Health workers in Cape Town, South Africa, getting vaccinated against COVID-19 in March 2021.

Pharmaceutical giant Janssen/Johnson & Johnson (J&J) and generic manufacturer Serum Institute of India (SII) charged the South African government more than the European Union for COVID-19 vaccines – and South Africa assumed all the risk in ‘take-it-or-leave-it’ contracts with Pfizer, J&J and SII.

This is according to an analysis of the contracts led by Health Justice Initiative (HJI), a South African NGO that won a court challenge last month to get access to all South Africa’s COVID-19 vaccine contracts.

J&J charged South Africa $10 a dose, 15% more than the company charged the European Union (EU), and the government was required to pay a non-refundable down payment of $27.5 million.

Pfizer also charged $10 a dose, which is 32.5% more than the $6.75 “cost price” it reportedly charged the African Union. South Africa was required to pay $40 million in advance, only half of which was refundable.

SII was to have charged South Africa $5.35 a dose for Covishield, its generic version of  AstraZeneca – which was 2.5 times more than it charged the EU. However, South Africa suspended its order over safety concerns related to the vaccine.

This is according to a media release issued on Tuesday by HJI and a group of medicines access advocates that analysed the first batch of contracts given to HJI since the court judgment.

Meanwhile, the exact price of vaccines supplied via the global COVID-19 vaccine access programme, COVAX, administered by Gavi, was “unclear” according to the group, but COVAX’s “all-inclusive weighted average estimated cost per dose” was $10.55.

In total, South Africa would have been liable for $734 million for COVID-19 vaccines including advance payments of $ 94 million.

‘Ransom negotiations’

HJI director Fatima Hassan

“The terms and conditions in these contracts and agreements are so one-sided, and so in favour of multinational corporations that they beggar belief,” said HJI director Fatima Hassan at a media briefing on Tuesday. 

“[The contracts] has placed governments, including South Africa and other countries in the Global South, in the unenviable position of having to secure scarce supplies in a global emergency in a manner which basically can only be described as a set of ransom negotiations,” added Hassan. 

“There was so much secrecy, no transparency, and very little leverage against late or no delivery of supplies when South Africa was really waiting for supplies and needing them.”

Vague delivery terms for J&J 

Jay Kruuse, director of South Africa’s Public Service Accountability Monitor (PSAM), said that the J&J vaccine contracts – which also involved Belgian company Janssen – were characterised by “very vague delivery terms”, which meant that South Africa had “very little leverage over the arrival time of doses”.

In addition, there were “extensive confidentiality conditions” and indemnity clauses, said Kruuse. 

The J&J vaccines were the first vaccines South Africa was able to buy and were prioritised for health workers and delivered via a mass clinical trial before the vaccine was authorised in the country.

Jay Kruuse, director of the Public Service Accountability Monitor (PSAM) in South Africa.

Pfizer’s ‘sweeping indemnity provisions’

Addressing the Pfizer contract, Canadian professor Mathew Herder said that the provisions “shift virtually all of the risk, all of the cost, and all of the burden onto the South African government, which at the time this deal was struck back in early 2021 had virtually no vaccines for the country’s people”.

Herder, who directs the Health Law Institute at Dalhousie University, described some of the contract’s provisions as “extreme” and “far more in Pfizer’s favour compared to some of the other deals I’m familiar with”.

“The contract does not guarantee that Pfizer will actually deliver any vaccines to South Africa and in the event that they don’t actually deliver, the most the South African government can recoup is 50% of the advance payment they were required to make under the contract,” said Herder. 

The contract refers to Pfizer making “commercially reasonable efforts” to deliver the vaccine whereas EU agreements refer to “best reasonable standard”, which is a higher standard to be met. 

“Why? Because the commercially reasonable thing to do is the most profitable thing to do so if it generates more returns to deliver elsewhere first, that is perfectly fine under the Pfizer-SA contract,” said Herder.

Mathew Herder, director of the Health Law Institute at Dalhousie University in Canada.

“Sweeping indemnification provisions” required the South African government to hold Pfizer ‘harmless of any and all claims against it’ and to “bear the costs of any product recalls if that needed to happen down the road”, said Herder. 

Pfizer also required the South African government to “set up a vaccine injury compensation programme as a condition precedent for delivering any of the vaccines that were contracted for”, he added. 

“These provisions shift virtually all of the risk all of the cost all of the burden onto the South African government, which at the time this deal was struck back in early 2021. had virtually no vaccines for the country’s people. So that certainly feeds into this very strong impression we have from reading the contract says as a group, that it was a very one-sided endeavour in the company’s favour.

COVAX ‘failed’ South Africa

“The COVAX programme was set up to equalise access and to be equal it needed to be both timely and in sufficient quantity. And if we look at what happened with Gavi’s COVAX programme, we would say that, particularly in South Africa, it failed in virtually every respect,” said US professor Brook Baker from Northeastern University School of Law, and  senior policy analyst at Health GAP Global Access Project.

“South Africa was one of the first countries to recognise the urgency and even promoted the TRIPS waiver proposal at the WTO to try to expand the number of manufacturers and overcome the monopoly barriers that companies had on products,” he added.

Brook Baker

“That urgency was met with protracted delay. Gavi had promised or at least projected – I guess we should say projected because Gavi never really made wholly committed promises –  to supply 20 million doses by the end of 2021, and it fell far, far short. At the end of the day, South Africa got somewhat over a million doses from COVAX. That was all that it was actually able to deliver.”

Challenge for pandemic accord negotiations

Nic Dearden, director of the UK-based Global Justice Now, said that had global COVID-19 vaccine negotiations been conducted openly and the terms of contracts been disclosed, such inequitable terms “would not have happened”.

“How can it possibly have been that South Africa was charged two and a half times what my country, the UK, and many European governments were paying for what was effectively the same AstraZeneca Serum Institute dose? That cannot be right, it shouldn’t have been allowed to happen,” said Dearden.

The group stressed that the problem of one-sided contracts favouring pharmaceutical companies requires a regional and global solution.

’Unless acted upon with clear, legally binding international agreement, we will arrive at the next pandemic with little more to enforce fair terms than platitudes and scathing press statements from the [health] minister and president in South Africa and other world leaders in the Global South,” the group asserted.

“This must be deliberated upon in pandemic accord negotiations and revisions of the International Health Regulations currently underway and at the upcoming United Nations General Assembly (UNGA).”

