Africa?

Coverage: Guardian - Scientists sound warning note over malaria drug resistance in Africa “Rwanda study raises fears erosion of efficacy may have begun, with children at greatest risk.”

UHC

HP&P - Fifteen years later: moving forward Heller’s heritage on fiscal space for health H Barroy & S Gupta; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czab033/6225877?searchresult=1

“Economist Peter Heller, writing a seminal paper published in Health, Policy and Planning in 2006, identified five opportunities for expanding fiscal space for health: raising revenue, reprioritizing expenditure, borrowing, using seigniorage and mobilizing external grants. The development of the initial framework marked a significant conceptual advancement in health financing, by situating health reforms within a broader macro-fiscal context. Fifteen years later, fiscal space for health is not viewed simply as a question of finding additional revenues but also as a matter of improving public financial management (PFM) in the health sector, specifically for publicly funded health systems. This paper advances the concept of budgetary space for health, which explores available resources generated through greater overall public expenditure, prioritized budget allocations, and improved PFM. The paper adds a critical component, unpacking the ways through which PFM improvements can maximize budgetary space for health. The approach fits the realities of public finances in the era of the Sustainable Development Goals. The key implication is that PFM aspects should be systematically included in assessments of budgetary space to inform more effective country dialogues between the finance and health sectors.”

WHO policy brief - From value for money to value-based health services: a twenty- first century shift https://www.who.int/publications/i/item/9789240020344#.YHV_O4DyMMk.twitter

“Health policy makers around the world have long shown interest in the value created by health systems and this preoccupation will likely only intensify in the current context of the COVID-19 pandemic and the ensuing global recession. Yet, there remains much confusion about what value actually means and none of the existing approaches has looked at value holistically, from the perspective of the entire health system. WHO’s policy brief explicitly looks at how to value health more holistically by working through 3 levers which act at the system level- setting a health benefits package, strategic purchasing and integrated people-centred health services -- to advance UHC objectives. WHO guidance on those 3 levers are highlighted, such as the “3D” (Data, Dialogue, Decision) approach to priority setting for benefits package selection, the “UHC Compendium”, and the Integrated, People-Centred Health Services Framework…”

BMJ Opinion -We must redesign the WHO’s building blocks to create more resilient health systems for the future A Takian et al; BMJ;

“…. The covid-19 is providing an opportunity for international health organizations to reconsider whether the existing health systems building blocks, which form the WHO framework, are sufficient. Based on the countries with the most efficient and successful responses to covid-19 so far, we advocate two additional domains be added to the WHO’s six conventional building blocks framework: 1) a meaningful inter-sectoral collaboration and 2) a functioning global health

surveillance and response system, both of which were meaningfully adopted in countries such as South Korea, Singapore and New Zealand to combat covid-19 crisis. Although both proposed components appear to be at the heart of governance, the experience of covid-19 has shown that neither has been fully addressed as a subset of governance in many countries. It is vital to consider these two important issues as independent blocks of a health system, in order to build a resilient health service that can overcome the complex public health challenges of the 21st century….”

Links:

HP&P – Do efficiency gains really translate into more budget for health? An assessment framework and country applications

HP&P - A framework policy analysis of national health insurance policymaking in sub-Saharan Africa

More on NCDs

WHO –WHO technical manual on tobacco tax policy and administration https://www.who.int/publications/i/item/9789240019188

“This WHO technical manual on tobacco tax policy and administration builds upon the 2010 WHO technical manual on tobacco tax administration by further detailing the strategies for effective tobacco tax policy development, design, implementation and administration. This 2021 edition also serves as an update to the 2010 manual, incorporating the latest developments in science, technology and policy, as well as providing illustrative recent examples from a variety of countries. The best practices laid out in this manual are designed to inform governments on the development of their tobacco taxation policy, facilitating the achievement of their health and revenue objectives while also supporting their overall development strategy. The evidence is clear: significant increases in excise taxes that lead to price increases have consistently proven to be the most effective, as well as the most cost-effective, mechanism for reducing tobacco consumption. Despite this undeniable fact, tobacco tax increases remain the least implemented policy in the package of effective tobacco control policies globally. In 2018 only 38 countries, covering 14% of the global population, had sufficiently high tobacco taxes. Tobacco industry interference and their SCARE tactics remains a major stumbling block to significant tax increases. Government resolve and commitment to protect people’s health is needed to counter powerful vested interests long opposed to tobacco taxation reform. This manual will guide readers through the necessary steps to create and implement the strongest tobacco taxation policies for their specific countries, including practical pointers on how to navigate through the political process and ensuring the right support for tax policy change….”

