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Africa CDC’s Director John Nkengasong

Within the last five years, Africa CDC has grown into a “formidable” public health agency.  

But equally formidable challenges remain for the agency, which must provide advice and guidance on Ebola, cholera, measles – as well facing yet another surge in COVID cases in South Africa – the country hardest hit by SARS-CoV2, says outgoing director John Nkengasong.  He was speaking at a farewell press briefing Thursday, shortly after being confirmed by the US Senate to lead the United States President’s Emergency Plan For AIDS Relief (PEPFAR).

The continent also faces an uphill battle to increase rates of COVID immunization in a region where many people don’t see the disease anymore as a major threat.  Against a WHO goal of having 70% of Africans immunised, only about 17% of Africans have had two jabs, and only about 30% of people in South Africa, despite being the country hardest hit by the successive pandemic waves.  

Future trajectory uncertain

“The future trajectory remains very uncertain, and unpredictable, except we vaccinate up to at least 70% of our population,” Nkengasong said.

“I’m departing the Africa CDC with a lot of mixed feelings,” he added. “One is really of joy to see that for the past five years, we collectively as a continent, in partnership with close allies, have actually built a formidable Africa CDC — a public health agency agency that has become a respectable public health organization for the continent and for the world, and is contributing in the fight against COVID-19 and other global health insecurities.  

“But with the right determination, I’m very convinced that we are going to make it as a public health agency,” he said.

Reacting to Nkengasong’s new PEPFAR appointment, African leaders told  Health Policy Watch that he’ll reinvigorate the US-funded programme that has been a flagship for the global battle against the AIDS pandemic for nearly two decades.

Southern Africa’s COVID upsurge

Meanwhile, the WHO African Regional Office has expressed concerns over the upsurge in COVID-19 cases in Southern Africa, for the third week in a row. This is coming as the winter season in the region approaches.  The uptick has broken a two-month-long decline in overall infections recorded across the continent.

In the week ending 8 May 2022, there was a 32% increase in new infections over the week before in the sub-region, which recorded a total of 46,271 new cases.  That, WHO said, is largely driven by the spike in South Africa where weekly recorded cases have quadrupled in the past three weeks. 

“Deaths have, however, not climbed as quickly. South Africa recorded 376 deaths in the past three weeks, twice as many compared with the previous three weeks,” WHO stated.

Similarly, hospitalization rates in South Africa remains low, with the number of patients currently admitted testing positive for COVID-19 at around 20% of the late December 2021 peak. 

The Omicron variant and relaxed public health and social measures are fuelling the surge. Since early April, South Africa alone has recorded 1369 cases of the Omicron sub-variant BA.2, 703 cases of sub-variant BA.4, and 222 cases of sub-variant BA.5. WHO however noted that BA.4 and BA.5 remain the most concerning because they contain the largest number of mutations, and their effects on immunity remain unclear.

“This uptick in cases is an early warning sign which we are closely monitoring. Now is the time for countries to step up preparedness and ensure that they can mount an effective response in the event of a fresh pandemic wave,” said Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response at World Health Organization (WHO) Regional Office for Africa.

While TB kills more people each year than malaria and HIV, more money is allocated to malaria and HIV than to TB in the new Global Fund strategy.

With a target to raise at least $18 billion to save 20 million lives, and reduce mortality from HIV/AIDS, TB, and malaria by 64%, the Global Fund to Fight AIDS, Tuberculosis, and Malaria is gearing up to implement its ambitious new strategy to defeat these longstanding pandemics by 2030. 

However, even though TB kills more people than HIV/AIDS and malaria combined, the global body will continue allocating just 18% of its overall funding to TB, while 50% goes to HIV/AIDS, and 32% for malaria for the first $12 billion of funds that are spent spent between 2023-2026. A new split of 45% for HIV, 25% for TB, and 30% for malaria will, however, be applied as cumulative funding rises above  $12 billion in that period. 