Meanwhile, Baker added that, if equitable access to vaccines and other pandemic-related medicines is to be achieved in future, the terms of contracts with pharmaceutical companies have to change.

Currently, “we give intellectual property monopolies to companies that maximise their commercial interests and profiteer to the maximum”, said Baker.

“It gives them the right to artificially control supplies because they don’t share the technology with other producers. We let them unilaterally set prices and different prices for different countries – sometimes more advantageous to some and less advantageous to others, and they get to decide who they distribute to and when.

Baker added that “when you invest all of their power over essential public goods in the hands of private companies, with no governments, other multi-stakeholders or international institutions that can override those commercial decisions,  you get exactly what we got in this pandemic”.

“Unless the pandemic accord is willing to address intellectual property monopolies and power over the supply price and distribution, we will have exactly the same thing in the future,” he added.

Lives were saved

The South African Department of Health responded to the HJI analysis saying it had “entered into these agreements to secure vaccine doses to protect the lives of South Africans against the deadly virus which claimed more than 100,000 lives in South Africa, and almost seven million globally”.

“There is no argument that low and middle-income countries around the world, including South Africa, had limited bargaining power to secure vaccine doses and negotiate the price of vaccines due to a number of reasons including the limited number of manufacturers and vaccine hoarding and nationalism by high and upper middle-income countries. The unequal distribution of vaccines has undoubtedly contributed to more deaths which could have been prevented.

“Given the uncertain circumstances at the time, the government took a difficult decision and prioritised saving the lives of the citizens. There is no doubt that this decision to make vaccines available despite the difficulties has saved lives.”

The department added that South Africa had recently deliberated with a number of local and global organisations – including the Africa Centre for Disease Control and Prevention – “on a potential African Union and BRICS framework of cooperation for pandemic, preparedness, prevention, resource and recovery” to address future inequity of access and distribution of pandemic products.

This story was updated to include the response from the South African Department of Health.

Image Credits: Western Cape government.

“All countries and virtually all children” are affected by substantially heightened risks brought on by climate change, the UN Children’s Fund said.

The health, development and safety of children in 98% of African countries are severely threatened by the effects of climate change, according to a new report by UNICEF. 

The report, published ahead of the start of the Africa Climate Summit in Nairobi on Monday, found that children in 48 of the 49 African countries for which data is available are at “high” or “extremely high” risk from the extreme weather, illnesses, pollution, and environmental degradation caused by climate change. 

Children living in the Central African Republic, Chad, Nigeria, Guinea, Somalia and Guinea-Bissau face the highest threat, according to the report. In Somalia, over 20,000 children under the age of five died last year amid the extended drought in the country, according to UN estimates. In Chad, nearly 40% of children under five are stunted, according to the World Food Programme. 

The countries most at risk from climate change also have weak health, nutrition, and water, sanitation, and hygiene (WASH) services, according to the report. This makes children in these countries even more vulnerable to the effects of climate change, as they are less able to access basic services such as safe drinking water, education, and protective services during extreme weather events.

“It is clear that the youngest members of African society are bearing the brunt of the harsh effects of climate change,” said Lieke van de Wiel, Deputy Director of UNICEF’s Eastern and Southern Africa region. “They are the least able to cope, due to physiological vulnerability and poor access to essential social services.” 

The report follows revelations made by the Children’s Environmental Rights Initiative, which includes UNICEF, in June, which found that just 2.4% of investments by multilateral climate funds (MCFs) in Africa directly support children.

UNICEF estimates that one billion children globally are at “extremely high” risk of suffering from the impacts of the climate crisis, which the organization has called a “children’s rights crisis”.

Weather extremes threaten children from all sides 

Overall Children Climate Risk Index (CCR) score by country in Africa.

Children are disproportionately vulnerable to the impacts of climate change, as their developing immune systems, behavioural characteristics and developmental needs make them more susceptible to diseases, food insecurity, water scarcity and air pollution. 

In the northern part of Africa, children are more exposed to risks related to water scarcity and air pollution, according to the report. In the western and eastern parts of the continent, children are more exposed to risks related to vector-borne diseases, heatwaves and riverine flooding.

Water and soil pollution, meanwhile, affects children across the entire continent. The risks of tropical cyclones and coastal flooding, however, are concentrated in specific coastal regions, the report said.

Climate change is also driving child labour, child marriage, extremism and forced migration, which can expose children to human trafficking, gender-based violence, abuse and exploitation, the report said. 

“Children and their families hit by one crisis may be able to absorb the shock provided the crisis is not too severe,” said UNICEF. “However, when they are hit by a second, a third and other subsequent shocks within a short span of time their coping mechanisms can become exhausted.”

A UN Development Programme report published earlier this year found that the promise of economic opportunity, not religious ideology, is the leading driver of violent extremist groups in Sub-Saharan Africa. Climate change is accelerating the expansion of these groups, with devastating impacts on the rights and security of women and children.

Extreme weather has destroyed crops and fish populations around Lake Chad, pushing young men in the region to turn to extremist groups like Boko Haram in search of income to feed themselves and their families.

The lake, which straddles the borders of Nigeria, Niger, Chad and Cameroon, has shrunk by more than 90% in the past 40 years due to climate change, overfishing and pollution. This has led to widespread food insecurity and poverty in the region.

“Present and future generations of children will bear the brunt of the intensifying effects of the climate crisis over the course of their lifetime,” said UNICEF. “These impacts are already occurring.”

Children must be heard in the climate conversation

The right of children to participate in climate decisions that will affect their future is enshrined in the UN Declaration on the Rights of the Child.

Africa has contributed very little to the carbon emissions that are at the root of the climate crisis. As of 2022, Africa as a whole has emitted just under 50 billion metric tons of CO2, less than 3% of the 1.73 trillion metric tons emitted since the turn of the twentieth century.

This is especially true of the continent’s children: around 40% of Africa’s population was under the age of 15 in 2022, making it the world’s youngest continent. Another 20% of Africa’s population is under the age of 25.

This youth is Africa’s “greatest natural resource” in the fight against climate change, according to UNICEF. The agency added that the right of children to participate in decision-making that affects their future is recognised under the UN Convention on the Rights of the Child.

“Children are not only victims,” said UNICEF. “Despite this, children’s voices and perspectives are rarely heard or considered in the decision-making processes fundamentally shaping their future.”