• See also WHO - US$ 1.4 trillion lost every year to tobacco use - New tobacco tax manual shows ways to save lives, money and build back better after COVID-19

“WHO’s new technical manual on tobacco tax policy and administration shows countries ways to cut down on over US$1.4 trillion in health expenditures and lost productivity due to tobacco use worldwide….”

• Coverage on the launch via HPW: Tobacco Taxes Are Most Effective Yet Least Implemented Tactics, Says WHO

“Although taxing tobacco products is one of the most effective ways to discourage smokers – and it provides governments with revenue – it is “the least implemented” tobacco control policy globally, according to the World Health Organization (WHO). “It takes vision and courage for political leaders to stand up against the powerful vested interests that profit from tobacco,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at Monday’s launch of a manual on tobacco tax administration aimed at helping governments to levy taxes….”

WHO - Nothing for us, without us: opportunities for meaningful engagement of people living with NCDs: meeting report https://apps.who.int/iris/handle/10665/340737

“This report results from the 3-day WHO Informal Consultation on People Living with NCDs (PLWNCDs), which was held from December 9-11. 2020. It outlines the participatory methods, main themes discussed and key next steps to further support the meaningful engagement of PLWNCDs in the co-design, co-creation and implementation of WHO policies, programmes, and principles….”

Lancet Comment – Bringing equity in access to quality dialysis V Luyckx et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00732- 7/fulltext

« An estimated 2–7 million people with kidney failure worldwide die prematurely because they do not have access to kidney replacement therapy (dialysis or transplantation). The number of people who were on kidney replacement therapy exceeded 3 million in 2017 and is projected to grow to 5·4 million by 2030… … In response to the urgent global need to provide more accessible good-quality dialysis, the International Society of Nephrology (ISN) has developed the ISN Framework for Developing Dialysis Programs in Low-resource Settings to guide the establishment or expansion of chronic dialysis programmes in low-resource settings as part of its work as a non-governmental organisation in official relations with WHO….”

And a link:

Globalization & Health - Alcohol marketing versus public health: David and Goliath?

SRHR

Guardian - ‘Out of Trump playbook’: UK accused of ‘abandoning’ women with cuts to aid https://www.theguardian.com/global-development/2021/apr/12/uk-aid-cuts-trump-playbook- maternal-deaths-abortion-women-girls-creasy-ippf

“The director of a leading sexual and reproductive health charity has accused the (UK) government of “abandoning” women and girls it promised to help, as aid cuts derail a leading Tory programme to reduce maternal deaths and prevent unsafe abortions in poor countries. The threat to the women’s integrated sexual health (Wish) programme could mean 7.5m additional unintended pregnancies, 2.7m unsafe abortions and 22,000 maternal deaths over the next year, said Dr Alvaro Bermejo, director general of International Planned Parenthood Federation (IPPF)….”

UN News - Hundreds of millions of women living lives ‘governed by others’, UN report shows https://news.un.org/en/story/2021/04/1089702

“Almost half of women in some 57 countries do not have the power to make choices over their healthcare, contraception, or sex lives, a new United Nations report launched on Wednesday, has revealed. According to the UN Population Fund (UNFPA)’s State of World Population report, the lack of bodily autonomy may have worsened during the coronavirus pandemic, placing record numbers of women and girls at risk of gender-based violence and harmful practices such as early marriage. …”

See also coverage in the Guardian - Marry your rapist’ laws in 20 countries still allow perpetrators to escape justice

Lancet Global Health (Editorial) – Progressing the investment case in maternal and child health https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00178-9/fulltext Editorial of the new May issue. “…the Venice Forum on “Why investing in MNCH is critical for sustainable recovery after COVID- 19”—comprising online talks from and discussions among thought leaders from multilateral and non- governmental organisations, universities, and more—over March 22–24, 2021, might seem to be preaching to the choir. However, the Forum also delved into more complex questions around MNCH investment. Why do we struggle to get funding? How could we spend more efficiently? And how can we persuade those with money to spend that MNCH is a worthwhile target? We heard some illuminating perspectives….”

Planetary Health

BMJ Opinion -It’s time for the health community to back a Green New Deal

Andrew Harmer et al; BMJ;

Focus on the UK here, but obviously also relevant for all other countries. “ In 2009, the Lancet Commission on Climate Change and Health concluded that climate change is the biggest public health threat of the twenty-first century. Over a decade later, calls for the transformative changes needed to address this threat are getting louder and more urgent than ever, as covid-19 has only exacerbated the inequalities, driven by our economic system. As health workers and co-authors of a new Medact report—The Public Health Case for a Green New Deal—we are adding our voice to this growing movement….”

