The World Health Organization (WHO) has called for stricter masking policies and reduced isolation time recommendations for people with COVID-19 isolation, the organization announced on Friday.

Patients who test positive for COVID-19 but do not have signs or symptoms are now recommended to isolate for five days in the absence of testing, WHO suggested – compared to the 10 days it previously recommended.

“Patients without symptoms are much less likely to transmit the virus than those with symptoms,” WHO said.

The organization advises that COVID-19 patients who test negative on an antigen-based rapid test may leave isolation early. People who have symptoms but do not test should isolate for 10 days from the date of symptom onset. This is an update from WHO’s previous recommendation that these individuals isolate for at least three additional days after their symptoms have been resolved.

In contrast, WHO has called for stricter masking policies, recommending the use of masks irrespective of the local epidemiological situation.

“Masks are recommended following a recent exposure to COVID-19, when someone has or suspects they have COVID-19, when someone is at high-risk of severe COVID-19, and for anyone in a crowded, enclosed or poorly ventilated space,” WHO wrote in a release.

At the same time, WHO did say there are instances when masks might be suggested based on a high-level of risk, such as being in a place with increased infection and hospitalization levels or lower levels of vaccination.

Finally, WHO stressed that it recommends the use of Pfizer’s Paxlovid or its generic equivalent, Hetero’s COVID-19 oral drug Nirmacom, for patients with mild or moderate COVID-19 who are at risk of developing severe disease or being hospitalized.

It does not recommend two other treatments – sotrovimab and casirivimab-imdevimab – because these monoclonal antibody medicines “lack or have diminished activity against the current circulating virus variants.”

Image Credits: Flickr/Nicolò Lazzati, IPPR.

Uganda’s Health Minister, Jane Ruth Aceng

There is no clear path to test the three candidate vaccines developed to combat the Ebola Sudan strain now that Uganda’s outbreak is over.

The three candidate vaccines – produced by IAVI (called SUDV), Sabin (ChAD3) and Oxford (ChAdOx1) – were delivered to Uganda with much fanfare in mid-December. But scientists attending a meeting convened by the World Health Organization (WHO) on Thursday could not agree on how to test them now, and discussed options including regulatory approval based on animal-only studies and “immunobridging”.

Candidate vaccines for Ebolavirus Sudan.

So far, only one vaccine, BioThrax, developed to protect against anthrax, has been given US Food and Drug Administration approval based solely on animal studies. 

BioThrax had already been licensed in the 1970s to prevent anthrax inhalation but received a futher FDA approval as post-exposure prophylaxis for anthrax exposure in 2015, based on the FDA’s Animal Rule.  

Under the Animal Rule, efficacy is established based on “adequate and well-controlled studies in animal models of the human disease or condition of interest, and safety is evaluated under the pre-existing requirements for drugs and biological products”, according to the FDA.

‘Immunobridging’

There was much discussion about the possibility of immunobridging, an approach that allows scientists to infer a vaccine’s effectiveness to conditions other than those proven in a clinical trial. It has been used during COVID-19 to approach vaccines for different demographic and age groups.

It can also be used to change dose levels and formulation. In some cases, conclusions from animal trials have been extrapolated to humans – including to approve Ebola vaccines and treatment.

 

Given how lethal Ebola is, the WHO’s Ana Maria Hanao-Restrepo asked participants whether anything could be done with the thousands of doses of the three candidate vaccines currently in Uganda in order to prepare for the next outbreak.

More non-human primate efficacy data, testing the effects of one vaccine dose or two, which vaccine gave rapid protection and which gave long-term protection, and whether efficacy was affected by malaria were some responses.

CEPI’s Bill Dowling said that while efficacy studies in mice and guinea pigs were “not very applicable”, non-human primate studies, particularly in cynomolgus macaques, were similar to human progression and had been used extensively for Ebolavirus Zaire studies.

But having the assays in place to support trials was missing, said Dowling, including reagents for Sudan virus.

Dowling also noted that certain correlates of protection established during trials of the vaccine for Ebolavirus Zaire might be applicable to Sudan.

WHO’s Ana Maria Henao-Restrepo

Pathways to regulatory approval

Several pathways are open to regulatory approval for a vaccine for Sudan, Dowling added.

These include an accelerated approval pathway where efficacy is based on a surrogate endpoint likely to predict clinical benefit, conditional approval, where the benefit of the vaccine’s immediate availability to patients is deemed greater than the risk and an exceptional circumstances pathway, where it is recognised that the sponsor is unable to provide certain data.

“The US animal rule is very stringent, and does not apply if approval can be based on an efficacy standard elsewhere in FDA regulations,” said Dowling, and that it usually entailed “a large number of studies with a large number of animals, and was quite a lengthy process”.


Infectious disease expert Nancy Sullivan, director of Boston University’s National Emerging Infectious Diseases Laboratories, “efficacy data have to be generated in humans”.

“We have to be careful about trying to compare vaccines based on immunogenicity. I think we need those efficacy results and if it requires doing it over multiple trials, we should,” stressed Sullivan.

The University of Marburg’s Stephan Becker agreed: “The most important thing is really the efficacy trials that we can bring up very rapidly during an outbreak.

