IHP news 622 : Crunch time ?

( 21 May 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,

As an evidence-based believer in synchronicity, I doubt it was just a coincidence that I got my (first) jab on World Hypertension Day . I didn’t have a bittersweet feeling, like dr. Tedros last week when he got his, I just hope all 7 billion people (or at least the adults among them) get this jab (x2) sooner rather than later.

From that angle, it’s good to see that the pressure on G7 countries to share excess doses is at last steadily increasing, both from UNICEF & WHO this week. Sharing doses is long overdue and nowhere near enough, though. Tedros said the world has now effectively reached a stage of ‘vaccine apartheid’, while calling on vaccine makers to make up the (Covax) gap. Not for the first time, he didn’t mince words: “trickle down vaccination is not an effective strategy for fighting a deadly respiratory virus". Neither is the trickle down “global solidarity” we’ve mostly seen so far. Worse, our wonderful “winner takes all” global economic system has sparked a bunch of new vaccine billionaires, as the People’s Vaccine Coalition flagged, ahead of the G20 Global Health Summit in Rome: “Pharma monopoly logic: can create billionaires, can't vaccinate billions of people.”

Today’s Global Health summit should at least bring some progress (although our hopes shouldn’t be too high, it appears), while a full-blown multilateral effort led by the Biden administration can probably be expected in the coming weeks, by the G7 summit in the UK in June. (let’s hope it won’t be ‘for “democracies” only’). At least on the need for (boosting) manufacturing (capacity) in all regions, everybody increasingly agrees - if not for this pandemic, then for the next.

On Tuesday, Emmanuel Macron chaired a summit on post-pandemic recovery in sub-Saharan Africa, launching a multibillion-dollar “New Deal” for the continent. You don’t have to teach Jupiter how to communicate. Accelerating vaccination on the continent was also high on the agenda, as you can imagine.

On the conceptual & paradigmatic front, we’d like to flag the concept Health Systems for Health Security, increasingly in vogue. A WHO/University of Leeds workshop was dedicated to it on Thursday. A number of possible paradigm shifts could also be looming on the horizon in the slipstream of the Covid pandemic, at least if we dare to hope.

For the first one, see Gregg Gonsalves’ tweets of last weekend, commenting on increasingly critical coverage on Bill Gates in a number of areas (among others, re IP/global vaccine equity & Bill’s oversized role in global health governance) : “So many people, institutions in global health are in hock to industry or Gates or both. They have constrained the possibilities in global health along the contours of the market, so that private gain takes precedence over public good. May #COVID19 crack open a new world of hope.” “….The philanthropy-capitalist model of public health/global health hems in policies and programs along the contours of the market, puts private gain over public good. Always. It's time for a change. ” Agree .

A FT op-ed, by Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, pointed to another paradigm shift - Pandemic gives Africa a chance to free itself from aid dependency. Hope so too .

Finally, in an “Inside Geneva” podcast, looking ahead to the 74th World Health Assembly, Suerie Moon (Graduate Institute) indicated that IP waivers could, and probably should, be the foundation for a new “social contract” during global health crises, especially when, as with Covid- 19, governments ( and thus taxpayers) have shouldered the financial risk of developing the vaccines. She considered the changed US position as a signal of a shifting social contract in this respect, that needs to be renegotiated. Do inform Ursula, Charles, Boris & Angela, Suerie!

More in general, top of the agenda at the WHA will be learning lessons from the pandemic (if not now, then when ?) or as Suerie put it: “What do we need to do to fix a broken system? That Covid has shown over and over again is not functioning?”. She called the Covid pandemic ‘a reckoning’ at both national and global levels. Among others, the ‘pandemic treaty’ discussions might get a fair amount of attention. As well as a zillion other issues.

PS: as for Saturday evening’s Eurovision 2021 ’s “reckoning”, let’s wait & see. I’ll make sure I have some crunch food .

Enjoy your reading.

Kristof Decoster

Featured Article

Failing humanity: looking back on the week, remembering the past

Werner Soors (former ITM staff member)

What a week this was. In case I wouldn’t have noticed, on Friday 14th the mayor of the privileged town I live in (Antwerp) warned against “the identification of young Muslims, 14-15-16 years old, with a certain frustration - youngsters who now receive those images, unfiltered through social media and with one-sided interpretation”. I didn’t feel addressed. After all, I’m 65. He was referring of course to what was happening in the Gaza strip, and the possibility that the conflict would be exported to the banks of the river Scheldt. Saturday 15th. No need to be a Muslim to have a good morning coffee at Lari Chikh in my Antwerp- North neighbourhood. No usual Berber jokes about King Mohammed VI today. This is Nakba day, day of Palestinian mourning since 1948. We’re all watching the Israeli bombing of the Gaza strip on TV, mouth open, in painful silence. Sunday 16th. My favourite procrastination day. After contemplating missed deadlines, I dwell through the weekend edition of this country’s self-declared quality newspaper. On the last page, a reflection on the Palestine-Israel crisis under the heading ‘The echo of Hannah Arendt’. Poor Hannah. She once really believed in utopian Zionism, then became overtly critical, and has since been vilified by her kindred (with the exception of Albert Einstein, of course, who also wisely enough refused to become president of Israel). Monday 17th. In the Netherlands, Queen Máxima turns 50 and there is no way to escape that in the Low Countries. These days, anything goes to distract from the real news, even the daughter of a man actively involved in the ‘dirty war’ of the Argentinean military junta. And oh yes, Máxima gave a reading of a poem by Pablo Neruda. Aw. Tuesday 18th. Kristof asks me if my editorial will be ready by tomorrow. I say yes (another deadline). Good Latin American friends write me not to forget that Tupac Amaru and Micaela Bastidas were gruesomely executed by the Spanish occupants of their homeland, 240 years ago. Long dead, they have inspired indigenous resistance and anti-colonial movements ever since. Maybe I could write something about colonialism? Wednesday 19th. Quote from an opinion piece in ‘De Standaard’ by 100 Belgian doctors (I co-signed, no cause for congratulation): “a conflict in which the vast majority of victims fall on one side is not an operation of war. It is slaughter”. The killing in Gaza goes on. The European Union, minus Hungary, calls in vain for a ceasefire. I am on Facebook, reading a post from Gaza-born friend and colleague Majdi Ashour: “This time, from now on, our voices must rise above the voice of battle (…) Salute to the voices that rise above the sound of the battle, and to end this battle that targets the bodies, the right to self-determination and the resistance of our people”. Majdi worked many years for the United Nations Relief and Work Agency (UNRWA) in Gaza City. Is he safe? I haven’t seen him for a long time, so I call him. He’s in the UK, as a political refugee, yearning to be home. His voice is soft and gentle as he explains to me that even ‘battle’ is not the correct term for what is going on: “it’s a battering, with the intent to exterminate”. I’m afraid he’s right. In 1944, Hannah Arendt concluded her essay ‘A hidden tradition’ with this sentence: “only when a people lives and functions in consort with other peoples can it contribute to the establishment upon earth of a commonly conditioned and commonly controlled humanity”. What we witness now – something that comes dangerously close to ethnic cleansing - is failing humanity, and we all have blood on our hands. We should raise our voice too.

Highlights of the week

World Hypertension Day (17 May)

Via the Respond newsletter :

“This day has been initiated by The World Hypertension League (WHL), a non-profit, non- governmental organisation with 80 national hypertension societies as members, to increase the awareness of hypertension and non-communicable diseases (NCDs). This year’s theme is "Measure Your Blood Pressure Accurately, Control It, Live Longer", with a particular focus on increasing awareness of hypertension, especially in low- and middle-income countries. This date coincides with May Measurement Month (MMM) another initiative led by the International Society of Hypertension (ISH) and endorsed by the World Hypertension League (WHL), which consists of the global blood pressure (BP) screening campaign, which in 2019 saw 1.5m people participating….”

G20 Global Health Summit (Rome, 21 May)

Today’s summit [will] include G-20 members along with Spain, Singapore and the Netherlands as guests; leaders of WHO and other related UN agencies, as well as global health actors such as Gavi, The Vaccine Alliance, the Global Fund and CEPI, which has been investing in key aspects of COVID vaccine R&D.

Expectations aren’t too high (see the analyses ahead of the meeting, below), given that they aim for a “Rome Declaration of Principles”. Also some advocacy below.

HPW - Draft ‘Rome Declaration’ by G-20 Global Health Summit – Sidesteps Hard Commitments to New Finance and Vaccine Donations https://healthpolicy-watch.news/draft-g-20-health-summit-declaration-sidesteps-hard- commitments-to-new-finance-and-vaccine-donations/

Analysis ahead of the Global Health summit from late last week didn’t sound too promising...

“A draft “Rome Declaration” to be issued at next Friday’s G-20’s Global Health Summit, co-hosted by Italy and the European Commission (21 May), makes a series of 10 sweeping commitments to ensure equitable access to vaccines; expand medicines manufacturing capacity; assure WHO access to sites posing an outbreak risk; and invest in global health systems. But the draft manifesto seen by Health Policy Watch, framed as a “statement of principles,” also lacks any concrete targets for COVID vaccine dose-sharing, or medicines and vaccines finance. “

“… WHO and other global health officials have repeatedly said that COVAX and the other ACT- Accelerator initiatives urgently need some US$18.5 billion from the world’s most industrialised nations to fund purchases of medicines and tests, as well as vaccines. WHO and other global health officials have also begged for more vaccine donations. That means that if any such concrete commitments are to be made, they will have to be negotiated up until, and on, the day of the meeting of G-20 leaders. …”

… The draft declaration so far also sidesteps mention of another thorny issue – the proposed World Trade Organization (WTO) waiver on intellectual property rights for COVID products, that the United States recently said it would support, in the case of vaccine IP. A placeholder text, however, leaves open “{…possible references to ACT-A, WTO activity, WHO, the MPP, C-TAP, and through bilateral arrangements}.” The draft also stops short… of calling for a new Pandemic Treaty. “Finally, the draft Rome declaration also calls for a stronger global health architecture with a “fully funded, independent and effective WHO at its centre”. … … The Rome Declaration is being pitched primarily as a general statement of principles, according to the summit’s advance statement…”

See also Reuters – G20 snubs COVID patent waiver, waters down pledge on WHO’s funding

“Leaders of the world’s largest economies back “voluntary licensing” of COVID-19 vaccine patents, the draft conclusions of a summit show, watering down a U.S. push for waivers and earlier commitments to supply more funds to the World Health Organization….”

“The health summit's draft conclusions reflect these differing views and make no mention of patent waivers. G20 leaders are to commit instead to "patent-pooling" which is a less radical measure to encourage the sharing of patents. It is still an "unfriendly" move for pharmaceutical companies, an industry expert said, but far less extreme than a patent waiver.”

“… The conclusions may also deal a blow to the WHO and its scheme to accelerate the distribution of COVID-19 vaccines, drugs and tests across the world. Global leaders reaffirm their support for the scheme, known as ACT Accelerator, but refrain from clearly committing to fully funding it. They "underline the necessity to close its funding gap with fair burden sharing", the draft document reads, and they call for the scheme's "strategic review". This represents a major watering down of the initial draft in which leaders explicitly committed for the first time to "fair and full financing" of the scheme. The original draft, also seen by Reuters, was more influenced by the European Commission which is one of the hosts of the summit, together with the Italian government which holds the G20 presidency this year…”

FT - EU to back expansion of vaccine production capacity in Africa https://www.ft.com/content/d2a47c7e-0b00-4e31-92ab-cd3ff0b9070b

From Monday. “The EU plans to throw its weight behind a push to expand vaccine manufacturing in Africa after the coronavirus pandemic has underscored a need to broaden the production of life saving jabs. Ursula von der Leyen, European Commission president, is expected to back proposals to establish strategic manufacturing hubs in African countries at a global health summit in Rome on Friday, officials said. … … The bloc is also keen to promote initiatives to increase international vaccine production, which it argues is a better way to improve poor nations’ access to Covid-19 vaccines than the patent waivers proposed by the US this month. The EU’s contribution could include both direct EU aid and funding from national development agencies and the European Investment Bank, European officials said. Alongside the funding, which could extend into the hundreds of millions of euros, Brussels wants to help build up regulatory capacity, including the establishment of the African Medicines Agency — a continent wide drug regulator that was conceived in 2014 but has yet to get off the ground….”

“The European efforts are designed to mesh with an African Union goal set in April for up to 60 per cent of Africa’s routine vaccine needs to be supplied from within the continent by 2040, up from just 1 per cent now. Given the long timeframes involved in creating manufacturing capacity, the changes would be aimed at dealing with possible future pandemics and perennial threats such as yellow fever. …” The People’s Vaccine - COVID vaccines create 9 new billionaires with combined wealth greater than cost of vaccinating world’s poorest countries https://app.box.com/s/c487wmiyquh9q1glpbatzf5sukls7ph2

“At least nine people have become new billionaires since the beginning of the COVID pandemic, thanks to the excessive profits pharmaceutical corporations with monopolies on COVID vaccines are making, The People’s Vaccine Alliance revealed today ahead of a G20 leaders Global Health Summit. …. Between them, the nine new billionaires have a combined net wealth of $19.3 billion, enough to fully vaccinate all people in low-income countries 1.3 times. … … In addition, eight existing billionaires–who have extensive portfolios in the COVID-19 vaccine pharma corporations - have seen their combined wealth increase by $32.2 billion, enough to fully vaccinate everyone in India….

Reuters – Invest in health or face credit ratings 'stick' -WHO's expert panel Reuters;

“States that invest too little in public health could have their credit ratings cut, according to the chair of a World Health Organization panel that wants a new global body set up to spell out the risks to financial stability from healthcare failures. The comments by Mario Monti come before a global health summit on Friday in Rome at which leaders of the Group of 20 richest economies will discuss the coronavirus emergency and how to prevent major health crises in future. "A pandemic like this one poses huge threats not just to financial stability but to the whole economic and financial system," Monti told Reuters. … The former Italian prime minister chairs the WHO's Pan-European Commission on Health and Sustainable Development, set up last September by the world health body's chief for Europe, Hans Kluge. It has recommended the G20 establish a Global Health Board which would work to prevent future pandemics by identifying risks, setting global benchmarks for preparedness and promoting investment in health infrastructure….”

And via Politico: “…the European Union might announce vaccine donations. The European Commission asked EU members to donate 100 million doses, but countries are reluctant to commit to a number just yet…”

74th World Health Assembly coming up (24 May – 1 June) https://www.who.int/about/governance/world-health-assembly/seventy-fourth-world-health- assembly

With preliminary docs & agenda.

Some reads & analyses ahead of the WHA, related to some key issues on the agenda.

As Suerie Moon put it at the Graduate Institute introduction for new delegates (on Thursday), “for Covid to become a game changer, we need at all levels: political leadership, political courage, political wisdom, and political mobilization. “ HPW - Pandemic Treaty & Other New COVID Initiatives Grab Center Stage At World Health Assembly https://healthpolicy-watch.news/pandemic-covid-world-health-assembly/

Must-read analysis ahead of the WHA. “Conquering the COVID-19 pandemic will inevitably be the main topic for discussion at the impending 74th session of the World Health Assembly, which begins Monday, 24 May. Global health experts weighed in this week at a series of briefings on what to expect from at the upcoming event. …”

“The annual World Health Assembly will open online on Monday, with ministers of health from the World Health Organization’s 194 member states tasked with wading through a heavy agenda dominated by how to fix the COVID-ridden global health system and step up global response to future crises. …”

Among others, focal points at the WHA will be: Pushing for Legally Binding Instruments to Fight Pandemics; Cementing the Power of the WHO to Fight Off Future Health Crises and Eradicate the Current Pandemic; WHO’s political independence; governance and funding without strings attached; the question of vaccine equity.”

And this quote: “In the absence of strong action by wealthy donor countries at the G-20 and the WHA, the trajectory of COVID risks the disease becoming a “pandemic of the poor”, Joanne Liu warns. For Liu, if the opportunity is not seized at this year’s WHA to adequately address the WHA, by taking bold decisions and committing to actions then she believes COVID will become an endemic disease, mostly but will be limited to low and middle income countries, whilst high income countries leave the rest of the world behind.