Lancet Planetary Health – April issue https://www.thelancet.com/journals/lanplh/issue/vol5no4/PIIS2542-5196(21)X0004-6

Make sure you read the Editorial - Net zero clarity

“…In the lead up to the UN Climate Summit in Glasgow we need to press those making net zero commitments to be clear about their framing of the problem, what is included and excluded, and how that is justified in the context of what they assume others will or should do. We also need to see concrete planning and early emissions cutting. Heavy reliance on CO2 removal and/or offsetting, particularly in other nations are warning signs that real progress is expected elsewhere. Recent net zero progress remains encouraging, but much more remains to be done if these commitments are to put us on the road to Paris Agreement compliance. Continuing scrutiny and pressure to improve reporting will be vital in making net-zero (and net-negative) commitments meaningful in real terms.”

Also, for example (with focus on Australia here) - Is climate change exacerbating health-care workforce shortages for underserved populations?

PNAS - Years of good life is a well-being indicator designed to serve research on sustainability W Lutz et al ; https://www.pnas.org/content/118/12/e1907351118

“Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor- made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on

life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.”

Reuters - Health systems urged to develop green cure for fast-rising emissions https://www.reuters.com/article/us-global-health-climate-trfn/health-systems-urged-to-develop- green-cure-for-fast-rising-emissions-idUSKBN2C1283

“Hospitals and other healthcare facilities worldwide can prepare better for both climate change and future pandemics by adopting green technology and cutting planet-heating emissions from their operations and supply chains, health experts said on Wednesday. A new roadmap setting out ways for the health sector to reach net-zero emissions said healthcare has a “substantial” climate footprint, accounting for 4.4% of global emissions, mostly due to the use of fossil fuels for energy and products. Without action to shrink those emissions, they would more than triple by 2050, equalling the annual emissions from 770 coal-fired power plants, said the report from nonprofit network Health Care Without Harm (HCWH) and engineering firm Arup….”

“…The new roadmap, launched at the Skoll World Forum, details national healthcare emissions data for 68 countries and recommendations on how to decarbonise the health sector. It urges wealthy countries with big-emitting health systems to cut emissions the fastest and steepest, while calling on poorer countries to develop their health infrastructure using clean energy, such as solar power, and other green technologies….”

Decolonize Global Health

BMJ Global Health (Commentary) - The implicit ideological function of the global health field and its role in maintaining relations of power Hani Kim; https://gh.bmj.com/content/6/4/e005620

Also one of the reads of the week. Written by a Gates Foundation employee !

Starting from JH’s GHS index and this statement: “…One formidable barrier to equity in the global health field is its implicit function of legitimising and reproducing the existing power structure in addition to its explicit goal of improving population health and health equity.”

Excerpt: “Solving the much talked about ‘power imbalances’ in global health requires making visible the implicit ideological function that the field performs. However, ideological function is difficult to discern because ideology operates through the implicit, not through explicitly stated beliefs or intent. To my knowledge, no global health institution has an explicit mission of concentrating wealth and power within itself, or to serve the hegemonic value of its time. Ideological function is not found in organisational mission statements or in research proposal documents. Critiques of ideology

should be directed at what is implicit in the doing, and how the doing relates to the existing power structure. Global health programmes implicitly perform ideological function in two prominent ways: first, by providing an avenue for the global elites to discipline and control the non-elite countries and people; and second, by providing a sense of relief or redemption for (mostly European and North American, but really global) elites through acting out of ‘charitable’ impulses or fulfilling a sense of ‘moral duty’….”

Global Public Health - Vaccine hesitancy in the global south: Towards a critical perspective on global health https://www.tandfonline.com/doi/full/10.1080/17441692.2021.1912138

“The complex phenomenon of vaccine hesitancy has been causing increasing global concern. This systematic review aims at analysing the state of art of scientific literature concerning vaccine hesitancy in Latin America and Africa, observing if: (i) they use the same research trends as the global North; and (ii) the parameters recommended by the World Health Organization (WHO) and taken from the experience of the global North are adequate to the Global South’s context. … … The studies produced in the Global South bring up important context-specific issues, such as issues of access (that are not included in the WHO’s definition of vaccine hesitancy), cultural and religious issues, reactions to governments, reactions to recent episodes of vaccine tests on populations, and reactions to past of colonial violence. Initiatives to understand the phenomenon based on methodological and conceptual frameworks from the global North alone can cause wrongful conclusions.”