“Maybe this discussion about immunobridging studies does not help in a situation such as the Sudan Ebola outbreak,” he added. “I think it’s much more important to have all the vaccines ready to go at the beginning of an outbreak. These immunobridging studies are interesting to perform, but in essence, I think we need the efficacy trials.”

Erica Saphire from the La Jolla Institute agreed that “we don’t know a magic number that we need to hit in terms of binding antibody or neutralising antibody to know somebody will or will not be protected [against Sudan]. 

“But we do have the ability to generate useful and informative data on human samples and non-human samples in the meantime so that we have that at the ready for when we do need to deploy a Sudan vaccine during an outbreak,” she added.

Immediate vaccination?

Former FDA official Philip Krause challenged Sullivan and Becker: “If we’re saying the only way to evaluate these vaccines is efficacy trial, that means that a certain number of people are going to receive delayed vaccination versus immediate vaccination. And of course, everybody would rather have immediate vaccination [in an outbreak].”

If it was “reasonably likely” that a vaccine was efficacious, regulators could allow all trialists to get immediate vaccination, he added.

But Sullivan and Becker were convinced that immunobridging could assist to determine efficacy as the different vaccines behave so differently.

Given the lack of clarity and consensus about the way forward, the WHO is conducting further discussions with scientists and collaborators.

Genomic Surveillance
Lineage tree of Sars-CoV-2 strains according to genomic sequencing data.

British scientists have launched a new initiative to expand the sequencing of common seasonal respiratory viruses with the aim of developing an early warning system for new viral threats and help prevent future pandemics.  

At the height of the COVID-19 pandemic, labs around the world were sequencing tens of thousands of Sars-CoV-2 genomes a day. The data being shared from around the world allowed health authorities to keep pace with the evolution of the virus responsible for causing COVID-19, and identify where the next threat was coming from. 

The Respiratory Virus and Microbiome Initiative launched on Tuesday by researchers at the Wellcome Sanger Institute aims to build on these lessons. The project, run in collaboration with the UK Health Security Agency and other scientists, will track and sequence the evolution of respiratory virus pathogens like SARS-Cov-2, as well as other coronaviruses, flu families, and respiratory syncytial viruses (RSV) in order to establish a what it calls a “large-scale genomic surveillance system for respiratory viruses.” 

“It comes out of the simple idea that what we’ve done for Covid, we should now be doing for all respiratory viruses because if we can establish a better understanding of these viruses, we can be in a better place to understand their transmission and how to develop vaccines against them,” Dr Ewan Harrison, who is leading the initiative, told the Guardian.

Viral genome sequencing expanded significantly during the pandemic. The public release of the Sars-CoV-2 sequence by Chinese scientists in January 2020 allowed the world to start developing diagnostics and vaccines within days, saving millions of lives. To date, scientists have shared millions of Sars-CoV-2 sequences on public databases.

Influenza has attracted a lot of research interest over the years. However, many other respiratory bugs, like rhinovirus or adenovirus, are poorly monitored, leading to a gap in scientific understanding of their transmission dynamics.  By providing large amounts of data for academics and public health officials to use in their work, the program hopes to “supercharge” research efforts to fill these blind spots and improve scientific understanding of the particular characteristics of individual strains that make up respiratory virus families.

“Understanding which specific strains of each virus is causing disease in patients, and if there are multiple strains or multiple viruses present at any one time will hugely change our understanding of how viruses lead to disease, which viruses tend to coexist, and the severity of disease caused by each virus,” said Dr Catherine Hyams, an expert in respiratory viruses at the University of Bristol.

If the program succeeds, it could provide a blueprint for other countries to implement as part of their pandemic preparedness strategies – and become a cornerstone of global defenses against viral threats in the future.

Image Credits: MinMaj.

china
WHO’s director-general Dr Tedros Adhanom Ghebreyesus.

The World Health Organization (WHO) has called for more data on China’s COVID-19 situation to better understand the transmission dynamics of the virus on the ground and  flagged China’s under-reporting of COVID-related deaths. 

“There are some very important information gaps that we are working with China to fill. First and foremost is to have a really deeper understanding of the transmission dynamics of Covid across the country,” Dr Maria van Kerkhove, WHO’s COVID-19 technical lead, told a media briefing on Wednesday.

She added that the WHO has an open communication channel with the Chinese authorities and has offered technical advisory support to the country’s authorities. 

China’s management of COVID-19has been a cause for increased global concern in the recent past. Since the country lifted its ‘zero-COVID’ measures in December 2022, it has seen an unprecedented surge in infections and deaths.   

China recently narrowed its definition of COVID-related death to indicate only those with a positive COVID test and died of respiratory failure or pneumonia. By definition, this excludes deaths caused due to underlying conditions worsened by Covid-19. 

WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus, told the briefing that the number of COVID-19 deaths across the world has remained constant at between 10,000 and 14,000 per week since mid-September.

Describing these deaths as “unacceptable” since there are tools to prevent it, Tedros added that “this number is almost certainly an underestimate given the underreporting of COVID-related death in China”.