Geneva Observer – What does the WHO need? Public health experts are unanimous: More power, more independence, and more transparency. https://www.thegenevaobserver.com/

Some more pre-analysis by Jamil Chade. Based on the three reports presented and debated during the WHA.

Plus: “…Debating and accepting the reports’ conclusions might be the easy part. Agreeing to transfer power to the organization and fund it adequately might prove to be more difficult and require some serious diplomatic jostling. It is expected that a resolution calling for the strengthening of the organization will be approved by consensus—the draft is circulating—but after that things will proceed incrementally once the low-hanging fruits are dealt with….” The draft has been watered down substantially already….

HPW – Far-reaching Proposals For Reform On Table at World Health Assembly – But Will Member States Heed The Call? https://healthpolicy-watch.news/far-reaching-proposals-for-reform-on-table-at-world-health- assembly-but-will-member-states-heed-the-call/ Coverage of the “Introduction to WHA 74 session,” by the Global Health Centre of the Geneva Graduate Institute.

“…some far-reaching recommendations for reform that will be on the table this year could make a big difference, said a group of high-level global health voices … They referred to proposals by The Independent Panel for a Pandemic Treaty; limiting the Director General’s term to one five-seven year stint to remove the position from political influences; and the granting of stronger investigative powers to visit countries and publish data on outbreak threats, said Julio Frenk, former minister of health for Mexico and president of the University of Miami, speaking at the event. …”

“However, in the realpolitik of WHA negotiations, passage of most of these key reform measures remains doubtful to dim, people close to the organisation also told Health Policy Watch….”

“…That has led to two versions of a draft WHA resolution circulating. According to one version, WHA member states would explicitly agree to begin negotiations towards a legal treaty or convention on pandemics. But the other version would merely agree upon the creation of a working group to take forward the recommendations of the Independent Panel as well as two other investigative committees, which explored the functionality of the International Health Regulations as well as WHO’s own emergency response team during the pandemic….”

Geneva Health Files - Tied Funds To WHO, But Flexible Funds To Its Partners: Sustainable Financing Working Group Confronts Challenges P Patnaik; Geneva Health Files;

Last week Friday’s GHF issue, with focus on the discussions in WHO’s Sustainable Financing Working group.

“As WHO’s working group on sustainable financing gets down to work, it is bringing to light the extent to which its financing is tied – this includes even those funds coming from partner agencies. The inter-governmental working group on sustainable financing met late last month (April 29-30) for its second meeting and set off discussions on the potential ways to prioritize essential functions of the WHO given the limited access to “sustainable funds” that the organization currently has. Geneva Health Files spoke to diplomatic sources who were present at the meeting, to get an understanding on the discussions evolving within the working group. The emergency preparedness resolution currently being discussed among WHO member states is expected to come up with a set of recommendations for this working group. …”

A few excerpts:

“… Member states were informed at the meeting that while donor countries provided flexible funds to WHO partners including Gavi – The Vaccine Alliance and The Global Fund, those donors however provided earmarked funding to WHO. … In addition, it also emerged that the funds from these WHO partners come to WHO in a tied manner. … … … When these agencies were created, it was decided that they would only accept unearmarked funding and long-term funding, the source said. (This is in the form of replenishments.) Representatives from Gavi and The Global Fund were invited to the meeting to discuss these issues. … One of the reasons for member states’ preference to give flexible funds to other global health agencies include the governance structure….” … “… Officials at the meeting discussed the various options that the working group can consider in order to prioritise essential functions of WHO… during these preliminary discussions, it appears that member states have not been able to prioritise essential functions within the programme budget, an official said. …”

And a final remark: “… Clearly, the narratives around WHO financing are unfolding in complex times with deep geopolitical changes underway, and in the context of a disruptive pandemic which has transformed international health policy-making in definitive terms including in the creation and endorsement of super structures such as the ACT Accelerator. Inevitably these will have implications for financing which helps set policy priorities for WHO. “Essentially, the other global health players do not want to enter the intricacies of emergencies’ preparedness and response, and that is why the financing of WHO shall now be increasingly geared towards emergencies. We are observing this Davos ‘reset language’ in the context of redefining roles and financial strategies for the WHO,” Nicoletta Dentico, a global health governance expert said at a recent event discussing sustainable financing. “

See also WHO - Sustainable financing Report of the first and second meeting of the Working Group on Sustainable Financing Report by the Director-General

(14 May) Report of the two meetings so far by this Working Group on sustainable financing.

HPW - Top Scientists Call For Further Investigation Into Virus Origins Ahead Of World Health Assembly https://healthpolicy-watch.news/86225-2/

“A group of 18 prominent scientists, primarily based in the United States, have called for further investigations into the origins of the SARS-CoV2 virus, including that it could have been created in the Wuhan Institute of Virology lab, in a letter published on Thursday in the journal Science. …”

AP - Diplomats, donors concerned about sex abuse reports at WHO https://apnews.com/article/united-nations-europe-ebola-virus-health- edfde9bd5d8b251488f3174f6585868f

“British, European and American diplomats and donors have voiced serious concerns about how the World Health Organization handled sex abuse allegations involving its own staff during an outbreak of Ebola in Congo, as reported this week by The Associated Press….”

See also Thomson Reuters - Rocked by new sex claims, World Health Organization appeals for information

“ Facing scrutiny over new claims of sexual abuse by its workers, the World Health Organization (WHO) on Wednesday urged anyone with information to come forward so that action can be taken….” Nature Editorial - Universal health care must be a priority — even amid COVID https://www.nature.com/articles/d41586-021-01313-3

“A focus on specific diseases has derailed efforts to achieve health care for all before. The world must not repeat that mistake with COVID-19.”

“The WHO has placed ‘health for all’ high on the agenda of next week’s meeting, hoping to drive political and financial commitments from governments. Perhaps mindful of the vagueness that doomed past efforts, Tedros has created a new council of economists, health and development experts to advise on the economics of providing everyone with basic health care, including ways to quantify its value.”

“Universal health care might seem a lofty goal amid a crisis, but if we do not push for change now, we will regret it. The pandemic has increased the number of people living in extreme poverty, making them more vulnerable to disease. It’s infected, killed and traumatized health-care workers everywhere, most devastatingly in places that had too few already. “Our failure to invest in health systems doesn’t only leave individuals, families and communities at risk, it also leaves the world vulnerable to outbreaks and other health emergencies,” Tedros said in October 2019. “A pandemic could bring economies and nations to their knees.” A few months later, it did. We must not let that happen again.”

Devex – Will the World Health Assembly adopt a pandemic treaty? https://www.devex.com/news/will-the-world-health-assembly-adopt-a-pandemic-treaty-99952

The “ crystal ball “ question as somebody put it.

“A pandemic treaty can take months to years to draft and negotiate, and it’s unlikely one would be adopted at next week’s 74th World Health Assembly. But some experts are hoping member states would endorse a resolution for the formation of an intergovernmental task force to draft and negotiate a treaty….”

Related link: Politico - US and Russia seek to squash talks for pandemic treaty

“… Washington and Moscow are cool to talks on the creation of a pandemic treaty and are stalling efforts to bring forward a decision at the World Health Assembly starting May 24, according to several officials in Geneva, Switzerland, with knowledge of the discussions. This resistance has brought conversations on the decision down to the wire. Negotiations are further complicated by push back from several other countries that argue there isn’t sufficient time to discuss a treaty as long as they battle the ongoing pandemic. …”

“…The U.S. remains skeptical, saying more time is needed to consider recommendations from international panels examining what went wrong with this pandemic response. The focus, a senior U.S. health official said, should be on building global consensus on how to strengthen WHO….”

Quote: “… “Our current collective efforts should be focused on achievable near-term goals, which can lay the groundwork for any potential instrument in the future,” the U.S. official added. But one of the Geneva officials who spoke to POLITICO suggested that the real U.S. concern may lie elsewhere: Getting enough support to pass the treaty in the U.S. Senate, which would require a two-thirds majority — in other words, Republican support.”

BMJ Analysis - Post-covid reforms: can we avoid fighting the last war? https://www.bmj.com/content/373/bmj.n1184

One of the reads of the week. “Anna Bezruki and Suerie Moon explain why post-pandemic reforms are unlikely to leave the world fully prepared for the next emergency and argue for a focus on strong monitoring systems and flexible arrangements”

The authors discuss the difference post-Ebola reforms made for covid-19, the remaining gaps and blind spots, and implications for the future.

Key messages: “The global response to covid-19 has benefited from reforms implemented after the west African Ebola crisis; These include national preparedness, increased data sharing, international investment in vaccine research, and a stronger WHO; However, gaps and blind spots in that reform process left the world unprepared for the magnitude, breadth, and severity of the covid-19 pandemic; Wide ranging reforms are needed, but only a few are likely to be implemented, particularly those most relevant to covid-19; Post-covid reforms should prioritise continuous monitoring of the global system and flexible arrangements to adapt governance as new possible pandemics emerge.”

Graduate institute (report) - Envisioning an international normative framework for pandemic preparedness and response issues, instruments and options G L Burci, S Moon et al; https://repository.graduateinstitute.ch/record/299175

19 p. Commissioned by and prepared for the Global Preparedness Monitoring Board.

“…Calls for a “pandemic treaty”, first proposed by the president of the European Council and since endorsed by 26 heads of state and the Director-General of the WHO, have added some specificity and urgency to this question. This paper offers a concise analysis of the global systemic weaknesses to be addressed, the range of options of international normative instruments for doing so, and the strengths and weaknesses of each. We then turn to the suitability of WHO as the host intergovernmental organization for such an instrument. The paper concludes with three “menus” of options for possible paths forward.”

With a ‘basic menu’, ‘deluxe menu’, and ‘business menu’ for such a possible pandemic treaty.

• Another link related to the pandemic treaty:

South Centre - The Proposed Pandemic Treaty and the Challenge of the South for a Robust Diplomacy “…. he proposal nonetheless raises some structural and procedural conundrums for the Global South. The negotiation of a pandemic treaty should, as a matter of necessity, take into account the asymmetries of World Health Organization member-states and the interests of the Global South….” WHO - Stronger collaboration for an equitable and resilient recovery towards the health-related sustainable development goals: 2021 progress report on the global action plan for healthy lives and well-being for all https://www.who.int/publications/i/item/9789240026209#.YKaAaFv8vBk.twitter

“This second, annual Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) progress report illustrates how the SDG3 GAP is providing an important, long-term improvement platform for collaboration among 13 agencies in the multilateral system as they support countries on the path towards an equitable and resilient recovery from the COVID-19 pandemic and further progress towards the health-related SDGs.” With 8 case studies.

Think Global Health – Six Things to Watch at The World Health Assembly https://www.thinkglobalhealth.org/article/six-things-watch-world-health-assembly

Pre-analysis by David Fidler. The 6 things are: global vaccine access; preparing for the next pandemic; strengthening WHO and global health governance; the geopolitical factor; what developing countries want; the pandemic’s collateral damage.

Gates & “winds of change” in the US press ?

NYT - Long Before Divorce, Bill Gates Had Reputation for Questionable Behavior https://www.nytimes.com/2021/05/16/business/bill-melinda-gates-divorce-epstein.html

Some evidence of clumsy behaviour, and perhaps a bit more in the light of MeToo (cfr this pertinent tweet Angela Rasmussen – “Don’t know who needs to hear this but “sought to initiate an intimate relationship” with a subordinate is not “an affair,” which implies a relationship between two mutually consenting people outside of a spectacularly lopsided workplace power dynamic.” But no smoking gun re the Epstein connection – the only thing that would be a ‘game changer’ (at least in my (European middle-aged male) opinion).

On the latter, the Daily Beast reported, “The billionaire met Epstein dozens of times starting in 2011 and continuing through to 2014 mostly at the financier’s Manhattan home—a substantially higher number than has been previously reported.” “…a former Gates Foundation employee told The Daily Beast that Gates wanted to get in the good graces of some of Epstein’s professional connections. “My understanding was he wasn’t hanging out with Epstein to get women,” the employee said….”

See also FT - Bill Gates says investigation into affair ‘in no way related’ to leaving Microsoft board

“Bill Gates has denied that Microsoft’s investigation into an “intimate relationship” with an employee two decades ago had any impact on his decision to leave the software company’s board last year.” (Investigative journalist) Tim Schwab in a Twitter thread, putting some things in perspective https://twitter.com/TimothyWSchwab/status/1394398555863928835

“The rapidly evolving investigation into #BillGates & #MeToo creates serious contradictions w/ #GatesFoundation's woman-forward, equity-focused brand/PR. I don't underestimate Bill Gates, but this is a major existential crisis that could end the #GatesFoundation as we know it. ”

“The real threat to the #GatesFoundation right now is not the rule of law or institutional dynamics within a private foundation, but rather the court of public opinion. And by that I mean the news media turning against Bill Gates. The fact that NYT, WSJ et al. are doing some hard (tho maybe still restrained) reporting on #BillGates & #MeToo means he's losing perhaps his most important and long-standing ally.”

“Over the last decade the news media has been incredibly kind to Bill Gates, dead focused on his good deeds and very rarely interrogating his or his foundation's power (or flaws/failures/abuses). I had enormous difficulty trying to get this published…” “ For years, the news media coverage of the #GatesFoundation has traded in fiction and mythology: presenting Gates as a warm and virtuous sweater-wearing saint of a man, unimpeachable in his devotion to fixing the world, and highly effective in these efforts.”

For more, see The Nation - The Fall of the House of Gates? (by Tim Schwab)

ACT-A (including Covax donations & other Covax news)

As mentioned above, a key issue today is whether ACT-A will be fully financed at the G20 summit (or not). It doesn’t seem likely, for the moment.

The Accelerator – News from ACT-A https://spark.adobe.com/page/78pUl1wI9CfuT/

ACT-A has started a newsletter. Among others, this could imply ACT-A will become a global health stakeholder beyond this pandemic as well, not just for this one.

Some excerpts:

“In March, WHO, Coalition for Epidemic Preparedness Innovations (CEPI) and partners created a special COVAX task force to identify manufacturing plants that could be quickly adapted to carry out some of the steps of vaccine production—a prelude to the group’s longer-term goal of building a widely dispersed, sustainable network of vaccine makers. … “

PS: Germany and South Africa are co-chairs of this new working group. For more info on this taskforce, see also GAVI - COVAX Manufacturing Task Force to tackle vaccine supply challenges

… At a virtual summit in mid-April, the Africa Centres for Disease Control and Prevention and the African Union launched their Partnership for African Vaccine Manufacturing, with plans to create an ecosystem of sustainable vaccine development that would provide for 60 percent of the continent’s routine immunization needs by 2040. That number stands at 1 percent today. … … The Partnership plans to set up five vaccine production hubs on the continent over the next 10 to 15 years. The first three hubs, in Rwanda, Senegal and South Africa, would produce mRNA vaccines. These cutting-edge vaccines have only just come into use, developed in response to COVID-19 pandemic. … With the right support, factories in Egypt, Morocco, Senegal, South Africa and Tunisia that are now packaging and labeling vaccines, and occasionally filling vials, could broaden their roles….”

“… fundraising for diagnostics has been tough. ACT-A’s diagnostics pillar needs US$ 8.7 billion for 2021 to keep pace with the demands of the pandemic. Diagnostics is the least funded of the four ACT-Accelerator pillars; contributions have been running eightfold behind the contributions for vaccines….”

“In its sixth meeting, the ACT-Accelerator Facilitation Council on Wednesday focused on helping countries build stronger health systems to fight COVID-19 and prepare for future emergencies. … … The Council also discussed COVAX's new task force on expanding vaccine production, and hosted a session on raising US$ 18.5 billion to finance the global pandemic response through the end of 2021.”