CGD (blog) - The Way We Access Research Isn’t Working for Development. We Need to Fix It. Tom Drake et al; https://www.cgdev.org/blog/way-we-access-research-isnt-working-development- we-need-fix-it

“The current research publishing system—dominated by a number of large for-profit publishers—is expensive and ineffective at its main goal: disseminating the findings of research to all who need them…. In this blog we outline why affordable, open access to research is a critical issue for global development and call for development funders and researchers to: Support Plan S—an open access publishing initiative supported by a coalition of research agencies and funders—and ensure the perspectives of stakeholders in LMICs are heard in plans for reform; Choose to publish on progressive open access platforms; Seek opportunities to support access to evidence (and to publish) for researchers and research users in LMICs.”

• Link: Environmental Politics - Urgencies and imperatives for revolutionary (environmental) transitions: from degrowth and postdevelopment towards the pluriverse?

• And tweet Seye Abimbola: ““Decolonize Global Health!” inevitably leads to “Abolish Global Health!”

IMF/WB Spring meetings – Final analyses

Bretton Woods Project - Spring Meetings 2021 wrap up: Socialism for those who can afford it, neoliberalism for the rest https://www.brettonwoodsproject.org/2021/04/spring-meetings-2021-wrap-up-socialism-for-those- who-can-afford-it-neoliberalism-for-the-rest/

Neat (and recommended) analysis.

“Uneven pace of pandemic recovery and climate change key topics of discussions at 2021 Spring Meetings; Extension of DSSI to December 2021 does little to address looming debt crisis; Movement on SDR allocation and advanced IDA20 replenishment insufficient to address financing needs; Fund and Bank refuse to support essential Covid-19 vaccine intellectual property waiver.”

Link: Bretton Woods Project - G20 communiqué analysis – Spring Meetings 2021

Eurodad – Spring Meetings 2021: Yet another insufficient response to the Covid- 19 crisis https://www.eurodad.org/spring_meetings_2021?utm_campaign=imf_wb_spring_meetings&utm_ medium=email&utm_source=eurodad

“Eurodad's policy experts reflect on the 2021 IMF and WBG spring meetings, raising concerns of an insufficient response and the inability of the Bretton Woods Institutions to put global social equity at the heart of long-term plans to rebuild fairer post-pandemic.”

Additional link: Eurodad - The 3 trillion dollar question: What difference will the IMF’s new SDRs allocation make to the world’s poorest?

“The US$650 billion allocation of SDRs proposed by the IMF will not support the post-Covid economic recovery of the poorest countries. In the following article, we set out the argument for a much larger allocation, one worth US$3 trillion.”

Devex Pro Live: Spring Meetings 2021 recap https://www.devex.com/news/devex-pro-live-spring-meetings-2021-recap-99629

(gated) “This year's World Bank and International Monetary Fund Spring Meetings focused on three topics: COVID-19, debt, and climate.”

IMF, World Bank urged to ensure timely delivery of safe & effective Covid vaccines across countries

https://timesofindia.indiatimes.com/world/us/imf-world-bank-urged-to-ensure-timely-delivery- of-safe-effective-covid-vaccines-across-nations/articleshow/82004517.cms

See what the Joint Ministerial (Development) Committee of IMF/WB said at the IMF/WB Spring meetings. Cfr a joint communiqué after the Spring Meetings.

Obviously didn’t include a TRIPS waiver…

Financing for Development Forum (12-15 April)

UN News - Guterres calls for ‘paradigm shift’ to recover from COVID setbacks https://news.un.org/en/story/2021/04/1089542

“A “paradigm shift” aligning the private sector with the global goals is needed to address the challenges of the future, including those triggered by COVID-19, the UN chief said on Monday, addressing the Financing for Development (FfD) Forum. “

“To set the course for a sustainable and resilient COVID response and recovery, the UN chief called for urgent action in six areas, beginning with closing the funding gap of the UN-backed vaccine initiative, COVAX. … The debt crisis needed to be properly addressed, he said, including “debt suspension, relief, and liquidity”. “But we need to go beyond debt relief”, he continued, urging a strengthened “international debt architecture to end the deadly cycles of debt waves, global debt crises and lost decades”. … Investing in a new social contract, based on solidarity in education, green jobs, social protection, and health systems was the UN chief’s fifth priority action, which he maintained was “the foundation for sustainable and inclusive development”. …”

Apt tweet Ben Phillips: “The Secretary-General of the UN calls it. We either accept catastrophe, or we: share the vaccine; ramp up development assistance; tax the rich; drop the debt; invest in schools, health & jobs; protect the planet.”