Need for more sequencing

Recalling that the first gene sequence of SARS-CoV2 had been shared with the world three years ago, Tedros stated that the number of sequences that are being shared globally has decreased by more than 90% since the peak of the Omicron infection, while the number of countries sharing sequences has fallen by a third.  

“It’s understandable that countries cannot maintain the same levels of testing and sequencing they had during the Omicron peak. At the same time, the world cannot close its eyes and hope this virus will go away.”

He added that only 53 out of 194 countries provide data on Covid-19 deaths that are disaggregated by age and sex.

Since the early days of the pandemic, China has been accused of downplaying the number of COVID-19 infections and deaths. As of 12 January, China has reported a little over 17,000 deaths.

Dr Maria van Kherkhove, WHO’s Covid-19 technical lead.

The data from China will help WHO understand the breakdown, increases and decreases in the hospitalisations, ICU capacity and COVID-related deaths in urban and rural areas across the provinces in China, Van Kerkhove explained. 

While underlining that the agency has received some sequencing information from China, Van Kerkhove said that further information is necessary. “We have requested further information to have those sequences be shared publicly so that a deeper analysis and more phylogenetic analysis can be done so that we could look mutation by mutation to really assess what is circulating there.”

Reiterating that WHO believes that the “deaths are heavily underreported from China”, Dr Mike Ryan, executive director of health emergencies at WHO, said that the agency does not have enough information to do a comprehensive risk assessment. 

“We will continue to try to encourage access to that data but also recognize in the same breath that China has done a lot in the last number of weeks,” Ryan said, acknowledging the country’s efforts to strengthen its own internal capacities like increasing the number of hospitals, ICU beds and fever clinics, and prioritising vulnerable groups in treatment and using antivirals early in the course of the infection. 

Urging countries to maintain higher levels of sequencing and data sharing, Van Kerkhove said that this would greatly help WHO’s risk assessments.

“We need to maintain surveillance. We need to maintain sequencing and sharing of sequences from around the world so that risk assessments can take place, and we can ensure that any changes to our response, any changes to our advice is done in a timely manner.” 

Image Credits: Screengrab from Wednesday's presser. .

Health workers in Mubende, Uganda, to test suspected Ebola cases shortly after an outbreak of the Sudan virus strain was first declared there in September, 2022.

WHO’s Africa Region has declared the end to the recent outbreak of Sudan Ebolavirus – just a day before WHO convenes Ebola experts in a global consultation to explore a way forward on testing three candidate vaccines for the deadly Sudan strain of the virus.

The oubreak was declared over after the elapse of 44 days since the discovery of the last case.  That waiting period is double the 21-day period of time within which contacts of Ebola cases may become become ill with the deadly disease.

Uganda’s relatively rapid and effective campaign against the outbreak – which began on 20 September 2022 – was celebrated by health authorities, who fought the virus with classic measures like contact tracing, case isolation and treatment – in the absence of a vaccine against the Sudan strain of Ebolavirus.

At the same time, squashing the virus also has squashed the near-term prospects for a conventional clinical trial of three vaccine candidates that could prevent illness from the Sudan strain of the virus. WHO had originally planned to commence the randomized controlled trial last month in collaboration with Ugandan authorities. The trial was to be based on trials a convential demonstration of vaccine efficacy in a study group that would get the vaccine right away – as compared to a control group that would only get the vaccine after 21 days.  See related story:

Exclusive: Vaccine Trial Against Sudan Ebolavirus – With No Recent Infections in Uganda, What’s Plan B?

Similar trials were undertaken in Guinea for vaccine candidates against the Zaire form of the virus during the 2014-2016 West African Ebola epidemic.  The Merck vaccine candidate tested at the time, was eventually approved by United States regulatory authorities, after it helped bring an end to that tragic episode that killed over 11,000 people.  A second vaccine, by Johnson & Johnson, was later tested and aprpoved by the European Medicines Agency in 2020.

Is showing efficacy with animal models the best way forward?  

 

Microscopic image of an ebolavirus

Health Policy Watch conversations in late December with vaccine experts inside and outside of WHO, as well as with two of the three manufacturers of the Sudan Ebolavirus vaccine candidates, underline that a new strategy for testing the vaccines will now be needed.  And that is due to be discussed by WHO at Thursday’s meeting.

“Historically the number of cases of the Sudan Ebolavirus has been very limited,” one expert interviewed by Health Policy Watch also observed. Small outbreaks of only a handful of cases would deeply challenge any attempt to obtain statistically significant results from a randomized controlled trial of even one vaccine candidate, let alone three.

In the absence of any outbreak at all, experts have suggested that the most feasible pathway to regulatory approval might be throught the US Food and Drug Administration’s Animal Efficacy rule.  The approach could involve the testing of vaccine efficacy, per se, on non-human primates, along with more extensive testing of the vaccine’s safety and ability to produce an immune response, in healthy human volunteers.

The FDA’s animal efficacy rule is designed for just such situations, allowing initial regulatory approval of a vaccine for rare but deadly diseases based on animal model studies that replicate human disease, combined with evidence of safety and a strong immune response from clinical trials in healthy volunteers.