And some ACT-A related global health events coming up:

“21 MAY: Global Health Summit, Rome… present an urgent case for burden-sharing among countries to fast-track equitable access to COVID-19 tools. Vaccine sharing, scaling up vaccine production, and reaching full funding for ACT-A will be discussed. 2 June: COVAX AMC summit, hosted by Japan for Gavi, the Vaccine Alliance. 11-13 June, 47th G7 summit, in Cornwall, UK. Funding for ACT-A is expected to be a focal point for discussion.”

GAVI - Japan to host Gavi's COVAX Advance Market Commitment (AMC) Summit https://www.gavi.org/news/media-room/japan-host-gavis-covax-advance-market-commitment- amc-summit

“ The Government of Japan yesterday announced that it will host the virtual Gavi COVAX Advance Market Commitment (AMC) Summit on June 2nd 2021. The event, co-hosted by Japanese Prime Minister H.E. Yoshihide Suga and José Manuel Barroso, Chair of the Gavi Board, will aim to secure at least US $8.3 billion for 2020-21 in order to accelerate access to 1.8 billion COVID-19 vaccine doses for lower-income economies via the Gavi COVAX Advance Market Commitment by raising an additional US$ 2 billion from donors and the private sector in addition to US$ 6.3 billion raised before the campaign was launched at the “One World Protected” event on April 15th. … Securing 1.8 billion doses would enable the AMC to protect nearly 30% of the population in all AMC countries, or roughly half the entire adult population. Currently, the AMC has funds in place to protect approximately 20% of populations, equivalent to all health and social care workers, elderly and those with underlying health conditions….” FT - Indian vaccine maker to hold off exporting Covid jabs https://www.ft.com/content/63fbbb79-f657-4e6c-b190-cffd0d630593

Another setback for Covax.

“The Serum Institute of India, the world’s largest vaccine manufacturer, plans to hold off exporting Covid-19 jabs again until the end of the year in a blow to countries depending on its shipments to start their campaigns. “We continue to scale up manufacturing and prioritise India,” chief executive Adar Poonawalla said on Tuesday. “We also hope to start delivering to Covax and other countries by the end of this year,” he added, referring to the multilateral global vaccine programme….”

Meanwhile, GAVI hopes COVID-19 vaccine exports from India can resume in Q3 (Reuters).

But for now, “As India confronts a truly dreadful wave of the pandemic, Indian vaccine production, including the 140m vaccine doses initially destined for Covax, have been committed to protecting its own citizens,” a Gavi spokesperson told Reuters.”

Via AP - “Zain Rizvi, a law and policy researcher at the advocacy group, Public Citizen, called the new delay announced by the Serum Institute “a nightmare” for global vaccine access. “COVAX has no plausible path to meeting its modest goals unless rich countries share doses and technology immediately,” he said.”

In SSA (and other parts of the world counting on Covax), they’re very worried, clearly. See Reuters - … India's halt to vaccine exports 'very problematic' for Africa

“…. An extended halt to exports of COVID-19 vaccines from India, where authorities are battling a wave of domestic infections, risks derailing vaccination efforts already underway in Africa, one of the continent's top health officials said on Tuesday.” “…. Africa has lagged far behind other regions due to supply issues and meagre financial resources but had planned to vaccinate 30-35% of its population by the end of the year and 60% within the next two to three years. …. "This is very problematic as it means unpredictability of our vaccination programmes and a serious risk of not achieving our stated target... on time," the director of the Africa Centers for Disease Control and Prevention, John Nkengasong, wrote to Reuters. “

HPW - WHO Appeals For Vaccine Donations To Cover Huge COVAX Shortfall https://healthpolicy-watch.news/who-appeals-for-dose-donations-to-cover-huge-covax-shortfall/

“COVAX has a shortfall of 190 million COVID-19 vaccine doses, and the few manufacturers that have reached agreements with the facility will only deliver later in the year or even in 2022, World Health Organization (WHO) Director Dr Tedros Adhanom Ghebreyesus said on Monday.”

“Pfizer has committed to providing 40 million doses of vaccines to COVAX this year, but the majority of these would be [delivered] in the second half of 2021. We need those right now and call on them to bring forward deliveries, as soon as possible,” Tedros told the body’s biweekly pandemic briefing. “Moderna has signed a deal for 500 million doses with COVAX but the majority has been promised only for 2022. We need Moderna to bring hundreds of millions of this forward into 2021 due to the acute moment of this pandemic.” Meanwhile, COVAX discussions with Johnson & Johnson about getting its vaccine had not been finalised, he added….”

“… Tedros added that manufacturers needed to give the right of first refusal to COVAX for any additional dose capacity and also enter into their deals with manufacturers such as Inceptor, Biolyse, Teva and others that are willing to use their facilities to produce COVID-19 vaccines. … … Bruce Aylward, WHO’s lead at COVAX, stressed that the vaccine platform’s aim to ensure that 20% of the world’s population was vaccinated by the end of the year was “at risk” because of supply shortages. However, he said that COVAX was in talks with a number of countries and was hopeful about “the possibility of larger-scale donations over the coming days, hopefully weeks at the longest”. “I’d like to emphasise that, in speaking to everyone, no one has surplus doses”, but would be donating from what they had,” said Aylward. … Norway and Sweden have already made donations, while France, New Zealand, Belgium, the United Arab Emirates (UAE), Spain, Portugal and US have all indicated that they want to donate. …”

See also Reuters - WHO chief urges COVID-19 vaccine makers to advance doses for COVAX

“The head of the World Health Organization called on manufacturers to make COVID-19 vaccine doses available to the COVAX vaccine-sharing facility earlier than planned due to a supply shortfall left by Indian export disruptions. … Specifically, he asked Pfizer (PFE.N)to bring forward deliveries of some 40 million doses in the second half of the year and asked Moderna(MRNA.O)to make doses pledged for 2022 available this year.”

WSJ - Biden Commits to Exporting Covid-19 Vaccines by End of June https://www.wsj.com/articles/biden-to-commit-to-exporting-covid-19-vaccines-by-end-of-june- 11621269053?mod=hp_lead_pos7

“The U.S. plans to share 20 million doses of Covid-19 vaccines produced by Moderna Inc., Pfizer Inc. and Johnson & Johnson with the rest of the world, President Biden said, on top of the 60 million AstraZeneca doses it had already promised to export. Mr. Biden said Monday that 80 million vaccine doses are expected to be exported by the end of June. The AstraZeneca doses will be delivered once federal authorities sign off. … Mr. Biden said Jeff Zients, the White House Covid-19 coordinator, will lead the administration’s global vaccination efforts. Gayle Smith, a State Department official who is coordinating the U.S.’s role in the global coronavirus response, will also be a key part of the effort, Mr. Biden said. “

And via Reuters – U.S. will donate substantial portion of vaccines through COVAX -U.S. official | Reuters

“The United States will donate a significant number of COVID-19 vaccines through the World Health Organization's COVAX scheme for distributing doses to poorer countries, the U.S. global coordinator on COVID Gayle Smith told a news conference. … Smith said that the United States was also planning to increase its funding for COVAX, in addition to $2 billion which she said it had already donated to the facility in past months….” Geneva Health Files - At Risk: COVAX Plans to Vaccinate 20% of the People in LMICs Geneva Health Files;

See also above. “A top WHO official admitted this week, that initial plans to vaccinate 20% of the populations in LMICs might be at risk. Bruce Aylward, who leads the ACT Accelerator efforts at WHO, said at a briefing that the Facility faces a gap of 150 million by the end of May and that gap will increase in June. This could put at risk, the goal of vaccinating 20% of the people in the AMC countries, he said. … … The calls for more transparency in the supply forecasts from The COVAX Facility has gone louder in recent days, with even the International Chamber of Commerce calling for greater transparency on “when countries can expect shipments – and, if there are bottlenecks or issues getting orders to some countries, how these can be addressed.”…”

GAVI - Go Give One campaign gives public the opportunity to support access to COVID-19 vaccines for lower-income countries https://www.gavi.org/news/media-room/go-give-one-campaign-gives-public-opportunity-support- access-covid-19-vaccines

“The Go Give One campaign launches today, giving everyone everywhere a chance to play their part in helping to vaccinate the world. Created by the WHO Foundation, the campaign asks individuals to donate US$ 7 for a COVID-19 vaccine dose, with the aim of getting 50 million people to take part in the campaign. The money raised goes to the COVAX Advanced Market Commitment (AMC) … Part of the new campaign is a matching feature that allows companies around the world to contribute through a simple fundraising mechanism that puts the campaign in front of their employees or customers….”

Trips waiver & tech transfer

The debate (and momentum?) on a temporary waiver continues, even if Team Europe doesn’t want to have much to do with it. They rather want to focus on removing obstacles to commercial trade of vaccines.

Reuters - Backers of WTO vaccine waiver ask opponents to join talks - document Backers of WTO vaccine waiver ask opponents to join talks - document

“Supporters of a proposal to waive patent rights on COVID-19 vaccines at the World Trade Organization are set to call on opponents to join the negotiations, stressing the gravity of the pandemic, a draft document showed on Monday.”

"The cosponsors call on all delegations who have not yet indicated that they will join text-based discussions, to do so as soon as possible," the 62 proponents of the waiver, including India and South Africa that initially floated the proposal, said in a co-authored draft statement. "Continuous mutations and emergence of new variants of SARS-COV-2 highlight the significant uncertainties and complexities of controlling SARS-COV-2 and underscore the urgency of this proposal," they said. "A failure to respond in a timely manner on the waiver proposal undermines the legitimacy and credibility of the WTO." That call was echoed by the WTO's chief on Monday. "We need to sit down at the negotiating table and actually look at a text. People are dying, and the faster we can sit down and look at a text the better," said Ngozi Okonjo-Iweala at a virtual meeting of the Paris Peace Forum.”

“… The next formal TRIPS council meeting at the WTO is scheduled for June 8.”

See also TWN - Co-sponsors of TRIPS waiver proposal call for solidarity at WTO (19 May)

Reuters – Vaccine patent waiver will not be enough -WTO chief https://www.reuters.com/business/healthcare-pharmaceuticals/vaccine-patent-waiver-will-not-be- enough-wto-chief-2021-05-20/

“Waiving intellectual property rights for COVID-19 vaccines will not be enough to narrow the huge supply gap between rich and poor countries, the head of the World Trade Organization said on Thursday. …. Speaking to the European Parliament on Thursday, WTO director-general Ngozi Okonjo-Iweala said it was clear that an IP waiver alone would not be enough. "To have solved the unacceptable problem of inequity of access to vaccines, we have to be holistic. It's not one or the other," she said, adding this could not drag out for years….”

FT - Biden urged to oblige US vaccine makers to share technology https://www.ft.com/content/9408223f-0a6c-43b7-9f67-c7e4697005c2

“Activists say president should build on patent waiver with transfer of knowhow as part of global Covid fight.”

“Many of the scientists and campaigners who helped persuade Joe Biden to back an intellectual property waiver for Covid vaccines are urging the US president to go further and force vaccine makers to hand over their technology. … … many experts say that even if the WTO waiver proposal secures the necessary support of every member, production will not rise quickly enough. Instead they want companies to hand over instructions for how to make their vaccines to other companies around the world, even if that ends up undercutting their own revenues. They say it is especially important to do so with mRNA vaccines such as those made by BioNTech/Pfizer and Moderna, given they can be modified more quickly to deal with potential emerging variants.”

“One possibility is that the president could use his powers under the Korean war-era Defense Production Act to seize companies’ technology on the government’s behalf and then share that with other countries. Another is that the government could use its own patents to force vaccine makers’ hands. Moderna in particular has used a patent in its vaccine without a licence from the National Institutes of Health, which invented that piece of technology. … … Alternatively, the administration could set up an organisation to act as a third-party broker negotiating technology transfer deals on behalf of US manufacturers. The Clinton Foundation plays this role with HIV drugs, and says it has helped bring down costs by 100 times in certain parts of the world. The WHO has already launched a Covid-19 patent pool for companies to share their IP, and experts say this could also prove a global technology broker if needed….” FT - Brussels seeks to regain initiative on Covid vaccine patent debate https://www.ft.com/content/e84e927c-b99f-4113-ab46-280930f74f74

“EU calls for countries to use flexibility in current WTO system before waiving IP rights”

“Valdis Dombrovskis, executive vice-president of the European Commission, said World Trade Organization members should use existing rules to make it easier to share intellectual property (IP) for coronavirus jabs, rather than expand the ability of governments to override patents, as proposed by the US. Given the pandemic represents a national emergency, the requirement to negotiate with rights holders to license the production of Covid vaccines could be waived, he said in prepared remarks to the European Parliament. The intervention was a plea for countries to increase access to vaccine technology under the existing WTO agreement known as Trips, rather than create a major new loophole in the IP regime by waiving patents. But experts questioned whether the EU’s more cautious approach to patents would have a significant impact on the debate….”

“… Dombrovskis said the EU was also willing to engage in discussions for a “targeted and time- limited” patent waiver, but he said WTO members still needed to have full details of what the US was proposing. EU member states have given the US suggestion a frosty reception. Dombrovskis also confirmed that the EU would shortly be launching an initiative to boost vaccine manufacturing in Africa. …”

See also Bloomberg:

“The European Union’s executive arm will present a proposal to the World Trade Organization calling on other countries to help boost vaccine production capacity in developing countries and export more shots while they explore a possible waiver on patents….” “…Specifically this would mean limiting the application of export restrictions in order to keep supply chains open, and applying no restrictions to exports toward developing countries included in the Covax aid program….”

“The EU’s proposal to the WTO will be based on three components: boosting trade in vaccines and limiting restrictions on exports; expanding production, with the help of current vaccine manufacturers; a review of intellectual property rights, including potential compulsory licensing. “

But see also this tweet on the European parliament:

“@Europarl_EN passes a resolution to urge the European commission to support the proposal to suspend patents on Covid19 vaccines and treatments. Lets keep up the pressure and get the EU and UK to stop blocking progress on negotiations. #PeoplesVaccine.”

Guardian – Britain in talks to waive Covid vaccine patents to improve global access to jabs https://www.theguardian.com/global-development/2021/may/20/britain-in-talks-to-waive-covid- vaccine-patents-to-improve-global-access-to-jabs

“The UK government is in talks about a plan to waive Covid-19 vaccine patents to boost the production of shots in low and middle-income countries, the Guardian can reveal. The discussions come amid growing calls for Britain and other European countries to follow the US in supporting the proposal put before the World Trade Organization (WTO)….” “…A [UK Government] spokesperson said: “We are engaging with the US and other WTO members constructively on the Trips waiver issue, but we need to act now to expand production and distribution worldwide.””

Lancet World Report – What next for a COVID-19 intellectual property waiver? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01151-X/fulltext

“The USA has backed a waiver for intellectual property related to COVID-19 vaccines. What happens next? John Zarocostas reports from Geneva.” With views from various sides.

“… Aside from Germany, senior WTO diplomats expect Switzerland, South Korea, and Japan—all countries with influential pharmaceutical industries—to try to resist a waiver, especially if the scope is not narrowed to just vaccines, and could try to drag talks out.”

And with respect to C-TAP: “James Love, Director of Knowledge Ecology International, said that he thinks C-TAP needs to be rebooted if it is to remain relevant. “For C-TAP to become relevant, it needs to have a high profile leader whose only job is to make it work, and who can push industry and governments to engage. C-TAP needs to hold at least biweekly press conferences, and explain what is going right, and why things are not going right.”

Stat op-ed- Beyond a symbolic gesture: What’s needed to turn the IP waiver into Covid-19 vaccines P Erfani, L Gostin & V Kerry ; https://www.statnews.com/2021/05/19/beyond-a-symbolic-gesture- whats-needed-to-turn-the-ip-waiver-into-covid-19-vaccines/

“… To turn the [US] administration’s decision into action, World Trade Organization countries must rapidly pass the IP waiver, implement technology transfers, repurpose global manufacturing capacity, and boost production of raw materials. All of these require considerable global collaboration, not to mention the financial and political commitment of high-income countries….”