Reuters - U.N. chief pushes tax on rich who profited during pandemic https://www.reuters.com/article/us-health-coronavirus-un/u-n-chief-pushes-tax-on-rich-who- profited-during-pandemic-idUSKBN2BZ281

Guterres goes Piketty. “United Nations Secretary-General Antonio Guterres urged governments on Monday to consider imposing a “solidarity or wealth tax” on the rich - who made money during the coronavirus pandemic - in a bid to cut extreme inequality. “We must make sure funds go where they are needed most. Latest reports indicate that there has been a $5 trillion surge in the wealth of the world’s richest in the past year,” Guterres told a U.N. meeting on financing for development. “I urge governments to consider a solidarity or wealth tax on those who have profited during the pandemic, to reduce extreme inequalities,” he said….”

PS: now that we’re at it, for another great proposal, do check out also this new paper by Emmanuel Saez and Gabriel Zucman - A Wealth Tax on Giant Corporations

“ A new research report proposes the institution of a new tax on the shares of all publicly listed companies headquartered in G20 countries. The study by Emmanuel Saez and Gabriel Zucman (University of California, Berkeley) suggests that every year, each company would have to pay 0.2% of the value of its stock in taxes. As the G20 stock market capitalisation is around $90 trillion, the tax would raise approximately $180 billion each year….”

Devex - What to make of the 2020 DAC stats https://www.devex.com/news/what-to-make-of-the-2020-dac-stats-99641

“The generosity of OECD Development Assistance Committee members is at its highest in almost 30 years as the impact of COVID-19 saw total official development assistance grow almost $10 billion between 2019 and 2020, reaching $161.2 billion after three years of declining contributions. The preliminary ODA figures for 2020 released by the Organisation for Economic Co-operation and Development on April 13 show that generosity — determined by ODA as a share of gross national income — increased from an average of 0.29% in 2019 to 0.35% in 2020….”

Check out some of the main findings, donor generosity, …

Quote: “Following the declaration of a global pandemic a year ago, DAC members issued a statement identifying the importance of ODA in helping governments globally respond to COVID- 19. ODA as “an important means of supporting national responses to the COVID-19 crisis,” and that they would “strive to protect ODA budgets.” Donors including the U.S., U.K., and Australia announced pivots in their aid programs to support this need. But despite this, the preliminary ODA data for 2020 does not show a clear picture of how this is happening….”.

See also OECD - COVID-19 spending helped to lift foreign aid to an all-time high in 2020 but more effort needed

“ Within total Official Development Assistance (ODA) provided by members of the OECD’s Development Assistance Committee in 2020, initial estimates indicate that DAC countries spent USD 12 billion on COVID-19 related activities….” “…Bilateral ODA to Africa and least-developed countries rose by 4.1% and 1.8% respectively….”

And Eurodad - Just 1% of rich countries’ spending on Covid went to overseas aid

“ New preliminary figures on overseas development assistance (ODA) show that while spending went up to US$ 161.2 billion in 2020, it constituted just 1% of the amount countries have mobilised in economic stimulus measures in response to the Covid crisis….”

Some other news of the week

Stat - Google is exploring a health record tool for patients https://www.statnews.com/2021/04/09/google-health-records-app-care-studio/

“After 13 years, Google is coming back for patient health records. The tech giant has launched an early user feedback program aimed at exploring how patients might want to see, organize, and share their own medical record data….”

Devex - Global health leaders plead for renewed investment in polio eradication https://www.devex.com/news/sponsored/global-health-leaders-plead-for-renewed-investment-in- polio-eradication-99437

“As countries around the world make plans to roll out vaccination campaigns for COVID-19, other immunization efforts have taken a hit due to pandemic-related restrictions, putting a serious dent in global health efforts. That’s the case for the campaign to eradicate polio — a global coordinated effort initiated in 1985 by the global service organization Rotary International — which was temporarily scaled down in 2020 as social distancing measures were put in place, and resources diverted to fighting the COVID-19 pandemic.

“According to the World Health Organization, failure to eradicate wild polio could lead to the disease coming back in full force, and result in as many as 200,000 new cases every year worldwide. Further divestment from polio eradication campaigns will have severe consequences on at-risk populations, several experts told Devex….”

Papers & reports of the week

BMJ GH (Commentary) –Neglected tropical diseases as a barometer for progress in health systems in times of COVID-19 N Ehrenberg, D de Savigny et al ; https://gh.bmj.com/content/6/4/e004709

“…This paper argues that NTDs offer valuable insights for building back better health systems for pandemic preparedness, while also providing an important barometer for progress in health and social protection….”

You might also want to read (in the Guardian) - Neglected tropical diseases are the landmines of global health Apt metaphor. “ They are 20 disparate diseases that, like mines, unduly affect the world’s poorest people. Now there’s a plan to eradicate them by 2030.”