Such a model was used by Bavarian Nordic to gain US Food and Drug Administration approval of its MVA-BN® vaccine in 2018 against smallpox, which was then available for a rollout this year on a compassionate use basis in response to the global outbreak of monkeypox, which WHO now recommends calling mpox. Once mpox became widespread, clinical trials of vaccine efficacy in humans also commenced.

Developers of the vaccine candidates are quietly looking at such pathways to initial approval of Sudan ebolavirus vaccines. But it’s clear that the developers would also like the official, and proactive support of WHO for a new strategy, as the global health agency leading Africa’s Ebola response and the key partner of Uganda’s Ministry of Health as well as other countries on the continent in the Ebola battle.

“One would have to decide if it would be possible to test the vaccines clinically, or go for plan B, and accept the animal rule, whereby the vaccine is approved on the basis of experimental work, with non-human primates along with very robust safety and immunogenicity trials,” said an independent clinical trial expert with knowledge of the trial who spoke with Health Policy Watch.

Added another: “it would make a lot of sense to use the impetus of this outbreak, and the momentum that has been built, to do safety and immunogenicity trials, and then work in parallel on designing different Phase 3 trial [human] types that could be suitable for different types of outbreaks that might come in the future – trials of different intensity and so on, so that everything is ready to start the Phase 3 trials when the next outbreak comes.”

Ensuring adequate stockpiles of vaccine candidates

Swati Gupta, IAVI

Ensuring adequate stockpiles of the vaccine candidates in the field is another compelling concern – and on that point there appears to be broad agreement within WHO and beyond. Such stockpiles exist for approved Ebola vaccines – but not for candidates that also could and should be deployed quickly among volunteers should another outbreak emerge.

As the experience with the recent outbreak demonstrates, while the first Sudan ebolavirus vaccine candidates arrived in Kampala, Uganda in a record 79 days after the outbreak was first declared, that was still not fast enough – since by that time cases had dwindled, and most of the Ebola case contacts had already passed the 21-day virus incubation period without developing symptoms.

“When there is no outbreak, we need to ensure that we have adequate funding and resources are allocated so that people can produce the stockpiles, and then have a discussion about where you’re going to keep them, and how you would utilize them if there was a need,”  Swati Gupta, head of emerging infectious disease and scientific strategy at IAVI, a leading ebolavirus vaccine developer. “So we 100% support generating stockpiles and being prepared in advance.”

The WHO consultation from 14:00-18:45 p.m. CET is open to participation with registration in advance.  Registration link here:

Image Credits: @WHOAFRO, @WHOAFRO, Brittanica © jaddingt/Shutterstock.com.

WHO investigator into sexual abuse allegations.
“We are fast, we are rigorous,” said Lisa McLennon, Head of Investigations at WHO’s Office of Internal Oversight Services.

The World Health Organization (WHO) has rebutted allegations that the agency takes a soft approach to senior staffers accused of sexual misconduct following a report by the Associated Press that the same WHO official who allegedly harassed a British doctor at the World Health Summit (WHS) in Berlin last October had been accused of similar misconduct in 2017 – which top officials at the agency largely ignored. 

Meanwhile, the British doctor, Dr Rosie James, who alleged that a senior WHO staff member groped her during the World Health Summit, told Health Policy Watch that WHO’s investigation of her case, now nearly three months old, seemed to be taking too long and the process had been “scary and emotionally draining”.

Dr Temo Waqanivalu, who heads WHO’s work on integrated delivery of noncommunicable disease services, was named by AP as the staff member who is reportedly the focus of a WHO investigation into the Berlin incident.

But WHO also was well aware of a prior complaint against Waqanivalu, flagged to senior officials in 2018 – and did little about it, according to the AP account. That case involved physical approaches that he allegedly made to a female colleague during a 2017 WHO workshop in Japan.   

Investigation is ‘taking too long’

“In my humble opinion, I definitely think the investigation is taking too long,” said James in a written message to Health Policy Watch. “If they have a zero tolerance policy, why is he still working there and being considered for a promotion?” she asked. “The UN should have the highest standards and set a good example to other organizations.  I understand why many people fear the reporting process. It is scary and emotionally draining.”

On the day that the incident was reported, WHO Director-General Dr Tedros Adhanom Ghebreyesus tweeted that he was “sorry and horrified”, and WHO sources said that the staff member in question had been sent immediately back to Geneva.

But at least in terms of his public profile, Waqanivalu has remained active at his WHO post while the current WHO investigation took place, and was even mounting a candidacy to be appointed as head of the WHO’s Western Pacific Regional Office, with the support of officials in Fiji, his native country.   

Dr Temo K Waqanivalu
Dr Temo K Waqanivalu, a senior WHO staffer accused of sexual misconduct, is also campaigning to become Director of WHO’s Western Pacific Regional Office.

Former WHO ombudsman reportedly expressed frustration over handling of 2017 case

A former WHO ombudsman had expressed frustration about how the 2017 case involving Waqanivalu was handled – after the woman who alleged the harassment was advised by senior WHO officials to drop the case, AP also reported, citing internal emails and documents that it had obtained. 