HPW – ‘IP Monopoly Capitalism’ – A ‘Virus’ To Society During COVID-19 https://healthpolicy-watch.news/ip-monopoly-capitalism-virus-society-covid/

“Governments and pharmaceutical companies alike must work together in combating the ‘virus of intellectual property (IP) monopolies over COVID-19 vaccines – which further exacerbates inequality and lack of access to vaccines for vulnerable groups. That was the uptake of a group of experts speaking at a webinar Wednesday on “The Virus of IP Monopoly Capitalism”’ hosted by the Society for International Development (SID). “

“… IP, or ‘intangibles’, are “‘considered a lion’s share of powers concentrated in the global economy”, said Susan Sell of the Australian National University. Intangibles are IP trademarks and patents that play an outsized role in the global economy, with the political and economic powers that own those goods controlling the value of oft-essential products and services. In terms of the COVID- 19 pandemic, that can include patents governing tests, Personal Protective Equipment (PPE), vaccines, and medicines. “It’s a winner-takes-most system right now – and those who own the intangibles are the winners in this system,” said Sell. This means that developed countries and pharmaceutical companies are the “winners” of this system, said Sell, with developing countries and vulnerable groups struggling to access essential equipment and treatment, worsening inequality and poverty, and leading to many unnecessary COVID deaths. …”

“…. The future of the global health economy must shift towards a model where innovation, which is now left to the markets, would instead be the basis for a model that can deliver global public goods.

HPW - Sustainable COVAX Vaccine Funding & Voluntary Manufacturing Licenses are Better Solutions than IP Waiver, Says IFPMA Head https://healthpolicy-watch.news/sustainable-covax-funding-voluntary-manufacturing-alliances-are- better-solutions-than-ip-waiver-pharma-industry-leader/

Lot of fake news from Thomas Cueni (IFPMA) as usual. But a few excerpts are worth reading anyhow, re Covax & CEPI:

“We could put it the other way around. What went wrong, or why is COVAX [the global vaccine facility] struggling? I’ve heard some say they don’t have the money; that’s not true. COVAX actually more or less met its investment needs with cash injections for this year. Where COVAX was really handicapped was that they couldn’t sign contracts, before they had the money in the bank. … … when I look in terms of future pandemic preparedness, COVAX needs a pot of money, where they can be early movers. …”

“… It’s also a question for CEPI (Coalition for Epidemic Preparedness Innovation). Because when you look at the big manufacturers they, by and large, teamed up with BARDA early on. The smaller biotech companies, such as Novavax, they got quite significant sums from CEPI. But CEPI is a relatively small organization. Therefore, I think one needs to talk about how can we improve pandemic preparedness for the future; we need to make sure that COVAX and CEPI are equipped to have a level playing field for the deliveries to the poorer countries. …”

The Intercept – Documents reveal Pharma plot to stop generic Covid-19 vaccine waiver https://theintercept.com/2021/05/14/covid-vaccine-waiver-generic-phrma-lobby/

“Urging Biden’s reversal, industry lobbyists instruct Congress to talk up loss of jobs and fear of China.”

“THE PHARMACEUTICAL INDUSTRY is distributing talking points, organizing opposition, and even collecting congressional signatures in an attempt to reverse President Joe Biden’s support for worldwide access to generic Covid-19 vaccines. The behind-the-scenes moves, revealed in documents obtained by The Intercept…” “… Another talking points document, listed as “confidential — not for public distribution,” called for reinforcing the argument that “waiving intellectual property will undermine the global response to the pandemic and compromise vaccine safety….”

Other Global Health Governance & Financing news

UK - Summit to build global confidence in vaccines to be convened by the UK Government https://www.gov.uk/government/news/summit-to-build-global-confidence-in-vaccines-to-be- convened-by-the-uk-government

“The UK Government will convene a virtual Global Vaccine Confidence Summit on June 2nd, bringing together experts in the public and private sector. The Summit will look at innovative solutions to tackle misinformation and support confidence in life-saving COVID-19 vaccines around the world. Speakers at the summit will include Health Secretary Matt Hancock and Professor Heidi Larson, Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, with further international speakers to be announced on G7 social channels in the coming weeks…”

CGD - Dear President Biden and Congress: Time for US to Lead Response to the Growing COVID-19 Global Vaccine Crisis A Glassman et al; https://www.cgdev.org/blog/dear-president-biden-and-congress-time-us-lead- response-growing-covid-19-global-vaccine-crisis#disqus_thread

Pressure on the Biden administration is steadily increasing to lead a global effort.

“Today we joined colleagues from CSIS, Duke University, and the COVID Collective in an open letter to the Biden Administration and US Congress with a clear message: to hasten the end of the COVID-19 global pandemic, American leadership is required to ensure universal global access to high-quality and safe vaccines, support rapid vaccine distribution and administration, and build a sustainable global network of vaccine manufacturing capacity. “

The letter identifies five specific areas of urgent action: “Designate a clear leader to coordinate the US global response, leading to a robust and sustainable global strategy; Share vaccine doses now at the maximum amount feasible, while preparing for future needs; Strengthen and expand the manufacturing capacity for US-authorized and supported vaccines; Support distribution and delivery infrastructure, especially for low-income countries; Commit to leading development and implementation of a comprehensive, sustainable, 5-year plan for long-term scale-up of global vaccine manufacturing capacity.”

Geneve Health Files (guest essay) - “The Independent Panel did not meet the moment”: Sara (Meg) Davis Geneva Health Files Meg Davis’ take on the Independent Panel report from last week.

“The Independent Panel tasked by WHO with reviewing the global management of the COVID-19 pandemic has fulfilled its terms of reference. But despite the best efforts of the panelists, it did not meet the moment. The world might still need an Independent Panel -- but one that is transparent, accountable and participatory. … … Some of these recommendations are sensible, others less likely, but in seeking to avoid assigning blame, the panel ducks accountability, and its vision falls short of the scale of the problems revealed by COVID-19. … … Troublingly, considering that several of the panelists have been outspoken human rights advocates in the past, the Independent Panel also sidestepped numerous grave human rights abuses in the COVID-19 pandemic: praising the world’s most brutal authoritarian lockdowns as models, without a single caveat about government overreach. … … These omissions are concerning, but rather than blaming the panelists, we might reflect on the largely closed process. A process grounded in a robust, public consultation with civil society and community voices, frontline health care workers and trade unions, might have produced a different result….”

WHO - New international expert panel to address the emergence and spread of zoonotic diseases https://www.who.int/news/item/20-05-2021-new-international-expert-panel-to-address-the- emergence-and-spread-of-zoonotic-diseases

“International organizations have come together to launch a new One Health High-Level Expert Panel to improve understanding of how diseases with the potential to trigger pandemics, emerge and spread. The panel will advise four international organizations - the Food and Agriculture Organization of the United Nations (FAO); the World Organisation for Animal Health (OIE); the United Nations Environment Programme (UNEP); and the World Health Organization (WHO) - on the development of a long-term global plan of action to avert outbreaks of diseases like H5N1 avian influenza; MERS; Ebola; Zika, and, possibly, COVID-19. Three quarters of all emerging infectious diseases originate in animals. It will operate under the One Health Approach, which recognizes the links between the health of people, animals, and the environment and highlights the need for specialists in multiple sectors to address any health threats and prevent disruption to agri-food systems. Key first steps will include systematic analyses of scientific knowledge about the factors that lead to transmission of a disease from animal to human and vice versa; development of risk assessment and surveillance frameworks; identification of capacity gaps as well as agreement on good practices to prevent and prepare for zoonotic outbreaks….”

Coverage via Reuters - UN bodies set up 'One Health' panel to advise on animal disease risks

“The World Health Organization and three other international bodies have formed a team of experts to help develop a global plan to prevent the spread of diseases from animals to humans, the WHO said on Thursday.”

Devex - How CEPI is preparing for the next pandemic https://www.devex.com/news/how-cepi-is-preparing-for-the-next-pandemic-99945 Good analysis of what CEPI 2.0 involves.

“CEPI was catapulted into a leadership role in the coronavirus response, helping along with GAVI, the Vaccine Alliance and the World Health Organization to coordinate the Access to COVID-19 Tools Accelerator — which has become the linchpin of global efforts to provide much of the global south with vaccines — and announcing plans last month to help the African Union advance vaccine development and manufacturing on the continent. … … The lessons of the pandemic run through the preview of the new $3.5 billion investment case that CEPI released in March, which will ultimately guide the coalition’s strategy from 2022 to 2026. $1 billion of that money is earmarked for ongoing work around COVID…. The strategy, known as CEPI 2.0, will be fleshed out over the course of this year. It’s headlined by a “moonshot” objective of reducing the timeline for future vaccine development to 100 days. … …. To do so, CEPI is building on the idea of prototype pathogen preparedness, where researchers develop an in-depth knowledge of — and possible response to — prototype viral pathogens, essentially giving them a head start when threats from within those viral families actually emerge….”

Covid key news

With key trends & some more WHO (/UN) messages.

• Via Cidrap News :

“As India's total edges closer to that of the United States, some Asian countries continue to grapple with their new surges, including Taiwan, which is experiencing its biggest outbreak of the pandemic….. Though cases in the African region are declining overall, seven countries are reporting rises of 20% or more, the World Health Organization (WHO) African regional office said today in its latest weekly health emergencies report. They include Benin, Eritrea, Eswatini, Liberia, Nigeria, Sierra Leone, and South Africa….”

• Cidrap News - COVID hot spots persist in Latin American countries

“Brazil's decline in cases has stopped, and cases and deaths doubled last week in parts of Argentina and Uruguay, a sign that the Americas region is still in the heat of battle with COVID, officials from the Pan American Health Organization (PAHO) said today during a briefing. Though the world's cases declined last week, four of the five highest burden countries are in the Americas region, the World Health Organization (WHO) said yesterday in its weekly snapshot of the pandemic. They include the Brazil, the United States, Argentina, and Colombia….”

“… Though India's cases have shown some signs of decline, falling 12% of the past week according to the WHO's update, deaths continue to surge. Over the past day, deaths crossed the 4,500 mark, setting another daily high mark for India and for the world, according to the New York Times. Data from a private lab chain in India underscores the massive spread of the virus there, according to Reuters. The company said 63.5% of people have tested positive for SARS-CoV-2 antibodies over the past week, up sharply from 45% a month ago. The data cover people from 25 of the country's states. Reuters - World has entered stage of "vaccine apartheid" - WHO head Reuters;

“The world has reached a situation of "vaccine apartheid", World Health Organization Director- General Tedros Adhanom Ghebreyesus said on Monday, and was no longer just at risk of that status.”

Guardian - Vaccinate vulnerable global poor before children in rich countries, WHO says https://www.theguardian.com/world/2021/may/14/vaccinate-vulnerable-global-poor-before-rich- children-who-says

“Instead of offering jabs to young and healthy people, countries should give their doses to the Covax global vaccine-sharing scheme and thereby ensure that those most in need in all countries receive protection, Tedros said. World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus said the second year of the pandemic was set to be more deadly than the first, with India a huge concern. … The WHO also urged rich countries on Friday to reconsider plans to vaccinate children and instead donate Covid-19 shots to the COVAX scheme for poorer countries….”

See also HPW - Tedros: COVID-19 Vaccination is ‘Bittersweet’ Amid Global Shortages

Tedros was vaccinated last week. “Being vaccinated against COVID-19 this week was a “bittersweet” moment, reflecting both a “triumph of science” and a “gross distortion” in vaccine access, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyusus told the body’s media briefing on Friday. … … “At present, only 0.3% of vaccine supply is going to low income countries. Trickle-down vaccination is not an effective strategy for fighting a deadly respiratory virus,” noted Tedros.”

The Hindu - COVID-19 response over next 6-18 months critical, says Soumya Swaminathan https://www.thehindu.com/news/national/who-chief-scientist-soumya-swaminathan-interview- covid-19-response-over-next-6-18-months-critical/article34574108.ece

“Predicting that the COVID-19 pandemic is likely to have subsequent waves as well, Dr. Soumya Swaminathan, chief scientist at the World Health Organization, who has been maintaining a keen eye on the developments in India, says the efforts put in in the next 6-18 months will be most critical in battling the pandemic. “A lot depends also on the evolution of the virus itself, the ability of vaccines to keep up with variants, and it also depends on the duration of protective immunity of vaccines. A lot of this is changing,” she says. … “We know that there will be definitely an end to the acute phase of the pandemic — when we have vaccinated about 30% of the world’s population, which is what we would like to see by the end of 2021. Then we can start seeing a significant reduction in the deaths.” Then 2022 can be about ramping up vaccination….” Guardian - Fake Covid vaccine and test certificate market is growing, researchers say https://www.theguardian.com/world/2021/may/16/fake-covid-vaccine-and-test-certificate-market- is-growing-researchers-say

“A hidden pandemic market advertising fake vaccine and test certificates for as little as £25 has grown exponentially, with more than 1,200 vendors in the UK and worldwide, researchers have found. After UK ministers announced the return of overseas holidays – with travellers required to show proof of negative tests, and vaccine passports on the horizon – the Guardian has also learned that anti-vaxxers and people arriving in Britain from poorer nations make up a significant number of those buying forged pandemic paraphernalia….”

UN News - COVID-19 pandemic ‘feeding’ drivers of conflict and instability in Africa: Guterres https://news.un.org/en/story/2021/05/1092222

“Women and young people must be part of Africa’s plans to recover from the COVID-19 pandemic, which is feeding factors driving conflict on the continent, UN Secretary-General told the Security Council on Wednesday. “

The Security Council also worried (in a declaration) that Africa has so far only gotten 2 % of the vaccines, administered globally (1.4 billion).

Covid science

The Lancet: First data suggest Africa has higher death rate among critically ill COVID-19 patients than any other world region https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00441-4/fulltext

New Study by African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators.

Press release:

“ Study based on 3,140 adults admitted to 64 hospitals in 10 countries between May and December 2020, suggests high mortality may be partly explained by shortage of critical care resources and underuse of those available. Estimates suggest that the provision of dialysis is 7 times less, and the provision of ECMO (to oxygenate blood) is 14 times lower than required to adequately treat COVID-19 patients in this study. Findings have important implications for managing severely ill patients in resource-limited settings where shortage of functioning equipment and specialised staff must be taken into consideration.” “Death rates among adults in the 30 days after being admitted to critical care with suspected or confirmed COVID-19 infection appear considerably higher in Africa (average 48.2%; 1,483/3,077 patients) than globally (average 31.5%; from a meta-analysis of 34,859 patients, according to an observational study from 64 hospitals in 10 African countries, published in The Lancet. A critical factor in these excess deaths may be a lack of intensive care resources and underuse of those available, say the researchers, who are all based in Africa. For example, half of patients died without being given oxygen, and while 68% of hospitals had access to renal dialysis, only 10% (330/3,073) of severely ill patients received it….

Related Lancet Comment - Excess COVID-19 mortality among critically ill patients in Africa Adding an additional hypothesis for the excess mortality.

HPW - COVID-19 Research & Innovation Forum Calls for Tighter Collaboration in Face of New Virus Variants https://healthpolicy-watch.news/call-for-tighter-research-collaboration/

“Researchers have quickly developed an outstanding arsenal of vaccines, treatments and diagnostics to counter COVID-19. But closer global coordination of diverse clinical trials testing the same or similar treatments, extending even to a global platform to pool anonymized patient data, could strengthen and accelerate research findings – especially as emerging variants threaten to unwind gains. These were among the key points made during a two-day COVID-19 Global Research and Innovation Forum hosted by the World Health Organization (WHO), which brought together two dozen leading figures across academia, civil society, and ministries of health. … … Going forward, a portfolio of coordinated clinical trials could represent a fruitful strategy that would yield more robust data faster, while also avoiding duplication of research efforts, the panelists suggested….”