BMJ GH - Stop ‘controlling’ for sex and gender in global health research J R Shapiro et al ; https://gh.bmj.com/content/6/4/e005714

“Sex and gender are often ‘controlled’ for in global health research, which forces the relationship between the predictor and outcome of interest to be the same across sex (ie, males, females and intersex) or gender (ie, men, women and gender minorities). There are many examples where controlling for sex, gender or both led to incorrect findings that were detrimental to equitably improving global health. Instead of controlling for sex or gender, we urge researchers to consider sex and gender as variables of importance that can explain, rather than confound, their research.”

The Conversation -Foreign aid can help stem the decline of democracy, if used in the right way R M Gisselquist et al ; https://theconversation.com/foreign-aid-can-help-stem-the-decline-of- democracy-if-used-in-the-right-way- 157794?utm_source=twitter&utm_medium=bylinetwitterbutton

Linked to a new study.

“…Our new study built on existing evidence to create a new analysis of the impact of democracy aid in 148 countries between 1995–2018. Our approach married quantitative analysis to the large amount of research on democratisation to present a framework that addresses how aid should, in theory, support democracy. We had three main findings: first, aid specifically aimed at improving democratic infrastructure and institutions has a modest but positive impact overall. This impact is clearer than for the impact of development aid generally, but there is no evidence that either has a negative impact on democracy on average. Second, aid aimed at supporting civil society, media freedom, and human rights seems to be the most effective in terms of its impact on democracy. Third, democracy aid is more effective at supporting ongoing democratisation than at halting democratic backsliding. In short, democracy aid works, but it’s not magic….”

Critical Public Health - The impact of vertical public health initiatives on gendered familial care work: public health and ethical issues Z Meghani ; https://www.tandfonline.com/doi/full/10.1080/09581596.2021.1908960?scroll=top&needAccess=tr ue

“Rigorous evaluations of the effects of vertical public health enterprises on the health systems of low- income countries usefully identify the public health and ethical costs of those initiatives. …. …This paper argues that the scope of assessments of vertical public health ventures should be broadened to include gender as an additional axis of analysis. When members of socio-economically marginalized populations are sick with conditions that are not covered by fragmented and inadequate public health programs or disease-specific vertical public health schemes, their untreated illnesses add to the gendered familial caregiving responsibilities of the female members of their households. Those women and girls have to perform their ‘normal’ familial care work, work outside the home for pay, and take care of the unwell family members for whom the household cannot afford treatment. Given that women and girls from low-income households already shoulder a disproportionate amount of care work for their families, their health and life prospects are further affected by the amplification of their caregiving responsibilities. This paper argues that analyses of the impact of vertical public health initiatives should also track this gendered consequence of those enterprises because it is a crucial public health and ethical matter.”

Lancet Digital Health (Viewpoint) - Health data poverty: an assailable barrier to equitable digital health care H Ibrahim et al ; https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30317- 4/fulltext#.YHXZ0nJ_Hu8.twitter

“Data-driven digital health technologies have the power to transform health care. If these tools could be sustainably delivered at scale, they might have the potential to provide everyone, everywhere, with equitable access to expert-level care, narrowing the global health and wellbeing gap. Conversely, it is highly possible that these transformative technologies could exacerbate existing health-care inequalities instead. In this Viewpoint, we describe the problem of health data poverty: the inability for individuals, groups, or populations to benefit from a discovery or innovation due to a scarcity of data that are adequately representative. We assert that health data poverty is a threat to global health that could prevent the benefits of data-driven digital health technologies from being more widely realised and might even lead to them causing harm. We argue that the time to act is now to avoid creating a digital health divide that exacerbates existing health-care inequalities and to ensure that no one is left behind in the digital era.”

Lancet Global Health (Comment) - Challenges of adopting new trial designs in LMICs https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00168-6/fulltext

“The Series of four papers on Clinical Trials in Global Health presents a useful understanding of adaptive and other innovative trial designs, as well as their efficiency in terms of resources and timeliness of results compared with conventional fixed randomised controlled trials….”

Some blogs of the week

Partners for Impact - International development partnerships – Why countries are still being left behind K Bertram; https://pfipartners.org/2021/04/13/international-development-partnerships-why- countries-are-still-being-left-behind/

“In this blog, we look at policy and funding cycles in international development. Across the entire cycle, partner countries are still being left behind – at the cost of impact and sustainability.”

The blog lists 5 key reforms.