In the 2017 instance, the WHO staff member reportedly alleged that Waqanivalu groped her between the legs during a workshop dinner, and then on her buttocks after he followed her to a train station. In the 2022 Berlin incident, James reported that Waqanivalu had groped her similarly while they were with a group having drinks one evening after a full day of summit events. 

Months after raising her concerns in 2017, the WHO staff member alleging the misconduct in Japan was informed by the WHO Ombudsman’s office that Waqanivalu was to be given a general “informal warning” that didn’t reference the alleged misconduct, according to AP. 

The WHO Ethics Office told her it would be difficult to prove a sexual harassment case, saying it might “compromise” her name and that she likely lacked “hard evidence,” according to the series of internal emails and documents that AP obtained.

WHO – ‘we are fast, we’re rigorous’

Speaking to the allegations at a WHO press conference on Wednesday, Lisa McClennon, head of investigations in WHO’s Office of Internal Oversight Services, denied that the agency had glossed over recent sexual misconduct cases. 

“We are fast, we’re rigorous, we’re thorough. We take a contemporary and survivor centric approach to the matters that are referred to us in this effort,” she said. “This increased effort and focus in increased resources towards this matter began over a year ago, and we have been able to clear up several cases that had perhaps languished in the past. 

“We are working these types of cases in real time,” she added. “We encourage people to report any instances of wrongdoing, particularly those involving sexual misconduct. And we work as hard as we possibly can to protect those who make such reports. There are multiple channels through which the reporting can be made and we encourage those who have information to use those channels.” 

In terms of the 2017 allegations, the alleged victim reportedly turned to WHO’s “integrity hotline” in July 2018, and then the case was “tossed around in (Geneva) for months” among officials tasked with misconduct claims, according to emails obtained by the AP.

“It seems our internal process is not efficient enough to address such cases,” AP quoted the former WHO ombudsman as saying, expressing frustration with the inconclusive results of the investigation into that case.

In the Berlin incident, James tweeted about the encounter just hours after it occurred, saying that she had been “sexually assaulted”.

At least one other colleague who said that he witnessed the unwelcome physical approaches, publicly supported her report on social media. According to WHO the investigation of that incident is still ongoing, but the results will not be made public.

New Global Advisory Committee: most members to be appointed by the WHO Director General

Meanwhile, a new 15-member WHO “Global Advisory Committee” to advise the WHO on policies around complaints of abusive conduct would include just five members elected by staff – while the other 10 members would be appointed by Dr Tedros, whose office already controls the entire internal WHO judiciary process.

On Wednesday, WHO circulated an internal memo to staff describing the formation of the new “Global Advisory Committee on formal complaints of abusive conduct.”

According to a copy of the memo obtained by Health Policy Watch, the new 15-member committee “GAC” would advise on WHO’s policies around preventing and addressing abusive conduct.

Elected staff members

It would be composed of five elected staff members, five staff members designated by the WHO Director-General in consultation with WHO’s six regional directors and five “senior staff members” also designated by the Director General “following consultation with the Regional Directors.

That means that like other internal judicial processes within WHO, control of the new advisory committee on complaints of abusive conduct would remain overwhelmingly in the hands of the Director-General himself.

 

Image Credits: Screengrab from WHO presser, WHO campaign brochure.

Child
7.1 Million Children, Adolescents and Youth Died in 2021: UN Estimates

An estimated 7.1 million children and teens up to the age of 24 years died in 2021, according to a United Nations (UN) report released on Tuesday. Sub-Saharan Africa, Central and South Asia bore higher burden of these deaths than other regions. 

This includes five million children under the age of five and 2.1 million children, adolescents and youth aged between five and 24 years’ old. 

The UN Inter-agency Group for Child Mortality Estimation (UN IGME), led by UNICEF, released two reports on 10 January 2023 with the latest data on child mortality and stillbirths. While one report consisted of data on child and youth mortality, the second report estimated that around 1.9 million babies are stillborn every year. According to the World Health Organization (WHO), a stillborn baby dies after 28 weeks of gestation, either before or during birth. 

The reports highlighted that equitable access to high-quality maternal, infant, child and adolescent health care could have prevented these deaths. 

Birthplace matters

The birth location of a child determines its life expectancy, both reports stated. 

More children and youth died in sub-Saharan Africa, and Central and South Asia than in other regions of the world. While the global average of under-five mortality rate in 2021 is 38 deaths per 1,000 live births, it is 74 deaths per 1,000 live births in sub-Saharan Africa.

“Children and youth older than five years old also face the highest probability of dying in sub-Saharan Africa.” 

“More than 80% of under-five deaths and over 70% of all deaths amongst five to 24-year-olds occurred in sub-Saharan Africa and Central and Southern Asia. This unjust burden must be recognised, prioritised and addressed,” the reports added.  

Respiratory diseases, diarrhoea, measles, malnutrition, malaria and newborn conditions are among the top causes of  deaths of newborns and children under the age of five. 

Similarly, the number of stillbirths across the world also differs vastly between regions. Of the 1.9 million estimated stillbirths, around 1.5 million took place in sub-Saharan Africa and southern Asia, according to the UN IGME report. 