Stat - How the Covid pandemic ends: Scientists look to the past to see the future https://www.statnews.com/2021/05/19/how-the-covid-pandemic-ends-scientists-look-to-the-past- to-see-the-future/

Different hypotheses, as you can imagine. Some think it’s a matter of a few years before SARS becomes endemic (and relatively mild), others are a lot more cautious. Excerpts:

“The viruses became endemic. If the pattern holds, and it is expected to, SARS-2 will at some point join a handful of human coronaviruses that cause colds, mainly in the winter, when conditions favor their transmission. When will that happen? …. Experience from the last four pandemics — the ones mentioned above — would suggest that viruses morph from pandemic pathogens to endemic sources of disease within a year and a half or two of emerging. But all of those pandemics were influenza pandemics. A different pathogen could mean we’ll see a different pattern….

“… “I think the scenario … remains the most likely one,” said Marc Lipsitch, an infectious diseases epidemiologist at Harvard’s T.H. Chan School of Public Health. “That essentially, almost everybody has some form of immunity from natural infection and/or vaccination and/or one followed by the other, and that that will persist long enough so that they don’t get really sick when they get it again. And then we transition to endemicity.” …. … [Jenny] Lavine is unfazed by the notion that SARS-2 could still be with us when the pandemic is over. “It’s not a death sentence in any way, shape, or form to say we’re not going to have herd immunity,” she said. “It just means it’s going to become endemic and then the question is, is it going to be mild and endemic, or is it going to be severe and endemic? And I would say my odds are on mild and endemic at some point. I think that seems really, really likely.” Lavine is not alone in thinking we’re not going control spread of SARS-2 through herd immunity.

Mike Ryan, head of the WHO’s Health Emergencies Program, is more cautious, like some others.

“We don’t know where we are, because this is the first pandemic of a SARS coronavirus,” he said. “From my perspective, crystal-balling it … we’re not even close to the end of it.”

Science News - Scientists tracking coronavirus variants struggle with global blind spots https://www.sciencemag.org/news/2021/05/scientists-tracking-coronavirus-variants-struggle- global-blind-spots

“Most countries sequence less than 1% of virus samples.”

Stat News - Sanofi, GSK announce positive early results for their Covid-19 vaccine candidate https://www.statnews.com/2021/05/17/sanofi-gsk-results-covid-19-vaccine/

“Sanofi and GSK announced positive results on Monday from a Phase 2 clinical trial of their joint Covid-19 vaccine, saying it generated strong levels of neutralizing antibodies in recipients across all ages studied. The partners said a large international Phase 3 trial will begin in coming weeks. The duo, two of the world’s largest vaccine manufacturers, is far behind in the effort to produce a Covid vaccine and lock down markets for their product, having suffered a setback in an earlier Phase 1/2 trial last year. But with vaccine supplies expected to trail global need into the foreseeable future, the companies believe there is still a place for their vaccine….”

See also HPW - Sanofi-GSK Position SARS-CoV2 Candidate Vaccine as Potential ‘Booster’

BMJ Editorial - Antivirals against SARS-CoV-2 by autumn? https://www.bmj.com/content/373/bmj.n1215

“An over ambitious target that risks forced errors.”

Politico - Russian vaccine’s hot streak is sputtering https://www.politico.eu/article/russia-sputnik-coronavirus-covid-19-vaccine-hot-steak/ “Questions around the shot mount as it faces scrutiny from Europe’s medicines watchdog.” Also including the Lancet-BMJ “discussion” on Sputnik.

Donald McNeil Jr - How I Learned to Stop Worrying And Love the Lab-Leak Theory* https://donaldgmcneiljr1954.medium.com/how-i-learned-to-stop-worrying-and-love-the-lab-leak- theory-f4f88446b04d

Donald McNeil cites growing evidence that the COVID 19 virus could have been a leak from the lab.

“…I now agree with Nick’s central conclusion: We still do not know the source of this awful pandemic. We may never know. But the argument that it could have leaked out of the Wuhan Institute of Virology or a sister lab in Wuhan has become considerably stronger than it was a year ago, when the screaming was so loud that it drowned out serious discussion….”

Bloomberg - Covid Is Airborne, Scientists Say. Now Authorities Think So, Too https://www.bloomberg.com/news/articles/2021-05-16/covid-is-airborne-scientists-say-now- authorities-think-so-too

“WHO, CDC recognize risk of virus aerosols in tweaked advice; Scientists seek ventilation overhaul to address airborne germs.

“That new acceptance, by the World Health Organization and the U.S. Centers for Disease Control and Prevention, comes with concrete implications: Scientists are calling for ventilation systems to be overhauled like public water supplies were in the 1800s after fetid pipes were found to harbor cholera. … “We are used to the fact that we have clean water coming from our taps,” said Lidia Morawska, a distinguished professor in the school of earth and atmospheric sciences at the Queensland University of Technology in Brisbane, Australia, who led the study. Likewise, “we should expect clean, pollutant- and pathogen-free air” from indoor spaces, she said over Zoom….”

“… The role of airborne transmission “has been denied for so long, partly because expert groups that advise government have not included engineers, aerosol scientists, occupational hygienists and multidisciplinary environmental health experts,” MacIntyre wrote in The Conversation last week….”

See also Wired on the Big Aerosol Blunder. Via Nature: “It took a year for public-health guidance to converge on the fact that COVID-19 mostly spreads through the air and rarely through contaminated surfaces. The confusion was spawned in part by just one number: 5 micrometres. That’s the size that — according to outdated guidance — separates aerosols, which linger in the air, and droplets, which fall onto surfaces. Another problem: the divide between engineers and physicists, who study aerosols, and physicians, who worry about pathogens. As the pandemic raged, a small group of scientists fought to trace the poorly documented origins of the 5- micrometre fallacy, overcome the chasm between disciplines and change our understanding of how respiratory diseases spread.” Nature (News) - How COVID is changing the study of human behaviour https://www.nature.com/articles/d41586-021-01317-z

“The pandemic is teaching us key lessons about crisis, communication and misinformation, and is spurring changes in the way scientists study public-health questions.”

Links:

WHO Removes Remdesivir From List of COVID-19 Medicines

MIT Technology review - Five reasons why you don’t need to panic about coronavirus variants

More on Covid vaccine access & other bottlenecks

Some more reads, analyses, advocacy from stakeholders, …

Devex – African nations may have to restart COVID-19 vaccination efforts https://www.devex.com/news/african-nations-may-have-to-restart-covid-19-vaccination-efforts- 99958

“As the global shortage of Oxford-AstraZeneca COVID-19 vaccines deepens, African countries that have already given first doses to populations, might need to restart their efforts, said Dr. John Nkengasong, director at the Africa Centres for Disease Control and Prevention. The African continent has been heavily dependent on vaccines from the COVAX Facility supplied by the Serum Institute in India. But as the COVID-19 crisis in India spiraled, the country restricted the export of vaccines — severing the facility’s access to these vaccines. … … Nkengasong recommended during a press conference Thursday that if countries don’t receive doses of Oxford-AstraZeneca vaccines in time to give people their second doses, they should revaccinate those who received first doses of AstraZeneca vaccine with a second, single dose of the Johnson & Johnson vaccine. … The African Union has secured doses of J&J vaccine for purchase by countries but there has been a slow uptake in orders. Nkengasong also said these doses are not expected to become available until at least August…. With this crisis in access to vaccines, many African nations are now depending on the donations of vaccine doses from wealthier countries that have hoarded excessive doses, but are committing to sharing vaccines, including the Oxford-AstraZeneca vaccine. The Africa CDC hopes that this will happen in time for people to instead have a second dose of Oxford-AstraZeneca. “We just hope that this can be done quickly so that we do not run into a gap between now and August when our doses from Johnson & Johnson will begin to kick in,” Nkengasong said.

And via Cidrap News:

“Africa's vaccine rollout has not only been hampered by a supply bottleneck due to a stall in a COVAX vaccine produced by India's Serum Institute but also by a lack of financial resources in some countries to put the shots into peoples' arms, the head of the WHO's African regional office, Matshidiso Moeti, MBBS, said today at a briefing. She added that the supply gap can be filled if developed countries donate doses, but some countries need help developing operational plans to best use their supplies, which includes hiring vaccinators, cold-chain storage, logistics, and transportation….”

People’s Vaccine Policy Manifesto May 2021 - A Five Step Plan for a People’s Vaccine https://www.globaljustice.org.uk/resource/a-five-step-plan-for-a-peoples-vaccine/

Five steps governments must take to a Peoples Vaccine. They all make damned good sense.

HPW - Big Pharma Commits to 5-Point Plan to Increase COVID-19 Vaccine Equity https://healthpolicy-watch.news/big-pharma-commits-to-5-point-plan/

Over to the ‘other side’ then: “Major global vaccine manufacturers and biotech companies have committed to a five-point plan to “advance COVID-19 vaccine equity”, focusing on “responsible dose-sharing” and “maximizing production”. “

“They pointed out that, within a few months, vaccine doses had gone from “zero to 2.2 billion” and were predicted to reach 11 billion doses by the end of 2021 – “enough to vaccinate the world’s adult population”. To enable more equitable distribution, the vaccine manufacturers and biotech companies committed to stepping up dose-sharing by working with governments with enough supply to “share a meaningful proportion of their doses with low- and lower-middle- income countries in a responsible and timely way through COVAX or other efficient established mechanisms”. Second, they committed to optimising production, “including through additional collaborations with partners that can produce significant quantities”. Third, they said they would identify trade barriers that needed to be eliminated. To do this, they aim to work with the new COVAX Supply Chain and Manufacturing Task Force that is identifying production gaps and facilitating “voluntary matchmaking for fill and finish capacity”. They would also urge governments to work with the World Trade Organization (WTO) to “eliminate all trade and regulatory barriers to export” and to “adopt policies that facilitate and expedite the cross-border supply of key raw materials, essential manufacturing materials, vaccines”. They also committed to supporting country readiness, “particularly in low- and lower-middle income countries, to ensure that they are ready and able to deploy available doses within their shelf life”. Finally, they committed to driving “further innovation”, and “prioritise the development of new COVID-19 vaccines, including vaccines effective against variants of concern”.”

Politico - Big vaccine makers reject offers to help produce more jabs https://www.politico.eu/article/vaccine-producers-reject-offers-to-make-more-jabs/

From earlier this week, the current (real) situation: “As much of the world remains starved for coronavirus vaccines, a group of companies is offering to partner with larger drugmakers as one way to rev up production. But they're getting the same answer: No thanks. Biolyse in Canada, Incepta in Bangladesh, Teva in Israel and Bavarian Nordic in Denmark have all asked to assist in the manufacture of vaccines. As yet, none has a deal. This reluctance to merge forces is even more puzzling given Big Pharma's line that current production capacity is to blame for vaccine under- supply. It's this reasoning that drugmakers cite to counter arguments in favor of waiving intellectual property for vaccines — a movement that got a jolt last week when the U.S. gave rhetorical support to the idea….”

Lancet - A global compact to counter vaccine nationalism

P Jha, D Jamison et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01105- 3/fulltext

The authors propose an integrated three-pillar global vaccine compact to expand vaccine supply and counter vaccine nationalism.

“Global vaccine production capacity in non-pandemic times is too small and too concentrated in a handful of pharmaceutical companies. … … The first pillar of our proposed compact would be for countries to adopt the idea of a fully immunised adult, and launch national adult vaccination programmes. … Next, uninterrupted supply of life-saving vaccines cannot be left only to market forces, or worse—insular political decisions. The second pillar we propose is a global vaccine manufacturing compact housed in less populous countries with good scientific and training infrastructure, a respect for legal contracts, and a reputation for fair play. Canada, Norway, Singapore, and Switzerland are possibilities, as might be several others—some of which are in Africa. The manufacturing compact would produce vaccines in the billions, far in excess of domestic demand. … … A third pillar requires rapidly expanding production capacity by private pharmaceutical companies without encouraging the rent-seeking behaviour enabled by patent law…”

Science (news) - The pandemic surge at home is threatening an Indian vaccinemaker’s bid to protect the world https://www.sciencemag.org/news/2021/05/pandemic-surge-home-threatening-indian- vaccinemaker-s-bid-protect-world

Update on Serum Institute’s predicament.

Economist (Briefing) - The whole world needs protecting How can more covid-19 vaccines be made available? https://www.economist.com/briefing/2021/05/15/how-can-more-covid-19-vaccines-be-made- available

Interesting read. “The nuts and bolts of scaling up production matter more than intellectual property.”

Including this quote from Bruce Aylward: “Of the 40m doses that Pfizer has promised [to Covax], it has delivered only 960,000."” Lancet Comment - India's COVID-19 crisis: a call for international action https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01121-1/fulltext

“As authors working in India or with research & clinical collaborators in India, we call for 8 steps the international community must take to help address the crisis in India…”

FT - J&J pushes Latin America to take unfrozen vaccines in Covax talks https://www.ft.com/content/a3da0286-ec0b-4cdb-8c42-805205410f06

“WHO’s regional office for the Americas office says some countries would be unable to fully deploy doses before they expire.”

“… Johnson & Johnson has pushed Latin America to accept shipments of unfrozen Covid-19 vaccines that some countries would be unable to fully deploy before they expire, according to the Pan-American Health Organization. Jarbas Barbosa, assistant director at PAHO, told the Financial Times that J&J was asking for doses to be shipped at refrigerator temperatures rather than frozen, as required by the World Health Organization. … … Barbosa said J&J had been “aggressive” in its procurement negotiations, and suggested that the company was seeking to offload doses that it could not otherwise use. “Maybe they have vaccines that were already unfrozen and want to deliver them through Covax,” he said. … PAHO remained “in talks” with J&J and still hoped to resolve the issue before finalising the Covax contract next week, Barbosa said. Under the deal, agreed in principle in December, J&J will deliver 200m doses to Covax for worldwide distribution in the second half of 2021….”

HPW - African Countries Reluctant To Borrow Funds For COVID-19 Vaccines https://healthpolicy-watch.news/86305-2/

“A deal to supply 400 million doses of Johnson & Johnson COVID-19 vaccines to African countries hangs in the balance as most countries are reluctant to make upfront deposits and borrow money to get the supplies. With a looming deadline to express interest and complete the funding applications, Africa CDC John Nkengasong on Thursday appealed to countries to make use of the facility as it will ramp up vaccinations and help achieve herd immunity to curb the spread of the deadly virus. …”

Medium - Will Africa Receive Enough COVID-19 Vaccine to Blunt the Pandemic? Cooper/Smith; https://medium.com/cooper-smith/will-africa-receive-enough-covid-19-vaccine-to- blunt-the-pandemic-429538a551ef

Blog with debatable stance, that by vaccinating 7 % of the people in SSA you could already so a great deal. True, but still tricky, given how we see in some other parts now younger people (than 50, see definition below) dying in droves. Excerpts:

“COVAX aims to cover 20% of people in low-income countries, which will require 1.3 billion vaccine doses. However, this goal will be met incrementally, and doses are earmarked by country. In Africa, about 89 million doses have been allocated, which covers roughly 7% of the continent’s 1.3 billion people with a single jab (3.5% for double doses). On its face, this appears insufficient and far short of the estimated herd immunity threshold of 80%. Yet the important question is whether this seemingly small amount of vaccine could cover the most vulnerable and essential — those over age 50 and health care workers. …. … Here are the key numbers: According to data from the World Bank, only 1.3% of Africa’s population is 65 or older; only 8% is between 50–64. Health-care workers make up only 0.2% of the population. This means that continent-wide, enough vaccine to cover only 7% of the total population could cover 70% of the most vulnerable and health-care workers. Specifically, that number of doses could cover all health care workers, all people older than 65, and the majority (65%) of those aged 50–64….”

BBC - Malawi burns thousands of expired AstraZeneca Covid-19 vaccine doses https://www.bbc.com/news/world-africa-57168841.amp

“Health authorities in Malawi have incinerated 19,610 expired doses of the AstraZeneca coronavirus vaccine, saying it will reassure the public that any vaccines they do get are safe. It is the first African country to publicly do this. The World Health Organization initially urged countries not to destroy expired doses but has now changed its advice. Uptake of the vaccine in Malawi has been low and health workers hope the move will increase public confidence…..”