“Their ideas, creativity, and skills need to be taken seriously and become integral parts of the solutions, including policy and financing,” the agency said. “The time to act is now.”

Chance for action in Nairobi at the inaugural Africa Climate Summit

African leaders will have a chance to act on UNICEF’s findings at the inaugural Africa Climate Summit, which opened Monday in Nairobi, Kenya, under the auspices of the African Union.

Over 20 African heads of state are expected to attend the summit, Kenyan Environment Cabinet Secretary Soipan Tuya told Al Jazeera. The summit, which is running in parallel to Africa Climate Week, expects around 30,000 delegates to be in attendance.

Kenyan President William Ruto billed the summit as a chance for Africa to define its position on the ways “humanity should engage in effective action to save this planet from a climate catastrophe” and “lift hundreds of millions out of poverty.”

Ruto said he hopes to rally African leaders around the Nairobi Declaration on Green Growth and Climate Finance, which is set to be the key outcome of the summit. The declaration is a blueprint for a “new green industrial age” in Africa based on an “ambitious green growth agenda and climate finance solutions”.

Securing new financial commitments from wealthy nations and holding them to their $100 billion climate finance goal set out in 2009 at COP15 in Copenhagen will be a major focus of the summit.

The list of high-profile attendees of the Africa Climate Summit includes UN Secretary-General Antonio Guterres, US climate envoy John Kerry, COP28 Director-General Majid Al Suwaidi, and COP28 President Sultan Al Jaber.

“Climate action is not a Global North issue or a Global South issue,” said Ruto. “It is our collective challenge, and it affects all of us.”

Image Credits: UNICEF.

United Nations Headquarters in New York.

A draft political declaration on pandemics, due to be adopted by the United Nations General Assembly later this month, offers “little hope” that the UN process will make a difference in global pandemic preparedness, global health experts said on Friday.

The document, made public on Thursday, is long on words but short on commitments. The only specific action the text commits to is to convene another high-level meeting on pandemics in 2026 – and even this is problematic.

“The three-year timeline is far, far too long,” one expert told Health Policy Watch. “A new pandemic threat could arise at any time.”

The draft declaration does not include any numbers or financing targets for global and domestic health spending to prevent and prepare for pandemics.

Earlier proposals for the UN to create an independent monitoring body to assess member state compliance with the pandemic treaty have been scrapped, and no enforcement or independent review mechanisms remain in the draft. 

The draft requests that countries commit to removing trade barriers and strengthening medical supply chains, “especially during pandemics and other health emergencies”, and to support “technology transfer hubs and intellectual property sharing mechanisms”.

“The document is mired in platitudes,” Nina Schwalbe, a public health expert and professor at the Columbia School of Public Health, wrote in the Financial Times on Friday. “The political declaration for this [UN] meeting suggests that pandemic amnesia has already set in,” 

General Assembly kicks the pandemic preparedness back to WHO

The lack of concrete commitments in the draft political declaration on pandemics may reflect a feeling within the United Nations General Assembly that the real action on pandemic preparedness lies in the hands of the World Health Organization (WHO).

The draft commits member states to providing “adequate and predictable funding” for the WHO, which struggled to keep up with the demands of the COVID-19 pandemic on its shoestring budget. It also stresses the importance of funding for the WHO Contingency Fund for Emergencies, which would allow the UN health body to respond quickly to future pandemics.

“The ball is kicked squarely back to WHO and the joint treaty and international health regulation negotiations to actually figure out how to make anything happen,” Suerie Moon, a global health expert and professor at the Graduate Institute in Geneva, told Health Policy Watch.

The draft is due to be adopted by the UN General Assembly on September 21. Global health officials are calling on member states to step up to the plate and make real commitments to pandemic preparedness.

“The UN General Assembly High-Level Meeting’s Political Declaration offers a one-time and historic opportunity to commit to lasting and transformative change to pandemic preparedness and response,” Ellen Johnson Sirleaf and Helen Clark, co-chairs of the Independent Panel for Pandemic Preparedness and former heads of state of Libera and New Zealand, respectively, wrote in an open letter to UN delegates last month. “We call on leaders and decision-makers to make this moment count.” 

In its current state, the draft declaration offers “little hope” of making a difference in the next pandemic, said Schwalbe. “History is on track to repeat itself – in the form of more pandemics which could have been avoided.”

The draft text addresses key issues, but no numbers to be found

United Nations Headquarters, New York

The vague language and lack of real commitments in the UN’s draft pandemic declaration are emblematic of the reasons for public frustration with the organization.

“The document contains almost no concrete commitments to anything transformative, is weak, and has low ambition,” another expert told Health Policy Watch. “If this is indeed the outcome, it represents a missed opportunity to make high-level commitments to better protect the world against pandemic threats.”

The draft calls for countries to spend a “sufficient” amount on domestic health spending and asks governments to “maximise efficiency” in distributing this indeterminate amount of funds. On global health spending, it calls for “solidarity” through “enhanced official development assistance and financial and technical support” for developing countries, especially in Africa and for Small Island Developing States.

The technology transfer and intellectual property rules in international public health emergencies are addressed in similarly general terms in the draft declaration. Despite the lack of new commitments by the General Assembly declaration, steps to improve technology transfer have been made since the pandemic. 

The WHO mRNA vaccine hub in Cape Town, South Africa, began operating at full capacity last year, following its announcement in 2021. The facility, which celebrated its official launch in April, aims to support mRNA technology transfer and provide equitable access to vaccines and other medicines in low- and middle-income countries.

Pharmaceutical giants, such as Moderna and Pfizer, have declined to provide the technical knowledge necessary to replicate the COVID-19 vaccines to the WHO mRNA hub. However, both Pfizer and Moderna have set up new vaccine production hubs of their own in Africa in partnership with local governments and the private sector. 

Despite its failure to commit to any specific actions, the draft text does hit most of the key points that must be addressed to prepare for the next pandemic.

“The draft is very short on concrete commitments, long on aspiration,” said Moon. “It does flag what are clearly the high political priorities of many countries in the pandemic treaty and IHR negotiations: Medicines access, publicly funded R&D, IP, local production, tech transfer, and pathogen access and benefit sharing, get a lot of air time, as does One Health and financing.”

“There’s some good language on some of these issues that could perhaps, eventually, make it into one of the binding agreements,” Moon added.