“The major causes of stillbirth include pregnancy and childbirth-related complications, prolonged pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, and foetal growth restriction (when an unborn baby is unable to achieve its growth potential and therefore smaller than it should be),” says the WHO. 

Threat to SDGs 

The UN IGME report on child and youth mortality stated that without urgent action, several countries are on the line to miss the Sustainable Development Goals (SDG) 2030 that target ending preventable deaths of newborns and children under the age of five. Achieving this milestone will save 11 million lives across the world, over half of which in sub-Saharan Africa. 

“Without urgent action, 54 countries will not meet the under-five mortality target by 2030 and an even larger number – 63 countries – will miss the neonatal mortality target. Most countries that are off track to meet the SDG target on under-five mortality are in sub-Saharan Africa or classified as low- or lower-middle-income countries,” the report added. 

In 2014, the WHO’s 194 member states endorsed the Every Newborn Action Plan (ENAP), committing to reduce the rate of stillbirths to 12 or fewer per 1,000 total births by 2030. 

“If every country were to meet the ENAP target by 2030, the world would still lose an estimated 13.2 million babies to stillbirth – but, importantly, 2.6 million lives would be saved,” the report pointed out. It also stated that the countries will not meet ENAP’s targets by 2030 if the current pace is maintained.

“Among the 195 countries studied, 131 have already achieved the target and a further 8 are on track to meet it. But 56 countries will miss the target unless urgent and rapid changes to health care systems are made.” 

Immediate intervention crucial

The deaths across ages have decreased since 2000, the reports said. 

“The global under-five mortality rate fell by 50% since the start of the century, while mortality rates in older children and youth dropped by 36 per cent, and the stillbirth rate decreased by 35%. This can be attributed to more investments in strengthening primary health systems to benefit women, children and young people.” 

However, these gains have reduced since 2010 and only through sustained efforts and investments into health systems and services can the situation be improved.

“If swift action is not taken to improve health services, warn the agencies, almost 59 million children and youth will die before 2030, and nearly 16 million babies will be lost to stillbirth.”

To prevent stillbirths, the reports recommended that the evidence and knowledge around the topic be enhanced through better measurement and that every mother and child must be delivered the highest quality of healthcare. 

“Among the 195 countries for which stillbirth estimates are generated, 22 countries have no stillbirth data, and an additional 38 countries lack quality stillbirth data. Many countries with data issues are also high burden: 32% of those without data are in sub-Saharan Africa and 63% are from low- and lower-middle-income countries. Improved evidence and statistics are particularly critical in these settings, where stillbirth rates are likely to be amongst the world’s highest.”

Image Credits: Photo by Alex Pasarelu on Unsplash.

COVID-19 cases have surged in China after the country relaxed various travel and social restrictions.

European countries that plan to introduce “precautionary measures” in light of the huge COVID-19 surge in China should ensure these are “rooted in science, proportionate and non-discriminatory”, the World Health Organization’s (WHO) Europe director has urged.

However, Dr Hans Kluge added that, based on information available to WHO, “the SARS-CoV-2 virus variants circulating in China are those that have already been seen in Europe and elsewhere”.

“We share the current view of the European Centre for Disease Control that the ongoing surge in China is not anticipated to significantly impact the COVID-19 epidemiological situation in the WHO European region at this time,” Kluge told a media briefing on Tuesday.

Dr Hans Kluge

Morocco is the only country so far to have banned flights from China in the wake of its COVID-19 surge, while some other countries including Australia, France, Japan, South Korea and the US, require a negative COVID-19 test for Chinese travellers.

But while Kluge acknowledged that China has been sharing virus sequencing information, he called for “detailed and regular information, especially on local epidemiology and variants, to better ascertain the evolving situation”.

“It is not unreasonable for countries to take precautionary measures to protect their populations, while we are awaiting more detailed information that is shared via publicly accessible databases,” added Kluge.

There is concern that China is hiding the extent of its COVID infections death toll, particularly as it recently narrowed the definition to only cover people with a positive COVID test who died of respiratory failure or pneumonia.

Yet there are widespread reports on social media and elsewhere about the effects of COVID on hospitals, funeral homes and graveyards. 

Airfinity, the independent health modelling body, predicts that China’s outbreak will peak on 13 January with about 3.7 million daily cases, with a second peak in rural areas on 3 March with 4,2 million daily cases, resulting in 1.7 million deaths in the country by April.

Airfinity modelling on China’s COVID-19 cases released in December 2022

“There is likely to be over one million cases a day in China and over 5,000 deaths a day. This is in stark contrast to the official data which is reporting 1,800 cases and only seven official deaths over the past week,” according to an Airfinity statement in late December.

The WHO has long advised countries to use excess mortality data to assess the impact of COVID-19.

Spread of XBB.1.5

Meanwhile, the new XBB.1.5 recombinant virus that is spreading rapidly across the US, is starting to expand in Europe.

Kluge said that in some European countries that have maintained strong genomic surveillance, such as Denmark, France, Germany and the United Kingdom the new XBB.1.5 recombinant virus was being picked up in “small, but growing numbers” and the WHO was assessing its potential impact.