Some tweets of the week

Caroline Soyars “Begging my Twitter friends to take 30 sec to write to your reps to urge their endorsement of a letter asking @POTUS to include $2B for a Fund for Global Health Security and Pandemic Preparedness in his FY22 budget requests. NOW is the time to stop the cycle of pandemics. “

Jeremy Farrar “We have to find a different way of global manufacturing of essential crisis public health goods. An idea. A globally mandated, globally funded network of 8-10 “small population countries” who could in a crisis meet domestic demand quickly & meet global access & supply.” “ If all manufacturing remains in large population countries tension of domestic supply & global access will always happen in global crisis. Imagine distributed network across all regions/continents that could meet both domestic need & global access under a globally agreed mandate.”

Matthew Kavanagh “The AU seems nearly the only real example of multilateral flourishing amidst this pandemic.”

Anthony Costello “More than 90 percent of vaccine development is funded from taxes or charity. 130 countries have no vaccines. The market has failed. It’s time for nation states to take back control. We’re all in this together.”

Nick Dearden “Here we go: #Pfizer hikes cost of future orders of vaccines to the EU by over 60%. AstraZeneca investors urge to follow suit. The pandemic is over for Big Pharma. The profiteering starts in earnest. #PeoplesVaccine.”

Global health events

Coming up: Global Health Summit (21 May) https://global-health-summit.europa.eu/index_en

“On 21 May 2021 in Rome, the European Commission and Italy, as chair of the G20, will co-host the Global Health Summit. The Summit is an opportunity for G20 and invited leaders, heads of international and regional organisations, and representatives of global health bodies, to share lessons learned from the COVID-19 pandemic, and develop and endorse a ‘Rome Declaration’ of principles. … The Summit will build on: the Coronavirus Global Response, a pledging marathon that last year raised close to €16 billion from donors worldwide for universal access to coronavirus treatments, tests and vaccines; the existing work of multilateral institutions and frameworks, notably

the World Health Organization and the International Health Regulations; other health initiatives and processes, including those taking place in the G7 and G20.”

In essence shaping up as a funding meeting for ACT-A.

20 April - AfroPHC - “Build the African PHC team” https://afrophc.org/

Join AfroPHC and Launch 20th April 2021.

Global governance of health

Devex - The battle for the future of OCHA, explained https://www.devex.com/news/the-battle-for-the-future-of-ocha-explained-99620

“The clock is ticking for Secretary-General António Guterres to appoint the next United Nations relief chief — or, more formally, the undersecretary-general for humanitarian affairs and emergency relief coordinator. A number of people have been discussed as potential leaders of the Office for the Coordination of Humanitarian Affairs, with two Britons — Nick Dyer and Harriet Matthews — among the top contenders. Other confirmed nominations are Olof Skoog and Koen Davidse, while Joanne Liu and William Chemaly are potential candidates. Devex has learned that Francesco Rocca, Denise Brown, and Martin Griffiths are possible candidates as well. OCHA has been led by U.K. nationals since 2007. But demands for a “transparent” and “merit-based selection process” are growing louder….”

Science News - Biden wants $6.5 billion for new health agency to speed treatments https://www.sciencemag.org/news/2021/04/biden-wants-65-billion-new-health-agency-speed- treatments

“The Biden administration today began to flesh out a proposal for a new agency—modeled on the military’s Defense Advanced Research Projects Agency (DARPA)—that would seek to speed the development of medical treatments by funding risky, innovative projects. The agency, dubbed ARPA-Health (ARPA-H), would be housed at the National Institutes of Health and have a 2022 budget of $6.5 billion, according to a White House spending request released today. Few other details about ARPA-H have been released, except that it would initially focus on cancer and diseases “such as diabetes and Alzheimer’s.”..”

See also Stat - Inside the White House’s push for a new, $6.5 billion agency aimed at curing cancer

“The Biden administration on Friday proposed the creation of a $6.5 billion medical research agency with an audacious goal: quickly developing cures for diseases including cancer, Alzheimer’s, and diabetes. Could mark a fundamental shift in how the US government funds

research …. Steering the emphasis from basic science to higher-risk projects more directly aimed at major medical breakthroughs. …”

Planetary health

Journal of Political Ecology - Could "degrowth" have the same fate as "sustainable development"? A discussion on passive revolution in the Anthropocene age N Trantas; https://journals.librarypublishing.arizona.edu/jpe/article/id/2362/