Calls for “solidarity” recall failures of COVID-19 response

Vials of Pfizer´s COVID-19 vaccine. COVID vaccines mostly reached in or around the regions they were produced, a WHO report finds.

Calls for solidarity proved to not be worth much at the height of the pandemic. In June 2020, the WHO and 30 low-income countries priced out of the vaccine supply race issued a “Solidarity Call to Action” that accompanied the launch of the UN health body’s COVID-19 Technology Access Pool (C-TAP) initiative.

The hope for C-TAP was that it would become a ‘one-stop shop’ where patent holders of COVID-19 vaccines, treatments and technologies could license their products for worldwide use. The initiative called on key pharmaceutical stakeholders to “advance the pooling of knowledge, intellectual property and data that will benefit all of humanity”.

Just two institutions – the Spanish National Research Council (CSIC) and the National Institutes of Health (NIH) – responded to the call, entering into licensing agreements for diagnostic tests.

Pfizer, BioNTech and Moderna rebuffed C-TAP when their vaccines hit the market, while rich governments with the ability to afford their vaccines elected to prioritize securing domestic supplies over global solidarity.

Earlier this week, Taiwanese vaccine manufacturer Medigen Biologics Corp. became the first private pharmaceutical company to share its vaccine technology with C-TAP.

Waiting on WHO?

Tedros addressing the opening of the 73rd WHO Africa regional meeting on Monday.

The Pandemic Accord process, launched by WHO in 2021, is scheduled to conclude in May 2024 at the World Health Assembly, the top decision-making forum of the UN health body.

Negotiations at the WHO, however, have also proven difficult. WHO Director-General Dr Tedros Adhanom Ghebreyesus warned on Monday that the slow pace of negotiations has put the pandemic accord at risk of missing the May 2024 deadline.  

“This is a unique opportunity that we must not miss to put in place a comprehensive accord that addresses all of the lessons learnt during the pandemic with a particular emphasis on equity,” Tedros said at the WHO Africa regional meeting. “As the COVID-19 pandemic laid bare, there are serious gaps in compliance and implementation which must be addressed.” 

Tedros has chafed at the power of pharmaceutical companies over the final outcome of negotiations. At a heated press briefing in July, Tedros called out “groups with vested interests” for spreading “lies” about the pandemic treaty that are “endangering the health and safety of future generations”. 

Despite the expansion of vaccine manufacturing worldwide – which now totals over 90 manufacturers – fewer than ten companies control the vast majority of global vaccine supplies, the WHO found in its vaccine market report released in May. 

“The new global architecture cannot be designed, built or managed by those with the most power, money and influence,” Tedros said on Monday. 

Whether the companies and governments with the power, money and influence to make that determination will choose to play ball remains an open question. 

Image Credits: UN, United States Mission Geneva, UN Photo/Manuel Elias, Photo by Mat Napo on Unsplash.

Methane, a colorless gas, is released from a rig during oil and gas extraction – other key human-made sources include agriculture, livestock production and poor waste management.

International climate targets cannot be met without rapid and drastic cuts to global methane emissions, according to a series of reports published on Wednesday by the Global Climate and Health Alliance (GCHA).

The reports found that reducing methane emissions by 45% by 2030 would avert nearly 0.3C degrees of global warming by 2045, a margin that could prove critical to global ambitions to keep temperature rise at or below 1.5C degrees.

Methane is a powerful greenhouse gas that is 80 times more effective at trapping heat than carbon dioxide over a 20-year period. It is emitted by livestock production, rice cultivation and from uncontrolled waste dumping, as well as gas flaring and leaks from fossil fuel extraction, as well as from natural sources like peat bogs. Overall, methane emissions are estimated to have caused more than 30% of global warming to date.

But since it´s lifespan in the atmosphere is limited, reducing methane emissions would deliver quick gains for climate as well as health – where methane is a key contributor to ground level ozone levels. The adverse health outcomes of ground-level ozone include cardiovascular diseases, asthma, and respiratory illnesses which result in roughly one million premature deaths every year.

“Every pathway to limiting climate warming to close to 1.5C demands rapid, substantial cuts to methane,” said Dr Jeni Miller, Executive Director of the GCHA, which is a network of health professional and health civil society organizations addressing climate change. The pathway to limit global warming to 1.5C  set out by scientists from the Intergovernmental Panel on Climate Change (IPCC) also includes substantial cuts to methane emissions as a key component of its roadmap. 

Low hanging fruit ?

Livestock production is another key source of human-produced methane emissions.

Reducing methane emissions has long been seen as ¨low-hanging fruit¨ in climate policy circles – although political action has lagged behind its mitigation potential. While carbon dioxide remains in the atmosphere for centuries after it is emitted, methane has an atmospheric lifespan of just 12 years. This makes methane an ideal target to achieve rapid reduction of the impact of the greenhouse gas effect on global temperatures.

“Methane mitigation offers a quick win, while tackling CO2 is the long game – at this stage in the climate crisis, we need both,” said Miller. “Fortunately, both offer opportunities that could improve people’s health.”

Global momentum building – but COP28 host UAE fails to report methane emissions

Methane emissions are set to be a key topic of discussion at the UN climate summit, COP28, set to take place in the United Arab Emirates in December later this year.

Around 150 countries have signed the Global Methane Pledge since its launch at COP26 in Glasgow in 2021. The pledge commits countries to reduce methane emissions by 30% by 2030.  See related story:

Africa’s Methane Gamble – Can A Climate-Warming Gas Become An Asset to Health?

The UAE has said that it will work with NGOs and governments on a plan to slash methane emissions ahead of the arrival of delegates in Dubai. However, the host nation has also been charged with failing to report its own methane emissions for around a decade.

The fossil fuel, agricultural and waste management sectors are the major sources of human-produced methane emissions, according to GCHA.

“We’re constantly learning more about the extent and impact of methane sources,” said Miller. “Methane leaks from fossil fuel production and use are far greater than previously thought, and leaks are occurring at every stage in the fossil fuel life cycle.”

The extent of the UAE’s commitment to reducing methane emissions and acting as a shepherd of international climate goals remains questionable, given that the president of COP28, Sultan al Jaber, is also the CEO of the UAE’s state oil giant.