“After three long pandemic years – with many countries grappling with overstretched health systems, shortages in essential medicines, and an exhausted health workforce – we cannot afford more pressures on our health systems,” Kluge concluded.

South Africa’s health minister Dr Joe Phaahla also confirmed on Tuesday that the first XBB.1.5 case had been picked in his country in late December. 

South Africa’s health minister, Dr Joe Phaahla.

However, Phaahla assured a media briefing on Tuesday that there was no indication that XBB.1.5 was “more severe” or caused more hospitalisation.

“Even in the People’s Republic of China, there is no indication that these various sub-variants are more severe in terms of illness, but it’s just the sheer numbers in a huge population, where people are now travelling freely, both in the country and also able to travel out of the China. We believe that the dominant variant of concern in China and in the world remains the Omicron,” said Phaahla, adding that South Africa would not impose any travel restrictions on Chinese travellers.

Image Credits: Flickr.

Pakistan
The UN estimates over 20 million people still require immediate assistance in Pakistan.

World leaders, representatives of international development and humanitarian organizations, and UN delegations gathered in Geneva on Monday to rally financial support for Pakistan’s recovery from the devastating floods that hammered the country last year.

Pakistan has appealed for $16.3 billion to assist it to rebuild the country, and almost half this amount had been pledged by countries attending the International Conference on Climate Resilient Pakistan by Monday evening.

The United States committed an additional $100 million in recovery funding for flood-hit areas, while the European Union raised its total contribution to Pakistan to $500 million. The Islamic Development Bank’s pledge of $4.2 billion is the largest single donation to date.

At their height, the historic floodwaters submerged over a third of Pakistan, directly affecting over 33 million people and pushing nine million to the brink of poverty. Over 1,700 people, a third of whom were children, lost their lives to the torrential rains. More than two million homes were severely damaged or destroyed, along with 8,000 kilometres of roads and 3,100 kilometres of railway tracks. 

Of the eight million people displaced in early October 2022 by the floods that Pakistani Prime Minister Shehbaz Sharif described as a “tsunami from the sky”, 5.4 million remain displaced. The UN says money raised for flood victims is set to run out this month without fresh commitments, leaving millions at risk of disease, illness and malnutrition.

With millions still living near contaminated floodwaters, over 1,000 confirmed cholera cases and 76,000 dengue cases were recorded in 2022. Diarrhoea remains widespread and malnutrition in children continues to increase.

“No country deserves to endure what happened to Pakistan,” UN Secretary-General Antonio Guterres told reporters at a news conference with Sharif on the sidelines of the meeting. “If there is any doubt about loss and damage — go to Pakistan.  There is loss. There is damage. The devastation of climate change is real.”

Guterres: the global financial system is ‘morally bankrupt’

Pakistani Prime Minister Shehbaz Sharif described the flood waters that hit his country last year as “a tsunami from the sky.”

The funding push comes as Pakistan finds itself running out of avenues to turn to for the credit it needs to rebuild the country. Prior to the floods, Pakistan’s economy was already teetering on the brink of collapse, with dwindling foreign exchange reserves and debt default looming large over the country’s balance sheets.

With over 60% of developing nations in “critical” debt, according to the IMF, the conference is shaping up to be a litmus test for how rich countries will respond to the financial needs of the developing world as the impacts of climate change worsen.

Though a historic loss-and-damage fund was agreed to at COP27 in Egypt, it is not yet operational. Strong language on the reform of multilateral development banks was also included in the deal, but no changes have taken place to date.

Pakistan, which is one of the top 10 most affected countries by climate change, plays a negligible role in global warming, emitting less than 1% of global carbon dioxide annually. In the months prior to the floods, Pakistan was caught in a scorching heat wave that caused forest fires and aggravated droughts in the country’s western provinces. Some of the same areas on fire in the early spring were underwater by summer. 

Pakistani Prime Minister Shehbaz Sharif says that “Pakistan simply cannot do this alone”.

“Pakistan is doubly victimised by climate chaos and a morally bankrupt global financial system,” Guterres said. “That system routinely denies middle-income countries the debt relief and concessional funding needed to invest in resilience against natural disasters.”

In August, as the floods were in full swing, the Pakistani government agreed to new terms with the IMF on its foreign debt repayment. The $1.17 billion loan saved Pakistan from default – an outcome that would have made future borrowing more difficult, and likely sparked a recession – but forced the country to accept harsh austerity policies, passing the burden of debt on to ordinary Pakistanis. 

Amid overlapping food and energy crises arising from the Russian invasion of Ukraine and the destruction of Pakistan’s arable land in the floods, Prime Minister Sharif called the requirements imposed by the IMF to pass additional burdens on already struggling people “not in line with the norms of justice.” 

“How could you expect that, after the floods hit Pakistan and almost destroyed everything, we will pass on this imported inflation to the common man and he or she will accept it,” Sharif said.

“The rich can enjoy both worlds whether the price of oil touches $200 or $30 a barrel. And you expect a poor man who is able to meet these two ends with great difficulty will absorb this price hike without any protest? That is not normal.”

Pakistan offers a window into climate change future

Pakistan
The UN estimates 14.6 million people need food assistance, while over seven million children and women need immediate access to nutrition services.