See also WHO Afro - Expiry date and shelf life of the AstraZeneca Covishield vaccine produced by the Serum Institute of India.

BBC – Covid-19 vaccines: Why some African states can't use their vaccines https://www.bbc.com/news/56940657

“Despite many African countries struggling to obtain enough Covid-19 vaccines, some have thousands of expired doses which they have been unable to use. Some countries are now destroying these vaccines, in line with the latest World Health Organization (WHO) advice. … Many countries failed to prepare adequately before receiving the vaccines, Phionah Atuhebwe, from the WHO in Africa, says. "That is one of the reasons we are seeing the slow pace of rollout," she says. And some countries also faced financial challenges. Africa Centres for Disease Control head John Nkengasong says countries need more support to increase the numbers of health workers and obtain supplies, such as personal protective equipment. And those who have vaccines approaching or beyond their expiry date should contact the WHO or Africa CDC….”

See also WHO Afro - Risks and challenges in Africa’s COVID-19 vaccine rollout.

Covid analysis

Nature Medicine Review - Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

V Haldane, A Nordström, H Legido-Quigley et al; https://www.nature.com/articles/s41591-021- 01381-y#Ack1 “Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.”

WSJ - Covid’s Next Challenge: The Growing Divide Between Rich and Poor Economies https://www.wsj.com/articles/covids-next-challenge-the-growing-divide-between-rich-and-poor- economies-11621343332

“The U.S., U.K. and China are roaring ahead, while most lower income nations are struggling, reversing decades of progress in alleviating global poverty. ‘This has become the inequality virus.’”

“Covid-19 is reopening a rift between economies in the world’s richest and poorest nations, driven by growth rates that are moving firmly in opposite directions. Yet across the developing world, where people are largely unvaccinated and governments are unable to afford sustained stimulus measures, economies are falling further behind, struggling to rebound from last year’s record contraction. …. …The International Monetary Fund, which calls the dynamic “the great divergence,” warns that many developing economies outside the advanced economies and China could languish for years. “This has become the inequality virus,” said Amina Mohammed, deputy secretary-general of the United Nations. “The diverging world we’re hurtling towards is a catastrophe.”…”

BMJ GH Commentary – Flashing red lights: the global implications of COVID-19 vaccination passports K Voigt et al ; https://gh.bmj.com/content/6/5/e006209

“COVID-19 vaccination passport schemes tied to international travel threaten to widen global inequalities and to undermine global solidarity. Until COVID-19 vaccinations are a global public good, accessible to all countries, the global health community should caution against restrictions on international travel based on vaccination status. The interests of citizens of low/middle-income countries must become part of this debate. Global health professionals should engage in domestic policy conversations about vaccination passports because they have global implications.”

BMJ Analysis - Why have so many African leaders died of COVID-19?

JB Falisse, P Nugent et al ; https://gh.bmj.com/content/6/5/e005587

« This paper provides evidence that the COVID-19-related mortality rate of national government ministers and heads of state has been substantially higher than that of people with a similar sex and age profile in the general population, a trend that is driven by African cases (17 out of 24 reported deaths worldwide, as of 6 February 2021). Ministers’ work frequently puts them in close contact with diverse groups, and therefore at higher risk of contracting SARS-CoV-2, but this is not specific to Africa. This paper discusses five non-mutually exclusive hypotheses for the Africa-specific trend, involving comorbidity, poorly resourced healthcare and possible restrictions in accessing out-of-country health facilities, the underreporting of cases, and, later, the disproportionate impact of the so-called ‘South African’ variant (501Y.V2). The paper then turns its attention to the public health and political implications of the trend. While governments have measures in place to cope with the sudden loss of top officials, the COVID-19-related deaths have been associated with substantial changes in public health policy in cases where the response to the pandemic had initially been contested or minimal. Ministerial deaths may also result in a reconfiguration of political leadership, but we do not expect a wave of younger and more gender representative replacements. Rather, we speculate that a disconnect may emerge between the top leadership and the public, with junior ministers filling the void and in so doing putting themselves more at risk of infection. Opposition politicians may also be at significant risk of contracting SARS-CoV-2. »

NYT - Why Is Covid Killing So Many Young Children in Brazil? Doctors Are Baffled https://www.nytimes.com/2021/05/16/world/americas/brazil-covid-child- deaths.html?searchResultPosition=1

“Experts believe Brazil’s overloaded hospital system and uneven access to health care are among the reasons babies and small children are succumbing to the virus at a high rate.”

Lancet Comment - Disease surveillance for the COVID-19 era: time for bold changes O Morgan, T Frieden et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(21)01096-5/fulltext

“The COVID-19 pandemic has exposed weaknesses in disease surveillance in nearly all countries. … … As communities and economies struggle to recover from the consequences of these surveillance deficiencies, now is the time for countries and multilateral agencies to take a hard look at what failed and to act boldly to implement the necessary improvements to disease surveillance. … .. Future disease surveillance should comprise well integrated national systems based on five principles …”

Imperial College – Global report tracks changing health behaviours and attitudes over the past year https://www.imperial.ac.uk/news/221294/global-report-tracks-changing-health-behaviours/

With trends on vaccine hesitancy, trust in health systems, etc. The Conversation - World’s worst pandemic leaders: 5 presidents and prime ministers who badly mishandled COVID-19 S Ganguly, S Greer et al; https://theconversation.com/worlds-worst-pandemic-leaders-5-presidents- and-prime-ministers-who-badly-mishandled-covid-19- 159787?utm_source=twitter&utm_medium=bylinetwitterbutton

“COVID-19 is notoriously hard to control, and political leaders are only part of the calculus when it comes to pandemic management. But some current and former world leaders have made little effort to combat outbreaks in their country, whether by downplaying the pandemic’s severity, disregarding science or ignoring critical health interventions like social distancing and masks. All of the men on this list committed at least one of those mistakes, and some committed all of them – with deadly consequences.”

Modi, Bolsonaro, Trump, Lukashenko & Obrador. All men. And the list could easily be expanded with a few more (men).

The Gender Analysis and COVID-19 Matrix: Utility and usability https://www.genderandcovid-19.org/research/the-gender-analysis-and-covid-19-matrix-utility-and- usability/

“In this blog Alice Murage explores the Gender Analysis and COVID-19 Matrix. She explains how to use the Matrix to rapidly collect and analyse data and how this data can be used in decision-making and in designing larger studies. The Gender Analysis and COVID-19 Matrix is an important analytical tool developed by the Gender and COVID-19 Project to rapidly capture and share a snapshot of gendered impacts of the pandemic across countries and case studies….”

And some links:

The Telegraph - As infections climb, could slow vaccine rollout undermine Asia’s success curbing Covid?

“While the UK and US look forward to lifting restrictions, Asian countries who managed to control transmission are now tightening curbs.”

Covid resources

World Bank – World Bank Support for Country Access to COVID-19 Vaccines

World Bank;

New portal. “As of May 13, 2021, the World Bank Board approved operations to support vaccine rollout in 22 countries amounting to $2.4 billion. See the latest project financing, project documents and procurement information in the list below. More information will be shared here as it becomes available. We expect to reach 50 countries amounting to $4 billion by mid-year….” Bloomberg - More Than 1.45 Billion Shots Given: Covid-19 Tracker https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

Good to keep an eye on the Covid-19 vaccination tracker from Bloomberg from time to time.

The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00684-X/fulltext

This Lancet commission is calling attention to the global burden of cardiovascular disease on women's health.

“Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.”

The report lists 10 recommendations for reducing cardiovascular deaths among women.

Health systems for Health Security

As mentioned, on Thursday a WHO/University of Leeds workshop took place on this concept. Some related reads & info:

WHO - Health systems for health security – Strengthening prevention, preparedness and response to health emergencies S Chungong, G Brown et al; http://apps.who.int/iris/bitstream/handle/10665/341320/WER9619- eng-fre.pdf

“… In March 2019, WHO convened a panel of experts in health systems and health security to define key elements of HSforHS. They achieved consensus that, to attain health security and realize UHC goals, integration of a health system that can deliver an essential set of services with other sectors is necessary … A key outcome of the panel discussion was recognition of the need to urgently establish and advance the notion of “health systems for health security”. The term HSforHS has been used in public health circles for some time, but should now be implemented in countries. Countries that wish to ensure HSforHS will have to develop capacities beyond the requirements of the IHR. To guarantee a comprehensive framework for HSforHS, the WHO benchmarks for IHR capacities, which are actions that countries can take to improve emergency preparedness capacities, would need to be supplemented by the elements of the 6 building blocks of health systems and by interdependent elements essential to health systems and health security in related sectors … Such a framework would be aligned with the increasingly evident dynamic that shows, including in recent experiences in countries, that health security exists only if there are resilient health systems and when the social, economic, commercial and environmental determinants of health are appropriately addressed. Moreover, the HSforHS framework reflects and encompasses known associations between health system strengthening, UHC and health security in global health policies, which have so far remained underdeveloped and nonspecified. … The finalized HSforHS framework illustrates the elements of the health sector and of other sectors that would contribute to health security in each technical area in the IHR. By using the updated WHO benchmarks for IHR, countries will be able to identify comprehensive actions (elements) that would strengthen HSforHS…”

As a reminder: Leeds was chosen by WHO to help create global health strategy

“Leeds has been designated the WHO’s Collaboration Centre on Health Systems for Health Security (HSforHS) and has been tasked with developing and implementing its new HSforHS framework, with the aim of building resilient systems and healthier populations. The framework is the WHO’s response to the worldwide weaknesses in health security exposed by COVID-19. Developed by an interdisciplinary team of experts in medicine, public health, political science and law at the University, it will provide evidence-led guidance to help close gaps in health systems – organisations that deliver healthcare to populations – and enable countries to improve health security by preparing for events such as pandemics and other health risks including antimicrobial resistance….”

“… Following the [Thursday ] workshop, the team at Leeds will conduct a research project reviewing COVID-19 data to identify common findings and recommendations, and test the framework against them.

They will also help develop a HSforHS Return on Investment (RoI) toolkit so that member countries can determine how key investments in health system capacity building can generate long term health security dividends and population health outcomes….”

NCDs

WHO - Long working hours increasing deaths from heart disease and stroke: WHO, ILO https://www.who.int/news/item/17-05-2021-long-working-hours-increasing-deaths-from-heart- disease-and-stroke-who-ilo “Long working hours led to 745 000 deaths from stroke and ischemic heart disease in 2016, a 29 per cent increase since 2000, according to the latest estimates by the World Health Organization and the International Labour Organization published in Environment International today. “

“In a first global analysis of the loss of life and health associated with working long hours, WHO and ILO estimate that, in 2016, 398 000 people died from stroke and 347 000 from heart disease as a result of having worked at least 55 hours a week. Between 2000 and 2016, the number of deaths from heart disease due to working long hours increased by 42%, and from stroke by 19%. This work- related disease burden is particularly significant in men (72% of deaths occurred among males), people living in the Western Pacific and South-East Asia regions, and middle-aged or older workers. Most of the deaths recorded were among people dying aged 60-79 years, who had worked for 55 hours or more per week between the ages of 45 and 74 years. … With working long hours now known to be responsible for about one-third of the total estimated work-related burden of disease, it is established as the risk factor with the largest occupational disease burden. This shifts thinking towards a relatively new and more psychosocial occupational risk factor to human health. The study concludes that working 55 or more hours per week is associated with an estimated 35% higher risk of a stroke and a 17% higher risk of dying from ischemic heart disease, compared to working 35-40 hours a week. “

“Further, the number of people working long hours is increasing, and currently stands at 9% of the total population globally. This trend puts even more people at risk of work-related disability and early death. The new analysis comes as the COVID-19 pandemic shines a spotlight on managing working hours; the pandemic is accelerating developments that could feed the trend towards increased working time….”

WHO calls for 30 kilometer per hour speed limit in cities https://www.dw.com/en/who-calls-for-30-kilometer-per-hour-speed-limit-in-cities/a-57560873

“The global Streets for Life campaign calls for imposing strict speed limits in urban areas. Senior officials at the World Health Organization, including chief Tedros Adhanom Ghebreyesus, joined the appeal. With the UN launching its Global Road Safety Week on Monday, the WHO head Tedros Adhanom Ghebreyesus advocated a speed limit of 30 kilometers per hour in cities and towns….”

Decolonize Global Health

FT Op-ed - Pandemic gives Africa a chance to free itself from aid dependency A Alakijia; https://www.ft.com/content/e2a75e02-e2db-444a-be15-6a0af2b04527

The author is co-chair of the Africa Vaccine Delivery Alliance and former chief humanitarian co- ordinator for Nigeria.

“Unequal access to vaccines reflects an imbalance in global power that must be corrected.” “The US government’s support for intellectual property waivers has opened up possibilities. This seismic shift in positioning has gathered momentum and support for vaccine manufacturing in Africa is growing rapidly. Recent moves by the EU are indicative of strengthening ties between the “twin continents” and signals of significant support for vaccine delivery and manufacturing capacity on the continent will hasten us off the road of dependency. Health security equals lives saved, economies strengthened and jobs secured. The microbe has shown us that in our interdependent, interconnected world, our economic future depends on our ability to respond collectively to health crises, and to do so in a way that corrects the power imbalances of the past. Covid-19 has shown that we Africans must move faster towards real self-sufficiency in diagnostics, therapeutics and vaccine production. No one will help us if we do not attempt to help ourselves. It is time to stop feeding off the scraps from the table of high-income countries….”

Vice - Western Countries Prevented African Nations From Having Their Own Vaccine https://www.vice.com/en/article/epnxd7/africa-covid-vaccine-blocked-by-western-countries

Among others, for these paragraphs:

“Catherine Kyobutungi is a leading Ugandan epidemiologist who serves as the Executive Director of the African Population and Health Research Centre, a think tank devoted to improving healthcare systems across the continent. She told VICE World News that as a global health practitioner, she continues to find herself “on the receiving end of such imbalances.” “We are stuck in a system we can’t get out of which has Western roots, where we have no control over power and resources,” Kyobutungi said. “It’s the same system the entire world operates on, so how do you extricate yourself from that?”. Professor Dicky Akanmori, WHO’s Regional Adviser for Vaccine Research and Regulation, agreed. “We’re attached to the same old funding mechanisms, whereby grants come into Africa from international agencies or foreign governments like the EU or Bill & Melinda Gates Foundation,” Akanmori said. “Funding from within is still woefully inadequate, and if you don’t bring the money, you don’t set the agenda, so our research is driven by the Global North.”

“Kyobutungi and Jumbam are part of an international movement to “decolonise global health,” which aims to dismantle age-old racially oppressive structures in medical research and development. Both agree that in order to achieve more medical autonomy, African governments must recognise the value of self-sufficiency, and prioritise investments in healthcare and research. “We need to get our governments to see value in investing in African resources,” Kyobutungi said. “The missing link here is sustained engagement between the research community and those who hold the purse strings.”

“… “There's no debate over the remarkable role GAVI has played, but it hasn’t helped to encourage the kind of competition that would drive research and development on the continent. The evolving landscape requires introspection.... and now is the time for GAVI to reflect on a broader contribution it can make to incentivise and free up the markets in Africa," he explained. …”

Nature Editorial – Tackling systemic racism requires the system of science to change https://www.nature.com/articles/d41586-021-01312-4 “In response to the global Black Lives Matter protests, many institutions pledged actions to combat racism. That’s not enough.”

Lancet Perspective – An ironic guide to colonialism in global health S Chigudu; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01102-8/fulltext

Review of Eugene Richardson’s book, “Epidemic Illusions: On the Coloniality of Global Public Health”.