Agriculture, energy, and waste management systems must change

Birds scavenge for food scraps at a landfill in Connecticut. Landfills and sewage pools are another major source of methane emissions; the gas is released as disposed organic materials – including paper, food scraps, and human waste, biodegrade.

The technology to slash methane emissions already exists, but it will take individual and system changes to make it happen, said GCHA.

One important way to slash methane emissions would be to plug leaks during fossil fuel extraction to prevent methane gas escape,  employing the latest technologyies. Shifting away from fossil fuels to renewable energy at a faster rate would also make an impact, but the reports concede that eliminating fossil fuels from the global energy system is not likely in the immediate future.

“Cutting methane emissions from fossil fuel production, distribution, and end use through readily available, cost-effective solutions is a powerful lever for reducing near-term warming and avoiding dangerous warming tipping points, while also yielding benefits for people’s health,” the reports say.

Source: Climate and Clean Air Coalition.

Other ways to reduce methane emissions include rapidly moving towards regenerative agriculture, improving access to nutritious, plant-rich whole foods diets, and making existing livestock healthier. Improved waste management by composting or, better yet, developing industrial-scale biogas digesters to handle  food, farm, and human waste will also deliver big benefits, harnessing methane for fuel, which can then be used for energy production, in what is an almost climate-neutral process.

Biogas plant, South Africa. Pilots abound but largescale harnessing of methane has yet to take place.

“Methane’s effects on the environment are extensive and well understood,” said Amanda Quintana, the project director for Abt Associates who was involved with the reports. “What we need now is to mobilize the health community and help people understand that, because methane has both indirect and direct impacts on human health, there are direct health benefits to reducing methane emissions, both in the short- and long-term.”

Quintana added that the evidence in the reports is not new but puts the focus on the extreme health impacts of methane. “The report highlights these health impacts and linkages to make it easier for people to understand the important role the health community can play in methane mitigation.”

Stefan Anderson contributed reporting for this story. 

Image Credits: Clean Air Task Force , Evan Schneider, United Nations multimedia , SuSanA Secretariat/Flickr.

Vaccine access groups praised the agreement as a long-overdue victory for vaccine equality in low-income countries but called out major pharmaceutical companies for putting profit over people.

Three years after the launch of its COVID-19 Technology Access Pool (C-TAP) initiative, the World Health Organization (WHO) has secured its first COVID-19 vaccine license from a private pharmaceutical company, the UN health body announced on Tuesday.

The agreement with Medigen Vaccine Biologics Corp., a private vaccine manufacturer based in Taiwan, is a welcome but underwhelming landmark for C-TAP, whose initial launch was accompanied by ambitions of ensuring equitable access to COVID-19 vaccines, treatments and technologies around the world.

“This is not just about COVID-19, it is about setting a precedent for future global health challenges,” said Charles Chen, Medigen’s CEO. “We hope to inspire other organizations to follow suit.”

The agreement with the Taiwanese manufacturer is one of three new licences acquired this week by the WHO through the Medicines Patent Pool. The other two agreements are with the Spanish National Research Council (CSIC) and the University of Chile. CSIC is sharing a licence for a COVID-19 vaccine prototype, and the University of Chile is sharing its technology for a test used to measure COVID-19 antibody levels.

CSIC became the first entity to share technology with C-TAP in November 2021, when it signed a worldwide license for its COVID-19 antibody diagnostic test.

“COVID-19 is here to stay, and the world will continue to need tools to prevent it, test for it and treat it,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “WHO and our partners are committed to making those tools accessible to everyone, everywhere.”

C-TAP ambitions not shared by pharma 

C-TAP launched at the height of the pandemic in June 2020 to promote technology sharing based on “equity, strong science, open collaboration and solidarity”. The call to action was supported by 30 WHO member states, all of which were low-income countries without access to vaccines.

However, without the backing of major pharmaceutical companies and powerful governments, C-tap only secured two licencing agreements during the peak years of the pandemic – neither of which were vaccines. With the agreements announced this week, a total of just five licences – including two provided by CSIC – have been shared on C-TAP.

“It is shameful that, despite receiving unprecedented public funding and advance purchases, not even one of the major pharmaceutical companies has shared vaccine technology with C-TAP,” said Julia Kosgei, policy co-lead for campaign group the People’s Vaccine Alliance.

The WHO and its Director-General, Tedros Adhanom Ghebreyesus, have repeatedly called out the outsize power of pharmaceutical giants over the global vaccine market. This issue is once again in the spotlight as ongoing negotiations over the international Pandemic Treaty highlight the world’s dependence on a small number of companies to ensure equitable vaccine distribution for future pandemics.

In May, the WHO’s vaccine market report found that global vaccine supply is concentrated in fewer than a dozen manufacturers, leading WHO officials to call out the vaccine market for being controlled by “oligopolies”. Without “predefined and binding rules for vaccine distribution in times of scarcity” to prevent vaccine distribution from being guided by profits, the story of inequality borne out during the COVID-19 pandemic is destined to repeat itself, Tedros wrote in the foreword to the report.

Pfizer, BioNTech and Moderna refused to join C-TAP once their vaccines hit the market, citing research and development costs and the high risks associated with vaccine development.

In its press release accompanying the new license agreements this week, the WHO credited C-TAP with “raising awareness” for the need for wider sharing of patents for critical medicines – a tacit admission it has fallen well short of its ambitions to spur solidarity in the boardrooms of pharma giants.

Image Credits: Photo by Mat Napo on Unsplash.

A technician weighs cannabis buds.

Cannabis should be avoided during adolescence and early adulthood; in pregnancy, by people prone to mental health disorders and while driving, according to experts in a study published in The BMJ on Thursday.

Cannabis contains over 100 cannabinoids, of which tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most clinically relevant. THC can induce a psychoactive “high” and can foster dependence, as well as other adverse psychiatric health effects.  Conversely, CBD has certain anti-psychotic and anti-anxiety properties and one purified form, Epidiolex®, has even been approved by the FDA as a medication for certain forms of epilepsy.

The BMJ study confirmed that CBD is indeed effective in helping people with epilepsy, while some cannabis-based products containing THC can help ease multiple sclerosis, chronic pain and inflammatory bowel disease in affected adults.

The researchers based their findings on 101 meta-analyses on cannabis and health conducted over 20 years (2002-2022), grading evidence as high, moderate, low, or critically low certainty in randomised trials – and as convincing, highly suggestive, suggestive, weak, or not significant in observational studies.