While Pakistan’s situation is particularly acute, its overlapping crises are set to become a common occurrence in poor countries in the path of climate change. Multilateral development banks, Guterres said, need to make available concessional funding and rework their business models to allow countries to deal with extreme weather events without suffering from crippling debt loads. 

“We need first of all to recognize that we presently have a situation in the developing world in which countries are strangled by debt,” Guterres said. “We need to redesign our financial system in order to be able to take into account vulnerability and not only GDP when decisions are made about concessional funding to countries around the world.”

Citing a recent discussion with Kenyan President William Ruto, Guterres noted that his home country of Portugal – whose debt is 117.7% of GDP – is easily able to access loans at interest rates of 4%, while the lowest offer presented to Kenya was 14%. 

“It is very clear that the present system is biased. The system was conceived by a group of rich countries and naturally benefits rich countries,” he said. “It shows that there is a basic injustice in the system and that we need effective reform.”

Despite the painful conditions associated with the IMF loan, Sharif emphasized that Pakistan’s government “will do everything to comply with the terms and conditions” of the programme. Dialogues appealing to the IMF for “compassion” and “breathing space” are ongoing, he said.

“I hope that member states that control the boards of these institutions will be able to implement the kind of reforms that are needed to establish more justice,” Guterres concluded. 

Image Credits: UNDP, UNDP.

The 2022 World Health Assembly.

A high-level council to govern global health emergencies, made up of heads of state and other international leaders, is one of the proposals to be discussed by the World Health Organization (WHO) this year.

It is the first of 10 proposals to strengthen the WHO’s response to health emergencies put forward by WHO Director General, Dr Tedros Adhanom Ghebreyesus, in a document published late last week.

The proposals, distilled from the numerous inputs from member states and global health in light of COVID-19, will be considered by the body’s executive board meeting from 30 January to 7 February.

The executive board develops the agenda for the WHO’s annual World Health Assembly, the body’s highest decision-making forum.

The proposed global health emergency council would be guided by the principles of equity, inclusivity and coherence and “complement the Standing Committee of the Executive Board, and a main committee on emergencies of the World Health Assembly”, according to Tedros’s document.

Its three primary responsibilities would be to address “obstacles to equitable and effective health emergency preparedness, response and resilience (HEPR)”, foster compliance with, global health instruments including the International Health Regulations (2005), and “identify needs and gaps, swiftly mobilize resources, and ensure effective deployment and stewardship of these resources for HEPR”.

Balancing health and economic considerations

The second proposal aims to make targeted amendments to the International Health Regulations to address weaknesses exposed by the COVID-19 pandemic, particularly how to balance often contradictory health and economic considerations.

The third proposal is scaling up universal health and preparedness reviews and strengthening independent monitoring.

Proposal four addresses strengthening the health emergency workforce, while the fifth proposal is aimed at improving global coordination by standardising approaches to the “strategic planning, financing, operations and monitoring of health emergency preparedness and response”.

The other proposals address partnerships, better coordination between finance and health decision-makers and strengthening the Pandemic Fund set up by the World Bank.

The crucial ninth proposal calls for the expansion of funds available for a rapid, sustainable emergency response.

“Drawing on the experience of the ACT-Accelerator, the funding required for the rapid and equitable deployment of medical countermeasures against a pandemic pathogen is in the order of tens of billions of United States dollars,” according to the document.

It calls for the WHO Contingency Fund for Emergencies (CFE) to be expanded for immediate relief, but acknowledges that “an additional financing facility that is capable of disbursing large tranches of funding quickly should be triggered” following the CFE response.

“The triggers for activation of this draw-down facility should be pre-negotiated, transparent and based on the ‘no regrets’ precautionary principle,” it proposes. 

Strengthened WHO

The 10th proposal is for the WHO to be strengthened so that it can be at the centre of the global health emergency and preparedness architecture.

To achieve this, the WHO needs “the authority, sustainable financing and accountability to effectively fulfil its unique mandate as the directing and coordinating authority on international health work,” according to the document.

Should member states adopt a pandemic accord, this would “reinforce the legitimacy and authority of WHO and complement the steps that member states are already taking to ensure sustainable financing of the WHO”. 

The zero-sum conceptual draft of a pandemic accord was discussed by the WHO intergovernmental negotiating body at a meeting in December, with the final draft of the accord to be put forward at the World Health Assembly in 2024.

Explaining the need for the overhaul of the WHO, the document explains that “the fragmented nature of the current modes of health emergency governance, functional systems and financial mechanisms has given rise to a global health emergency preparedness, response and resilience architecture that is often less than the sum of its parts, and which fails to respond rapidly, predictably, equitably and inclusively to health emergencies”.

“It is vital that the world now seizes the chance to do things differently. The devastation caused by COVID-19 has brought a welcome sense of urgency to efforts to strengthen the way the world prepares for, prevents, detects and responds to health emergencies. It is equally vital, however, to ensure that the collective efforts of member states, the WHO Secretariat and partners at national, regional and global levels are coordinated, coherent and reflective of a broad and inclusive participation by all stakeholders.”