And a link:

• GHDM - Pragmatic approaches to decolonizing Global Health in Africa

“A guide for global health practitioners and organisations in High-Income Countries. This document presents “common-sense” approaches to decolonising global health practice. It specifically speaks to various categories of global health stakeholders based in high-income countries (HIC) with respect to their activities in or about Africa. Given that the approaches mentioned in this document are founded on general principles of diversity, inclusion, and equity, we believe that they could also be applied with respect to other persons or groups that are Underrepresented in Global Health (UIGH). “

Digital health

Global Policy - Avoiding the Road to Nowhere: Policy Insights on Scaling up and Sustaining Digital Health Amnesty LeFevre, A George et al ; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12909

“Digital health solutions offer tremendous potential to enhance the reach and quality of health services and population‐level outcomes in low‐ and middle‐income countries (LMICs). While the number of programs reaching scale increases yearly, the long‐term sustainability for most remains uncertain. In this article, as researchers and implementors, we draw on experiences of designing, implementing and evaluating digital health solutions at scale in Africa and Asia, and provide examples from India and South Africa to illustrate ten considerations to support scale and sustainability of digital health solutions in LMICs. Given the investments being made in digital health solutions and the urgent concurrent needs to strengthen health systems to ensure their responsiveness to marginalized populations in LMICs, we cannot afford to go down roads that ‘lead to nowhere’. These ten considerations focus on drivers of equity and innovation, the foundations for a digital health ecosystem, and the elements for systems integration….” SDGs

IISD - Secretary-General’s SDG Progress Report Recaps Pandemic Impacts on 17 Global Goals IISD;

“The advance unedited version of the 2021 report on ‘Progress towards the Sustainable Development Goals’ has been released. It includes several paragraphs on the status of each SDG, to inform discussions during the July 2021 session of the HLPF. Governments should use COVID-19 recovery to adopt low-carbon, resilient and inclusive development pathways that will reduce carbon emissions, conserve natural resources, create better jobs, advance gender equality and tackle growing inequities.”

“The report will inform discussions during the July 2021 session of the UN High-level Political Forum on Sustainable Development (HLPF). … The report begins by stressing that even before the COVID-19 pandemic, SDG progress was not on track. Progress towards the Goals was not occurring fast enough for achievement by 2030, and was even stalled or moving backwards in some areas. According to the report, the world’s collective response in the next 18 months will determine whether the pandemic turns out to be a “much-needed wake-up call.”…”

PS: “On Goal 3 (good health and wellbeing), the report finds that essential health services are still disrupted in 90% of countries. The most affected include services for: mental, neurological, and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; cancer and other non-communicable diseases; and family planning and contraception.”

Planetary Health

BMJ Feature - How Wellcome’s opaque fossil fuel investments harm its global health mission

Tim Schwab; https://www.bmj.com/content/373/bmj.n1202

“The Wellcome Trust’s commitment to tackle the health impacts of carbon emissions is threatened by its own lingering investments in the fossil fuel industry. So why does it continue to shun calls to divest while raising the status of climate change in its strategy? Tim Schwab reports.”

“… Wellcome’s website features an animated video describing its work on climate change and offering several solutions, including, “We need to switch from fossil fuels to clean renewable energy.” That may not sound like a particularly bold proposal in this day and age, but it is for Wellcome, which has long faced criticism about its £28bn (€32.5bn; $39.6bn) endowment’s deep investments in fossil fuels. This includes a stake of more than £300m that the trust currently holds in BP and Shell. …. But The BMJ has found that Wellcome’s financial stake in the continued use of fossil fuels extends well beyond its shareholder positions in oil and gas companies. In recent tax filings in the United States, Wellcome reported more than $130m (£92m; €107m) in deductible “qualified expenses” related to “intangible drilling” costs from 2014 to 2018. …” PS: Also some info/analysis in this article on the Gates Foundation and its divestment.

Dynamic WHO dashboard for island states highlights barriers and progress on climate change and health https://www.who.int/news/item/18-05-2021-dynamic-SIDS-report-climate-change-health

“… A new Small Island Developing States (SIDS) dynamic data dashboard, launched today, illustrates the progress made by island states to date in responding to the health threats of climate change. The interactive dashboard, presenting data from the WHO UNFCCC Health and Climate Change Country Profiles, visualises key health and climate change indicators to empower SIDS policy makers to: Assess the implementation of policies and plans; Identify gaps in evidence; Better understand the barriers to achieving health adaptation and mitigation priorities, including for implementation and monitoring….”

Guardian - No new oil, gas or coal development if world is to reach net zero by 2050, says world energy body https://www.theguardian.com/environment/2021/may/18/no-new-investment-in-fossil-fuels- demands-top-energy-economist

“Exploitation and development of new oil and gas fields must stop this year and no new coal-fired power stations can be built if the world is to stay within safe limits of global heating and meet the goal of net zero emissions by 2050, the world’s leading energy organisation has said. In its strongest warning yet on the need to drastically scale back fossil fuels, the International Energy Agency (IEA) also called for no new fossil-fuel cars to be sold beyond 2035, and for global investment in energy to more than double from $2tn (£1.42tn) a year to $5tn (£3.54tn) The result would not be an economic burden, as some have claimed, but a net benefit to the economy. “

“… Birol made it clear that the technology needed to reach net zero is neither blue-sky nor futuristic. He said: “These technologies are already invented, but not yet in full development. Innovation is critical, but the technologies are here with us.” … … The crucial new technologies in development are: advanced batteries, particularly for use in electric vehicles; hydrogen; and carbon capture. These will be needed because some sectors are especially hard to decarbonise, such as steel and cement manufacturing, aviation and shipping, and those using heavy-duty road vehicles. Birol said that most of the rest of the global economy could be decarbonised using economical technologies that are already in widespread use, such as wind and solar power….”

Guardian -Climate disasters ‘caused more internal displacement than war’ in 2020 https://www.theguardian.com/global-development/2021/may/20/climate-disasters-caused-more- internal-displacement-than-war-in-2020

“Intense storms and flooding triggered three times more displacements than violent conflicts did last year, as the number of people internally displaced worldwide hit the highest level on record. There were at least 55 million internally displaced people (IDPs) by the end of last year, according to figures published by the Norwegian Refugee Council’s Internal Displacement Monitoring Centre (IDMC). There were more than twice as many people displaced within their own country as forced out of their country as refugees, the IDMC said. ….”

African summit on Covid-19 financing (18 May, Paris)

FT - France hosts push for post-pandemic recovery in Africa FT;

Analysis ahead of Tuesday’s summit in Paris.

“Rich countries have been accused of doing far too little to help lower-income nations cope with the scourge of Covid-19… This week, France and the EU will attempt to change that narrative with a pair of summits aimed at addressing the wider fallout from the pandemic beyond their shores. First up is Emmanuel Macron, the French president, who convenes a summit for Africa in Paris today to launch what his advisers have called a multibillion-dollar “New Deal” for the continent. Among those attending the summit will be the presidents of South Africa, Nigeria, Kenya, Ethiopia, Angola, Mozambique, the Ivory Coast and the Democratic Republic of Congo, French officials said. The objective, said one of Macron’s advisers, is to go beyond existing instruments used by the World Bank and the IMF to help African economies. Among the ideas is extra help for the African private sector, “which has been the big motor of African growth in the past 20 years and which we think has suffered from the effects of the pandemic and needs to scale up and find access to funding”. An EU official said European Commission president Ursula von der Leyen will announce a European initiative at the summit to invest in young businesses in Africa. Its goal will be to help small and medium-sized companies take off and create jobs through technical and financial support…”

As a reminder, the IMF estimates that SSA needs 350 billion euros till 2025 to get out of the pandemic crisis.

Reuters – France, African leaders push to redirect $100 bln in IMF SDR reserves by October https://www.reuters.com/world/africa/macron-hosts-summit-financing-africas-post-pandemic- recovery-2021-05-18/

“French President Emmanuel Macron said on Tuesday a summit in Paris on Africa financing had agreed to work towards persuading rich nations by October to reallocate $100 billion in IMF special drawing rights monetary reserves to African states.” (i.e. up from up from the $33 billion originally foreseen.)

“Impoverished African economies must not be left behind in the post-pandemic economic recovery and a substantial financial package is needed to provide much-needed economic stimulus, African and European leaders concluded at a summit in Paris. In the immediate term, that meant accelerating the COVID-19 vaccine rollout and creating the fiscal breathing room for African nations, which will face a spending shortfall of some $285 billion over the next two years, the summit communique showed….” PS: via IMF – “Our new estimate is that Africa needs additional financing of around $285 billion for COVID response through 2025. “

The World Bank committed $150b in African investment over the next 5 years.

PS: as already mentioned in the intro, the acceleration of vaccination on the continent was also high on the agenda: participants agreed to push the ambition of Covax from 20 % till 40 % of vaccinated people in Africa, from 2021 on thanks to the transfer of doses. In the medium term, via setting up manufacturing capacity.

Related links:

East African - France to host African Summit on Covid-19 financing

Other news of the week

Ecofin agency - African countries need more fiscal space to better cope with the challenges caused by the Covid-19 pandemic (Alassane Ouattara) https://www.ecofinagency.com/public-management/1205-42630-african-countries-need-more- fiscal-space-to-better-cope-with-the-challenges-caused-by-the-covid-19-pandemic-alassane- ouattara

“Ivorian President Alassane Ouattara (photo) was the guest of a virtual debate organized on the occasion of the 60th anniversary of the Africa Department of the International Monetary Fund (IMF) last May 10. During his speech, the former official of the Bretton Woods institution made a strong plea for an in-depth reform, and an improvement of the measures taken to help African countries get out of the Covid-19 crisis.”

“According to the Ivorian head of state, African countries need the necessary fiscal space to finance their economic recovery processes. In this regard, he asked the IMF to be flexible regarding the rate of public deficit required of African states wishing to benefit from financing from the institution. "The deficit-to-GDP ratio is 9% in the USA and nearly 8% in France. Germany, which has always been a surplus country, will this year record a deficit of 6%. However, in the context of our trade, African countries are required to be at 4%. This is impossible," he said. "If the IMF continues to be rigid on deficit issues for poor countries during this period of pandemic, I'm sorry Ms. Georgieva, but you will have problems with all countries. We cannot accept that France, for example, has a deficit of 8% and that Côte d'Ivoire is forced to have a deficit of 4%. It is not sustainable.”

WHO - WHO issues new guidance for research on genetically modified mosquitoes to fight malaria and other vector-borne diseases https://www.who.int/news/item/19-05-2021-who-issues-new-guidance-for-research-on-genetically- modified-mosquitoes-to-fight-malaria-and-other-vector-borne-diseases “New guidance from the World Health Organization (WHO) sets essential standards to inform future research and development on genetically modified mosquitoes, particularly in addressing issues relating to ethics, safety, affordability and effectiveness. … The guidance framework for testing genetically modified mosquitoes, developed in partnership with TDR, the Special Programme for Research and Training in Tropical Diseases, and the GeneConvene Global Collaborative, an initiative of the Foundation for the National Institutes of Health, describes best practices to ensure that the study and evaluation of genetically modified mosquitoes as public health tools is safe, ethical and rigorous….”

UNICEF - In a first, Ministries of Education and Health from more than 20 African countries link up to discuss keeping schools safe and open during COVID-19 https://www.unicef.org/esa/press-releases/african-ministries-discuss-keeping-school-open

“Today, the UN Children’s Fund (UNICEF), the World Health Organization (WHO) and the Global Partnership for Education (GPE) will co-convene a virtual dialogue with Ministries of Health (MoH) and Ministries of Education (MoE) on COVID-19 and keeping schools safe and open. For the first time, representatives from the two ministries from over 20 countries across Eastern and Southern Africa will join to share the latest knowledge and best country practices, as well as put in place action plans that are key for keeping learners and teachers safe, and institutions open….”

Papers and reports of the week

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

Most of the articles we already flagged when ‘early online’.

For the new ones, do have a look at Family planning in COVID-19 times: access for all (by Marleen Temmerman, who comments on a few new research papers in the Lancet Global Health.

And a research article: Geographical distribution of fertility rates in 70 low-income, lower-middle- income, and upper-middle-income countries, 2010–16: a subnational analysis of cross-sectional surveys There’s substantial within-country variation in the distribution of fertility rates

Global Health Governance (special issue) - Special Symposium Issue 2021: Global Health Justice and Governance https://blogs.shu.edu/ghg/files/2021/05/Spring-2021-Issue.pdf

Guest editor Benjamin Mason Meier introduces this special issue, ‘Global Health Justice as a foundation for the future of global health governance’. “Global Health Justice and Governance offers a theory of shared health governance that calls for a universal vision of health through the merging of common values among global, national, and local actors. … Jennifer Prah Ruger contends that global and national responses to health governance must be grounded in moral and ethical claims about health. These claims build upon her previous work, Health and Social Justice, which submits a theory of “health capability” that centers the right to health and the necessary means to achieve health by focusing on issues at the intersection of economics, ethics, and politics. From the deeply theoretical to the highly practical, Prah Ruger’s new vision of global health justice analyzes the current public health problems of a globalized world, frames the norms by which global health policy should be structured, examines the current global health architecture, and proposes novel institutions to reconceptualize global health governance. This ethics-based focus on governance will not only allow global health actors to design solutions rooted in respect for public health, but will help realize accountability for achieving global justice. In confronting a cataclysmic pandemic in the absence of global leadership, such a vision of shared health governance is crucially necessary in charting a path forward global health governance. This special issue of Global Health Governance seeks to evaluate the global health governance implications and applications of Global Health Justice and Governance…”

BMJ GH (Editorial) - A priori registration of global health research—necessity or absurdity? E A Eboreime & S Abimbola; https://gh.bmj.com/content/6/5/e006199

The latest BMJ Global Health Editorial.

Nursing Now Final Report https://www.nursingnow.org/nursing-now-final-report/

“The story of the Nursing Now campaign is of nurses and their allies coming together around the world, growing in influence, and building a platform for improving health and health care for the future. There are now more than 800 independent and self-funding Nursing Now groups in 126 countries and more than 31,000 young nurses and midwives have participated in the Nursing Now ‘Nightingale Challenge’ … … The core message of this report, and the whole Nursing Now campaign, is that nurses are vital agents of change who can improve health and transform health care. Governments that want to see health improvements reaching every part of their populations – and leaving no one behind – need to invest in nursing and enable nurses to work to their full potential. … The aim of the Nursing Now campaign was to improve health globally by raising the status and profile of nursing; and it is a health campaign as much as it is a nursing one. … The campaign was run in association with the WHO and the International Council of Nurses (ICN).”

“…the most remarkable achievements have been national, where Nursing Now groups have influenced policy and investment in many countries … …. The combination of global, national and local action has created a social movement with energy, momentum and enormous reach. It has been immeasurably helped by social media and digital technology, bringing people together, creating digital communities and enabling anyone anywhere to spread ideas and innovation and start their own campaign for local and global improvements in nursing. It has also brought nurses together, sometimes for the first time, built confidence and strengthened links with partners and allies outside of nursing.” Conflict & Health - Introduction to collection: confronting the challenges of health research in humanitarian crises A Mistry et al; https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-021-00371-8

“Humanitarian crises, such as armed conflict, forced displacement, natural disasters, and major disease outbreaks, take a staggering toll on human health, especially in low-resource settings. Yet there is a dearth of robust evidence to inform the governments, non-governmental organizations (NGOs), and other humanitarian organizations on how to best respond to them. The Fogarty International Center of the U.S. National Institutes of Health commissioned a collection of Research in Practice articles that highlights the experiences of scientists conducting research in the context of humanitarian crises. Unlike traditional research papers, the case analyses in this collection go beyond what research was completed and focus on why the research was important and how it was conducted in these extremely challenging settings. The papers selected for this collection span 27 countries, cover a broad range of humanitarian crises, and discuss a wide variety of disease and health risk factors. …”

Berkeley Public Health - Study Finds Private Equity Investment Accelerates Concentration and Undermines a Stable, Competitive Healthcare Industry https://www.antitrustinstitute.org/work-product/study-finds-private-equity-investment-accelerates- concentration-and-undermines-a-stable-competitive-healthcare-industry/

“A decade’s worth of evidence supports troubling findings that private equity business practices have a negative impact on competition in healthcare and on patients. A new white paper, produced by experts at the American Antitrust Institute (AAI) and UC Berkeley, calls for immediate attention to the role that private equity investment plays in harming patients and impairing the functioning of the healthcare industry. In this groundbreaking new white paper, Soaring Private Equity Investment in the Healthcare Sector: Consolidation Accelerated, Competition Undermined, and Patients at Risk, AAI’s Laura Alexander and Professor Richard Scheffler of The Nicholas C. Petris Center on Health Care Markets and Consumer Welfare in the School of Public Health at UC Berkeley detail the emerging threat posed by private equity investment in healthcare markets….”