“An increasing number of studies have examined the effects of cannabinoids on health and other outcomes, but most findings are observational and prone to bias, making it difficult to draw firm conclusions,” according to the BMJ in a media release.

“To address this, an international team of researchers set out to assess the credibility and certainty of over 500 associations reported between cannabis and health in 50 meta-analyses of observational studies and 51 meta-analyses of randomised controlled trials, pooling data from hundreds of individual studies.”

Increased risk of psychosis

There was an increased risk of psychosis associated with THC-containing cannabis in the general population, particularly in adolescents, and with psychosis relapse in people with a psychotic disorder.  

The researchers also found an association between cannabis and depression and mania, as well as detrimental effects on memory, and verbal and visual recall.

Observational evidence suggested a link between cannabis use and motor vehicle accidents, while pregnant women who used cannabis use had an increased risk of having a small, low birth weight baby.

Cannabis-based medicines were, however,  beneficial for pain and muscle stiffness (spasticity) in multiple sclerosis but increased the risk of dizziness, dry mouth, nausea and drowsiness. 

For chronic pain, cannabis-based medicines reduced pain by 30%, but increased psychological distress. 

For cancer, some cannabinoids reduced sleep disruptions but resulted in increased gastrointestinal events.

Cannabidiol (CBD) was, on the other hand, beneficial in reducing seizures in certain types of epilepsy, particularly in children – but came with an increased risk of diarrhoea.

Weak evidence

This umbrella review is the first to pool observational and interventional studies on the effects of cannabinoids on humans, but the researchers note that most outcomes associated with cannabinoid use are supported by weak evidence, have low to very low certainty, or are not significant.

They also point to other limitations in the study, particularly the wide variations in the make up of cannabis products, such as the proportion of psychoactive THC. Additionally, not all individuals will experience the same effects of cannabis on their mental health and cognition.  And randomised trials might not be representative of the real-world population. 

Nevertheless, the researchers conclude that law and public health policymakers and researchers “should consider this evidence synthesis when making policy decisions on cannabinoids use regulation, and when planning a future epidemiological or experimental research agenda.” 

Millions are addicted

According to the Global Burden of Disease 2019 study, around 24 million people worldwide are addicted to cannabis, particularly men and people in high-income countries. 

In Europe, over the past decade, self-reported use of cannabis within the past month has increased by almost 25% in people aged 15-34 years, and more than 80% in people aged 55-64 years.

The potency of cannabis has also increased in Europe, with the THC content associated with the ¨high¨ and subsequent adverse psychiatric increasing from 6.9% to 10.6% between 2010 and 2019.

Image Credits: Unslash.

climate emissions
Fossil fuels are the primary cause of the climate crisis. Governments are spending trillions every year to prop up their production.

Global fossil fuel subsidies surged to a record $7 trillion in 2022 – $2 trillion more than in 2020, the International Monetary Fund (IMF) has said in its 2023 report on fuel subsidy trends.

The increase comes despite the mounting damage being caused by climate change, and clear scientific evidence that phasing out subsidies would save millions of lives in the near term from air pollution, as well as from extreme weather over time.

The whopping $2 trillion subsidy increase over the past two years came as governments raced to protect consumers from the spike in energy prices caused by Russia’s invasion of Ukraine. The return of global consumption to pre-pandemic levels also contributed to the rise, the IMF said.

“As the world struggles to restrict global warming to 1.5 degrees Celsius and parts of Asia, Europe and the United States swelter in extreme heat, subsidies for oil, coal and natural gas are costing the equivalent of 7.1% of global gross domestic product,” IMF researchers said in a press release accompanying the publication of the report.

“That’s more than governments spend annually on education (4.3% of global income) and about two-thirds of what they spend on healthcare (10.9%).”

Direct tax breaks for fossil fuel production and use more than doubled

Explicit subsidies, which are direct payments or tax breaks to fossil fuel producers or consumers, have more than doubled since 2020 to reach $1.3 trillion. However, these subsidies still only make up 18% of the total, and are expected to decline as energy prices stabilise and the global economy continues its recovery from the pandemic, the IMF said.

The remaining 82% of fossil fuel subsidies are implicit, meaning they are not directly paid by governments. Instead, they take the form of undercharging for the environmental and health costs of fossil fuels, such as the damage caused by air pollution and climate change.

Underpricing for local air pollution and global warming accounted for nearly 60% of global fossil fuel subsidies in 2022, according to the report. These implicit subsidies are projected to grow in the coming years as developing countries increase their consumption of fossil fuels to match that of advanced economies, the IMF said.

Record government spending on fossil fuel subsidies is the support beam holding up the “pervasive underpricing” of fossil fuels around the world, the IMF said, with some 80% of coal and 27% of natural gas sold at below half their real cost. 

This underpricing leads to excessive consumption and emissions, which contribute to global warming and impact health. The report estimates that properly pricing fossil fuels would avert 1.6 million premature deaths from air pollution by 2030.

The International Monetary Fund (IMF) estimates that governments subsidized $5 trillion in environmental costs for fossil fuels last year. However, the report’s authors noted that other methodologies find much higher numbers. 

A recent study published in Nature put the total cost of fossil fuel subsidies at around $12 trillion, nearly doubling the IMF’s $7 billion estimate. If the numbers from the Nature study are correct, then governments spent more money on fossil fuel subsidies than on healthcare globally last year. 

Eliminating subsidies could slash carbon emissions by one third by 2030

The IMF estimates that eliminating subsidies and imposing corrective taxes that incorporate the cost of health and environmental costs of burning oil, gas and coal would slash global carbon emissions by 34% by 2030, just 12% shy of the target set by the United Nations to keep global warming below 1.5 degrees Celsius and achieve net zero by 2050.

The report found that fully reforming fossil fuel prices would also raise substantial revenues, worth about 3.6% of global gross domestic product (GDP).

Green investment push shows subsidies work – but must change direction

Protests for more climate action in Glasgow, Scotland outside of the COP26.

The role played by subsidies in encouraging the burning of fossil fuels has long been recognised by scientists, governments and international organisations. G20 governments committed themselves to eliminating inefficient fossil fuel subsidies all the way back in 2009 and reiterated this commitment a decade later at COP26 in Glasgow in 2021.