“The sustainable development discourse, including the modern green growth version, may have aspects that contribute to environmental and social welfare but it is a top down reform project, that aims at correcting the environmental and social externalities resulting from economic growth. It is directed by governments that abide by the logic of capital. Although in principle there is civic engagement, public participation is limited and without challenging the dominant economic paradigm. Following Gramsci's terminology, sustainable development can be interpreted as a passive revolution, in the sense that change is managed through compromises with different social and political actors but within limits which neutralize any potential threat to economic and political power. On the contrary, the emerging (yet still marginal) alternative, multi-disciplinary, degrowth academic paradigm, has evolved from an activist movement since the first decade of this century, and retains close contacts and open communication with social movements that support a degrowth transition in economy and society. This transition directly challenges the established orthodox growth narrative and the mechanisms of capital accumulation. Thus, in contrast to the sustainable development discourse, it is difficult for the "power bloc" to accommodate degrowth. But in times of crisis and change, the dominant powers can certainly use some aspects of the degrowth discourse, assimilating and transforming them into elements that fit their new accumulation strategies, hegemonic visions and state projects. For this not to happen, degrowthers should focus their research and theory more on the workings of capitalist political economy, and their political practice on trying to form alliances with social actors, such as working-class movements,that are crucial for the achievement of hegemony.”

Lancet - The climate change–homelessness nexus Sean A Kidd et al ( on behalf of the Climate-Homelessness Working Group); https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00834-5/fulltext

“…. Although the mechanisms through which climate impacts human health are becoming better understood, substantial knowledge gaps remain. One such gap is the role of shelter. Housing and shelter are pivotal in considering the physical and mental health impacts of climate change for individuals without shelter or who live in temporary and unfit housing….”

World Politics Review - The ‘30x30’ Campaign to Save the Biosphere P Stewart; https://www.worldpoliticsreview.com/articles/29565/the-30x30-campaign-to-save-the- planet-from-biodiversity-threats

“Over the past two years, an extraordinary global campaign has emerged to protect 30 percent of Earth’s total surface from human exploitation by 2030. The members of this so-called 30x30 coalition, which now includes scores of governments, understand that climate change is only one half of the planet’s environmental crisis. The Paris Agreement, while imperative to curb greenhouse gas emissions, will do little by itself to save the planet’s collapsing biodiversity or preserve the massive ecosystems upon which humanity depends—and which we are fast degrading. … In April 2019, a group of 19 prominent scientists ignited international interest in the 30x30 proposal when they made it the centerpiece of a proposed “Global Deal for Nature.”

Guardian - Just 3% of world’s ecosystems remain intact, study suggests https://www.theguardian.com/environment/2021/apr/15/just-3-of-worlds-ecosystems-remain- intact-study-suggests

“Just 3% of the world’s land remains ecologically intact with healthy populations of all its original animals and undisturbed habitat, a study suggests. These fragments of wilderness undamaged by human activities are mainly in parts of the Amazon and Congo tropical forests, east Siberian and northern Canadian forests and tundra, and the Sahara….”

“… The researchers suggest reintroducing a small number of important species to some damaged areas, such as elephants or wolves – a move that could restore up to 20% of the world’s land to ecological intactness….”

IJERPH - Health Synergies across International Sustainability and Development Agendas: Pathways to Strengthen National Action

K Bowen et al; https://www.mdpi.com/1660-4601/18/4/1664

“Since 2015 there has been a surge of international agendas to address a range of global challenges: climate change (Paris Agreement), sustainable development (Agenda 2030), disaster risk reduction (Sendai Framework) and sustainable urban transformation (New Urban Agenda). Health is relevant to all of these agendas. Policymakers must now translate these global agendas into national level policies to implement the agreed goals in a coherent manner. However, approaches to synergise health activities within and across these agendas are needed, in order to achieve better coherence and maximise national level implementation. This research evaluated the framing of human health within these agendas. A content analysis of the agendas was conducted. Findings indicate (i) the importance of increased awareness of health systems strengthening as a helpful framework to guide the integration of health issues across the agendas, (ii) only two health themes had synergies across the agendas, (iii) the lack of a governance mechanism to support the integration of these four agendas to enable national (and sub-national) governments to more feasibly implement their ambitions, and (iv) the vital component of health leadership. Finally, planetary health is a relevant and timely concept that can support the urgent shift to a healthy planet and people.”

Link:

Global Health Action - Climate change and health in urban informal settlements in low- and middle- income countries – a scoping review of health impacts and adaptation strategies

Science – Biden proposes a funding surge—and new agencies to manage it

“ Biden also wants to create an Advanced Research Projects Agency-Climate to take more aggressive steps against global warming, although he didn't say where it would be housed. …”

Sounds a lot like ‘geo-engineering’, if you ask me.

Infectious diseases & NTDs

Telegraph - Killer viruses given a ‘credit rating’ as new app aims to halt future pandemics

Telegraph;