Action Aid (report) - Mission Recovery: How Big Tech’s Tax Bill could kickstart a fairer economy https://actionaid.org/sites/default/files/publications/Mission%20Recovery_ActionAid%20Tax%20Re port%202021.pdf

“New research by ActionAid shows that G20 countries may be losing as much as US$32bn annually in taxes from just five of the world’s largest tech companies. That could have paid for a full two- dose Covid-19 vaccination for every human on earth.”

And some links:

HP&P - An innovative leadership development initiative to support building everyday resilience in health systems (by J Nzinga, S Mollyneux et al) Blogs of the week

The Conversation - COVID-19 could be the end of ‘global health’ as we know it

C McInnes; https://theconversation.com/covid-19-could-be-the-end-of-global-health-as-we-know-it- 161119

“The “liberal vision of global health – one which held that the rich had responsibilities to the rest of the world, and progress was possible through cooperation – was already in trouble prior to COVID….” “…COVID-19 has thrown into sharp relief the current weaknesses of the global health project. During the most serious pandemic in living memory, the response has been dominated by national concerns and policies….”

“…this time around there has been no question that leadership on COVID-19 would come from anywhere except national governments.” “…COVID-19 has demonstrated that, in a time of crisis, the rich and powerful fell back to national approaches with only secondary concerns for the global health good. But since national health outcomes appear still to be inextricably linked to global developments, the need to rebuild global health after COVID is more pressing than ever.”

Some tweets of the week

Rachel Silverman “Just an awful situation. For Africa. For India. For everyone. But, of course, for some more than others. This must be a "never again" moment. We need to set up enough manufacturing capacity for everyone, on every continent. It's a prudent investment in our shared future.”

Ursula von der Leyen “We must support Africa in building up its own health industries and infrastructure. #TeamEurope will launch an initiative to help scale-up vaccine manufacturing in Africa, to empower countries to produce vaccines themselves.”

Matthew Kavanagh “why, in all that is good, would we task @IMF with assessing pandemic preparedness? very few institutions more responsible for undermine public health capacity in LMICs [receipts ] Panel must be shopping for a venue with teeth... Instead let’s give WHO & global health power?”

Raffaella Ravinetto “We learnt it during the #HIV #access crisis 20 years ago: reliance on a single #supplier is risky for national #pharmaceutical #SupplyChain, irrespective of who the supplier is. We need multiple suppliers, to make #CovidVaccine #availabe to all “ Anna Marriott (Oxfam) “As G20 leaders meet at the Global Health Summit they should consider how history will judge them for leaving the decisions of who lives and who dies in the hands of just a handful of hugely profitable and powerful pharmaceutical corporations.”

Spring Gombe “this deadly game of shifting goalposts: if proposed solution is a pandemic treaty, say goal is to use TRIPS flexibilities; if they say OK, waiver, say new goal is patent pools; if they say but C-TAP, say moves underway for a pandemic treaty; patronize, rinse, repeat, count bodies.”

Manuel Martin “IP fundamentalism is saying that there should be no exception to monopolies, not even in a pandemic with millions of deaths around the world. Make no mistake, that is exactly what the European Commision is saying right now and it needs to change. #TRIPSwaiver”

Global health events & announcements

WHO Alliance - Call for proposals Mentor institute – Strengthening HPSR capacities in francophone Africa https://ahpsr.who.int/docs/librariesprovider11/calls-for-proposals/year/2021/alliance-rfp-mentor- institute-fraocophone-africa.pdf?sfvrsn=5a7a48c5_5

Great opportunity. Deadline: 9 June!

Global governance of health

BMJ GH Commentary - How can we strengthen the Joint External Evaluation?

D Stowell & R Garfield; https://gh.bmj.com/content/6/5/e004545

“The COVID-19 pandemic raises fundamental questions about the appropriateness of the International Health Regulations and the effectiveness of the Joint External Evaluation (JEE) for strengthening global health security. In the wake of COVID-19, revision of JEE tool should be based on an understanding of the purpose, use and limitations of the measurement tool. Successfully strengthening the tool will necessitate countries to take action on the results of the assessment as well as addressing certain strategic, technical and operational considerations in the next edition of the tool.” Lancet Correspondence - HERA: a new era for health emergency preparedness in Europe? S Villa et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01107-7/fulltext

“… the EC proposed to create a new agency devoted to well organised stockpiling of preparedness and response tools as countermeasures: the European Health Emergency Preparedness and Response Authority (HERA). … We believe HERA should embrace the global dimension of health threats and the three main components of preparedness (ie, risk assessment, risk management, and risk communication), in close collaboration with other existing EU agencies (eg, the European Centre for Disease Prevention and Control [ECDC] and the European Medicines Agency [EMA]) and relevant non-EU agencies (eg, WHO), in a five-prong bundled model (panel)….”

And a link:

Devex - Q&A: Build ‘better, bolder, and bigger’ health systems, says Africa CDC (on what John Nkengasong understands under the ‘New Public Health order’.

UHC

BMC Health Services - Implementation research approaches to promoting universal health coverage in Africa: a scoping review C A Nnaji et al ; https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-021- 06449-6.pdf

“…this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa…”

Cochrane Review - Paying for performance to improve the delivery of healthcare services in low- and middle-income countries what are the effects? https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/PDF_summaries/payforperf ormance_lmic.pdf

Summary (2-pager).

Lancet Editorial – Lessons from the NHS for UHC and health security https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01056-4/fulltext

“…Broader concepts of health and wellbeing must be placed at the centre of government policy. Investment in public services that reduce inequality is necessary to maintain and improve population health and protect the UK population from future health threats. Lessons from the UK and the NHS show that universal health coverage is broader than health-care provision alone, and that a healthy population must be considered a prerequisite for health security and preparedness.”

Planetary health

Guardian - Twenty firms produce 55% of world’s plastic waste, report reveals https://www.theguardian.com/environment/2021/may/18/twenty-firms-produce-55-of-worlds- plastic-waste-report-reveals

« Twenty companies are responsible for producing more than half of all the single-use plastic waste in the world, fuelling the climate crisis and creating an environmental catastrophe, new research reveals. The Plastic Waste Makers index reveals for the first time the companies who produce the polymers that become throwaway plastic items, from face masks to plastic bags and bottles, which at the end of their short life pollute the oceans or are burned or thrown into landfill….”

Guardian - Greenland ice sheet on brink of major tipping point, says study https://www.theguardian.com/environment/2021/may/17/greenland-ice-sheet-on-brink-of-major- tipping-point-says-study

“A significant part of the Greenland ice sheet is on the brink of a tipping point, after which accelerated melting would become inevitable even if global heating was halted, according to new research….”

Infectious diseases & NTDs

BMC Health Services - Effects of transition on HIV and non-HIV services and health systems in Kenya: a mixed methods evaluation of donor transition

D Rodriguez et al ; https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021- 06451-y

“In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities….”

CSIS report – Five Years of DREAMS and What Lies Ahead: How to Address the Intersecting Crises of HIV, Gender Inequality, and Health Security https://www.csis.org/analysis/five-years-dreams-and-what-lies-ahead “On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS— Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. …. …. A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19….”

NCDs

SS&M - Women’s suicide in low-, middle-, and high-income countries: Do laws discriminating against women matter? Z Cai et al ; https://www.sciencedirect.com/science/article/abs/pii/S0277953621003671

“Women’s suicide is a serious public health issue in low- and middle-income countries (LMIC). This study explored whether institutional discrimination against women, as manifested in formal and informal laws, is relevant to country’s income-level variability in women’s suicide mortality. It also examined which discriminatory laws are associated with LMIC women’s suicides….”

Links:

New OECD report - Governments should step up their efforts to tackle harmful alcohol consumption

Sexual & Reproductive / maternal, neonatal & child health

BMJ blog - It takes the whole health system to improve quality of care for mothers and newborns

B Maliqi et al ; BMJ blog;

“A new WHO report on improving quality of care for maternal, newborn, and child health argues that it takes time to bring about changes in quality of care .”

HPW - Intestinal Worm Infection Can ‘Predispose Women To Viral STIs’ https://healthpolicy-watch.news/intestinal-worms-predisposes/

“New research has found that intestinal worm infections may put women at increased risk of sexually transmitted viral infections (STIs) – a discovery that researchers hope will help health workers to explain why STIs can be more virulent in areas such as sub-Saharan Africa, where worm infections are common. The study, published in Cell Host and Microbe, discovered that intestinal worm infection can change and increase the likelihood of Herpes simplex virus type 2 (HSV-2) infection, which is the main cause of genital herpes….”

Science (Policy Forum) – The impact of early childhood interventions on mothers David Evans et al ; https://science.sciencemag.org/content/372/6544/794

“Failure to measure the impacts on women's time and other maternal outcomes implicitly sets their value at zero.”

Access to medicines

CGD - How Does the Market for Vaccines Work? A McDonnell et al ; https://www.cgdev.org/blog/how-does-market-vaccines-work

“Effective vaccines are developed through collaboration between governments, publicly funded research universities and for-profit pharmaceutical companies. But the incentives to produce the doses can often leave out lower-income countries…”

Link:

BMJ Global Health - When technology precedes regulation: the challenges and opportunities of e- pharmacy in low-income and middle-income countries

Human resources for health

UNFPA - The State of the World’s Midwifery 2021 https://www.unfpa.org/sowmy

« The State of the World’s Midwifery (SoWMy) 2021 presents findings on the Sexual, Reproductive, Maternal, Newborn and Adolescent Health (SRMNAH) workforce from 194 countries. The report, produced by UNFPA, the International Confederation of Midwives (ICM), the World Health Organization (WHO) and Novametrics, shows the progress and trends since the inaugural 2011 edition and identifies the barriers and challenges to future advancement. The report establishes a global shortage of 1.1 million SRMNAH workers, the largest shortage (900,000) being midwives….”

And a link:

Human Resources for Health - Global trends in medical education accreditation. Miscellaneous

Nature News - Open-access publisher PLOS pushes to extend clout beyond biomedicine https://www.nature.com/articles/d41586-020-01907- 3?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

“The publisher will launch five new journals, and has introduced a new business model that aims to spread the cost of publishing more fairly.”

Science News - Two more coronaviruses can infect people, studies suggest https://www.sciencemag.org/news/2021/05/two-more-coronaviruses-can-infect-people-studies- suggest

“Research increases worry about the pandemic potential of other members of the virus family.”

Lancet World Report – $6·5 billion proposed for new US health research agency https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01150-8/fulltext

“The Advanced Research Projects Agency for Health would fund high-risk, high-reward medical research, but its short-term planning could stymie basic research. Susan Jaffe reports.”

Extra Covid section

World Development - The timing and aggressiveness of early government response to COVID-19: Political systems, societal culture, and more

M Nelson; https://www.sciencedirect.com/science/article/abs/pii/S0305750X21001650

“Factors that drove the early timing and strictness of government closure and containment responses to COVID-19 for 150 countries are examined. Authoritarian regimes tended to have weaker policy response than democratic regimes initially but pursed more aggressive policies later on. Unitary regimes tended to have stronger policy measures early on after the pandemic hit relative to federalist states but relaxed them sooner. The policy response of countries with greater freedom and those spending less on public health started slow but caught up in around three months….”

HPW - Rural India’s Hidden Pandemic: COVID-19 Spreads Unchecked, Cases and Deaths Under-Reported https://healthpolicy-watch.news/in-rural-india-covid-19-spreads-unchecked/ “India’s second wave is devastating the country’s rural areas where health infrastructure is rickety and a lack of trained healthcare workers, government support and access to healthcare is likely to worsen the spread of the COVID-19 pandemic. Health experts believe the number of new COVID-19 cases and deaths are vastly underreported and that strict lockdown regulations and amping up vaccinations will be the key to help curb a possible third wave….”

World Politics review - Reckoning With the Pandemic’s Second-Order Impacts J Youde; https://www.worldpoliticsreview.com/articles/29647/reckoning-with-the-pandemic-s- second-order-impacts

“… An outbreak of this magnitude also prompts leaders to make far-reaching policy decisions that have significant first-order impacts—the immediate consequences of their actions—as well as second-order impacts, which are the consequences of those consequences. Second-order impacts often play out in both positive and negative ways that are difficult to anticipate, and their outcomes can linger unexpectedly. …. In the global health realm, we are starting to see the second-order effects of COVID-19, and many of them are cause for concern….”

The ones listed here are: Losing progress in other areas; funding; effect on chronic diseases; increased use of telemedicine; opportunities for reform.

Guardian - Long Covid symptoms ease after vaccination, survey finds https://www.theguardian.com/society/2021/may/18/long-covid-symptoms-ease-after-vaccination- survey-finds

“Covid-19 vaccines tend to alleviate the symptoms of long Covid, according to a large survey of more than 800 people that suggests mRNA vaccines, in particular, are beneficial….”

BMJ GH (blog) - COVID-19 vaccination in India: we need equity B Baumik ; https://blogs.bmj.com/bmjgh/2021/05/18/covid-19-vaccination-in-india-we-need- equity/

Quote: « … India needs to prioritise people “who matter and are in need” over the “rich and elite”. Vaccination of non-priority people in 18-45 years of age, should be stopped until adequate coverage of priority groups is acquired. A moral, social, and human rights lens is essential for the purpose. Younger people with mental health conditions, informal sanitation and cremation workers, families of frontline workers and healthcare workers, hawkers, home-delivery workers, prisoners , homeless people, people living in slums and field journalists who are at higher risk need to be under priority groups….”

Reuters – Big pharma and private equity seek healthy returns in Europe's east Reuters;

“ In the race to supply vaccines to end the COVID-19 pandemic, U.S. drug developer Novavax turned to emerging Europe to speed up production with a pair of deals that endorsed a growing trend for consolidation in the region. As part of a doubling in merger activity, buoyed by a combination of private equity and big pharma, Novavax (NVAX.O) bought the Praha Vaccines factory near Prague in a $167 million transaction last May. It followed up by partnering with Polish biotech company Mabion (MABP.WA) in March…. … The pharmaceutical industry focused around Czech Republic, Hungary and Poland is dwarfed by that of nearby Germany, but industry insiders and analysts see scope for growth based on moderate costs and an expectation of higher healthcare spending, as well as a scientifically educated workforce….”

BMJ Feature - Covid-19: How the Brazil variant took hold of South America https://www.bmj.com/content/373/bmj.n1227

“Brazil has long been a pariah in the pandemic, but the consequences of its failure to control SARS- CoV-2 are manifesting across Latin America, writes Luke Taylor.”

Globalization & Health – How does globalization affect COVID-19 responses? S Bickley et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021- 00677-5

“…This paper examines the role of globalization on the pace of adoption of international travel- related non-pharmaceutical interventions (NPIs) during the coronavirus pandemic….”

“….The results of our survival analysis suggest that, in general, more globalized countries, accounting for the country-specific timing of the virus outbreak and other factors, are more likely to adopt international travel restrictions policies. However, countries with high government effectiveness and globalization were more cautious in implementing travel restrictions, particularly if through formal political and trade policy integration….”

Cidrap News – Nearly 1 million excess deaths in 29 nations during pandemic https://www.cidrap.umn.edu/news-perspective/2021/05/nearly-1-million-excess-deaths-29-nations- during-pandemic

“Nearly 1 million more people than normal died in 29 high-income countries during the COVID-19 pandemic in 2020, according to a time series study yesterday in BMJ….”

Links:

Devex - Guatemala to get 2nd Sputnik shipment as COVAX struggles to meet demand