But these words ring hollow as G20 countries continue to lead the way in providing fossil fuel subsidies globally. China is by far the biggest contributor, with $2.2 trillion in subsidies, followed by the United States with $760 billion, followed by Russia with $420 billion, India with $350 billion and the European Union with $310 billion.

The World Bank said in July that these “toxic” subsidies are wreaking “environmental havoc” and called for the trillions of dollars subsidising fossil fuels to be redirected towards climate action.

“China’s dominant role in critical mineral processing is the result of decades of targeted industrial policy which has significantly subsidized domestic industry,” according to a recent report by the Aspen Institute.

The United States, China and the European Union, meanwhile, have put in place massive subsidy packages to incentivise green investments.

The Inflation Reduction Act passed by the Biden administration has made $369 billion in funding and incentives for clean energy projects in the country, leading to a windfall of nearly $300 billion in new green investments – from battery semiconductor manufacturing plants to solar and wind farms – in the United States in 2022.

The European Union is working on its own green finance package to lure similar investments to the bloc. China, which already has a sizeable edge in critical sectors of the green economy such as EV batteries, rare earth and critical mineral processing, and solar panels, is also in on the green race.

The race for green energy supremacy is already reshaping the global economy. Reworking the financing of fossil fuels on a similar scale might do the same.

Image Credits: Chris LeBoutillier.

A researcher working on an mRNA vaccine at Afrigen, South Africa’s mRNA hub.

The best way to pandemic-proof the world is through ‘last-mile innovation’ based on strong regional and subregional research and development (R&D) hubs that can tackle disease outbreaks before they become pandemics.

These hubs should be led by local scientists and have the capacity to adapt established technologies without intellectual property restrictions to produce vaccines, treatments and diagnostics to address threatening pathogens.

This is the argument put forward by a group of health experts in a paper published this week in The Lancet amid three separate global negotiations aimed at improving the world’s response to future pandemics.

They assert that there has been too much focus on building new vaccine manufacturing facilities in developing regions and argue that the Pandemic Fund and development banks could finance “R&D for the common good rather than just vaccine manufacture and distribution through a market approach”. 

“As we have seen again during COVID-19, a system that largely relies on market dynamics to drive the research, manufacture and marketing, results in highly inequitable access and preventable deaths, particularly in developing countries,” said co-author Dr Soumya Swaminathan, former Chief Scientist, World Health Organization (WHO).

“Our proposal, which centres on equity from the start, would give researchers from developing countries greater ability to quickly and collectively contribute to solutions to infectious outbreaks in their regions. When each region has that ability, all of the world is better protected from pandemic threats, which are only going to increase due to climate change.”  

Speed is essential

“Time and again, developing countries are left waiting for tools like vaccines developed by others, while wealthier countries produce and access them first,” said Helen Clark, one of the authors and former co-chair of The Independent Panel for Pandemic Preparedness and Response. 

“The deadly lessons from COVID-19 demand transformative change, starting with action to ensure that all regions have the technology and capacities required to develop products that stop outbreaks before they spread worldwide. That’s not only equitable, it’s strategic.”

Dr Els Torreele, the lead author, explained that “in outbreak control, speed and versatility are of the essence, so having the ability to rapidly adapt the most suitable existing technology to local needs is critical”.

“The opportunity for ‘last-mile innovation’ will let researchers develop and produce products people can use, where they live, for the outbreaks in their regions,” added Torreele.

Dr Amadou Sall, Director of the Institut Pasteur de Dakar in Senegal, added that “given available technologies and in the wake of a pandemic that has led to some 24 million excess deaths, there should be no question that we need a new model – one that fully empowers all regions to be self-reliant”.

“Many of these technologies have been available for decades now, and others have been developed with public funds. It’s time to make them available in Africa and on other continents,” said Sall, who is also a co-author.  

Sharing mRNA technology

Professor Petro Terblanche, who heads the WHO’s mRNA technology development and transfer programme in South Africa, explains that if, for example, mRNA technology is made accessible, “researchers can innovate and develop vaccines that address local or regional health needs and are suited to optimal delivery into local and regional health care systems”.

The authors also make a strong case for a common goods approach to R&D, in which the ownership and control over technologies that are critical for public health are governed collectively and in the public interest.  

They cite the CERN research facility in Europe, which is jointly funded by 23 countries, as an example of a sub-regional R&D hub. 

“The public sector is already investing billions in research, which is then often sold or handed out to the private sector who decide whether or not to develop products based on profit potential,” said Dr Joanne Liu, a Canadian paediatrician, former International President of Medecins sans Frontieres (MSF) and member of The Independent Panel.

“We’re saying, tools to protect lives and stop outbreaks from crossing borders must be common goods – and must and can be funded with that mindset.” 

Timely intervention

The authors’ call comes as the Intergovernmental Negotiating Body (INB) working on a pandemic accord is set to meet in Geneva next week to continue negotiations. Issues of equitable access to pandemic countermeasures are being negotiated in specific articles on research and development and on technology sharing and co-development, and are considered some one of the most difficult areas to solve. 

The G20 Health Ministers also recognised the need for “sustainable global and regional research and development networks to facilitate better access to VTDs (vaccines, treatments and diagnostics) globally, especially in developing countries” at its meeting last week.

Meanwhile, the United Nations High-Level Meeting on pandemics is set for 20 September in New York, and will adopt a political declaration mapping out how to address future pandemics.

Image Credits: Rodger Bosch for MPP/WHO, Kerry Cullinan.

WHO Director-General Dr Tedros Adhanom Ghebreyesus arriving at the 73rd meeting of the WHO Africa region.

After a two-week hiatus in negotiations, United Nations (UN) member states this week received a third draft of the Political Declaration being developed for the High-Level Meeting on Pandemic Prevention, Preparedness and Response on 20 September.

The declaration was supposed to have been finalised by early August and put under silence procedure but member states failed to agree on a number of clauses and negotiations were interrupted by the northern hemisphere summer holidays.

Last week, bilateral meetings resumed and sources told Health Policy Watch that member states finally received an amended draft this week.

Slow pandemic accord talks

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus expressed concern this week about the slow pace of negotiations on the pandemic accord, warning that it may not be completed by the May 2024 deadline.

“I’m concerned that negotiations are moving slowly and that the accord may not be agreed in time for next year’s World Health Assembly (WHA). I urge all member states to work with a sense of urgency with a particular focus on resolving the most difficult and contentious issues,” Tedros told WHO Africa’s regional meeting at its opening on Monday.

“This is a unique opportunity that we must not miss to put in place a comprehensive accord that addresses all of the lessons learnt during the pandemic with a particular emphasis on equity. This region has more to gain from a strong accord than any other so I urge you to continue engaging actively in the negotiations to make sure the needs and expectations of Africa are heard,” added Tedros.

The Intergovernmental Negotiating Body (INB) in charge of developing the accord to present to the WHA is set to meet again on 4-6 September.

Tedros also referred to the negotiations to amend the International Health Regulations (IHR) currently underway, describing the IHR as the “cornerstone of detecting and responding to disease spread internationally”.

“But as the COVID-19 pandemic laid bare, there are serious gaps in compliance and implementation which must be addressed. We need an IHR that’s fit for purpose,” said Tedros.

“The proposed amendments now being discussed by member states address many crucial areas including compliance, cooperation, and more efficient communication. We must learn the lesson of COVID-19, which is that global threats require a global response that is based on coherence and mechanisms for cooperation, rooted in solidarity and equity.”

The Working Group on IHR meets again on 2-6 October for the fifth time and is expected to debate the definition of a pandemic, amongst other issues.

“Crucially, the new global architecture cannot be designed, built or managed by those with the most power, money and influence. It must be designed, built and managed by all member states and partners in a truly inclusive process,” Tedros urged.

Dr Tedros addressing the opening of the 73rd WHO Africa regional meeting

Botswana’s approach to health is an example to the African continent, with strong leadership, investment in research and development and universal health services available for a nominal charge, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya was speaking on Monday at the opening of the World Health Organization (WHO) Africa regional committee meeting being held in Botswana’s capital, Gaborone.

“Botswana was the first African country to achieve 70% coverage of COVID-19 vaccines because of the strong leadership of the president and the allocation of adequate resources to procure vaccines,” said Kaseya.

“Its investment of 1-2% of its GDP to research and development is why Botswana is one of the leaders in the development of vaccines for animals. Knowing that the next pandemic will be a zoonotic one, it means that Botswana will play a key role in addressing this issue in Africa,” he added.

Africa CDC head Dr Jean Kaseya

Kaseya added that he was surprised to learn that Botswana’s citizens were able to “access to all the healthcare that they need” by only paying a 15-cent contribution for every dollar charged.

Kaseya said that Africa needed to prepare for the next pandemic by pushing local manufacturing of vaccines and medicines and ensuring there was “enough funding for pandemic prevention, preparedness and response”.

The African region had failed to submit a regional application to the Pandemic Fund, unlike the Caribbean, Asia and Latin America and needed to ensure it made an application during the next call for proposals to fund a joint emergency action plan, he added.

The WHO Africa region excludes some of the countries in the far north of the continent that associate more closely with Arab states and are part of the Eastern Mediterranean Region (EMRO).

HIV laboratory declared WHO centre of excellence

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyusus told the meeting that Botswana’s National HIV Reference Laboratory has been designated as a WHO Collaborating Centre of Excellence “in recognition of the laboratory’s excellence in the field of HIV diagnosis and the potential of deeper collaboration with WHO in advancing the health and well-being of people living with HIV”.

“In 2021, WHO certified Botswana for reaching the silver tier on the path to eliminating mother-to-child transmission of HIV. And in 2022, Botswana reached the 95-95-95 targets for testing, treatment and viral suppression of HIV, one of only five countries to do so,” said Tedros, referring to the targets of 95% for testing all people, putting 95% of those with HIV on treatment, and achieving viral suppression in 95% of people living with HIV.

“Botswana is a model to show anything is possible, added Tedros. Peace is possible. Stability is possible. Democracy is possible. Growth is possible, even to an upper middle-income country or even even higher. Africa can grow. Africa can be stable, Africa can be peaceful. Africa can be a democratic continent,” added Tedros.

Botswana has a small population of 2.6 million people and has made its wealth from minerals.

Urgency of universal health coverage

Matshidiso Moeti

WHO Africa Regional Director Dr Matshidiso Moeti, who hails from Botswana, also expressed pride in her country’s health milestones. 

“It is one of the countries where direct payments for healthcare is almost non-existent,” said Moeti. “With a minimal nominal contribution, people have access to everything that is available in the country and transferred outside of it [for other treatment]. It is an example of how to make sure that payments are not a burden to the customer. I’m very proud of this.

“We could take many examples and I’ll just cite a couple. For example, the mother-to-child transmission of HIV has been reduced to less than 5%, and Botswana has been the first high-burden country in the world to achieve this milestone.

“HIV transmission rates have fallen from 40% of the sexually active age group in 1999 to below 1% this year. What an achievement for a nation that once had the highest HIV prevalence rate in the world.”

In contrast to Botswana, Moeti pointed out that “public spending on health is low in the majority of our countries, and Africa is home to two of the three poorest people who pay directly out of pocket for their health care.” 

Meanwhile, Tedros said that every WHO member state needed to “radically reorient health systems towards primary health care as the foundation of universal health coverage”.

“Nowhere is more important than here in our continent. Across the region, hundreds of millions of people lack access to essential services or are pushed into poverty by catastrophe out-of-pocket spending. Closing these gaps must be top of the to-do list for every member state,” urged Tedros.

Climate change threat

Moeti and Tedros both urged African member states to take measures to mitigate the effects of climate change on their citizens’ health.

“We have seen Europe burn literally over the past few months. Here in our region, prolonged drought in the Sahel, and also in the greater Horn of Africa and cyclones in southern Africa have increased morbidity, mortality and human suffering,” said Moeti.

“These phenomena are taking a heavy toll on health services. We are working with partners to support our member states in their efforts to provide essential health and nutrition services to affected countries and communities.”

She said that an African regional initiative to combat the health consequences of climate change on the continent had been launched in May on the sidelines of the World Health Summit, while the Climate-Health Africa Network for Collaboration and Engagement (CHANCE) had been formed in 2021 to assist countries in southern and east Africa to address climate change.

Meanwhile, Tedros encouraged all African member states to participate actively at COP28 in the United Arab Emirates, which will feature a day dedicated to health for the first time.

“Health systems are increasingly dealing with the consequences of climate change in terms of communicable and non-communicable diseases, and the impacts of more frequent and more severe extreme weather events,” said Tedros.