The increased allocation for TB was welcomed by Global Fund Board Chair Donald Kaberuka as enabling a “scale up of TB programs for the most affected while protecting HIV and malaria gains.”

TB is 60% of the disease burden in comparison to HIV and malaria

But for the TB community, the new allocation formula still falls far short of the realities, in which TB has a much larger global health impact overall while TB diagnosis and treatment also suffered big setbacks during the pandemic.

“This decision does not reflect the burden, and especially the mortality,” said Lucica Ditiu, Executive Director of the Stop TB Partnership, interview with Health Policy Watch. “If you put TB, HIV, and malaria together, TB alone is responsible for close to 60% of [disease burden and mortality], and HIV and malaria closer to 40%.”

And while the allocation share has risen, proportionately, from only 16% in 2013 – 2014, “this is far away from reflecting any needs and any realities – it will not really push the end of TB,” she asserted.

An implementation plan for the new five-year strategy “Fighting Pandemics and Building a Healthier and More Equitable World”, was discussed this week at the annual Global Fund meeting.

Allocating funding similar to cutting a cake

Dr Lucica Ditiu

Ditiu likened the difficulties of trying to split funding allocation between the three diseases to the cutting of a cake.

“You try to give more to one, it means the rest get less.”

She noted that HIV and malaria communities mobilized and warned that if funding were to decrease to either disease, the gains made over the years in both HIV and malaria would no longer be sustainable.

While no one wants to pit one disease against the other, “it becomes a matter of equity,” she said. This is especially noticeable for HIV vs TB funding – as TB has never received the ‘long end of the stick’.

Answer to the gap is not the Global Fund

“Not only does HIV get the biggest chunk from the Global Fund. They also have the President’s Emergency Plan for AIDS Relief (PEPFAR), which receives a huge amount of funding from the government of the United States. They receive billions of dollars every year from external funding, while TB receives barely a billion.”

While Ditiu hopes that the Global Fund’s Seventh Replenishment Conference, hosted by the United States in September – October 2022, will increase overall funding for TB, she also suggests that new financing solutions have to be identified.

“The answer to the gap in finances is not the Global Fund.”

Looking towards the future, Ditiu hoped that events such as the G20 hosted in high-burden TB countries such as Indonesia, Brazil, and India, will raise awareness about the continued threat posed by this ancient airborne disease, which also has developed new, and even more deadly drug-resistant forms which are even harder to treat.

Disproportionate TB funding leaves millions undiagnosed and untreated

Lack of funding has resulted in about 4 million people with TB left undiagnosed and unable to receive treatment each year, as a result of outdated technology and barriers to accessing services.

“We don’t have the foundation, we don’t have the bed. What is heavily missing is access to people to get diagnosed with TB,” said Ditiu.

Many low- and middle-income countries continue to diagnose TB with the now-outdated method of sputum smear microscopy, which is not as accurate as molecular diagnostic tools In addition, TB services in many of these countries lack resources and funding to find more vulnerable groups that are unable to get diagnosed and receive treatment on their own.

“Do we really want to end TB ever? According to laboratory estimates, around 24% of the world population is infected with TB, and 20% of that will develop the active form of TB in their lifetime. So we sit on a big reservoir, and it looks like we don’t want to clean it up,” said Ditiu.

Disease split was ‘difficult decision’ but an ‘essential step’

Despite the obvious dissonance in the existing allocation formula, it’s essential to the lowest-income countries where HIV and malaria remain bigger threats, says the Global Fund. 

“The disease split is a difficult decision, but it’s an essential step that enables the Global Fund to allocate funds to the highest burden countries with the lowest economic capacity, ” said a Global Fund spokesperson in response to a query by Health Policy Watch, citing a statement by Harley Feldbaum, Head of Strategy, in November 2021, when the strategy was first released. 

“Since we allocate well over 90% of the funds we raise directly to countries, there are no easy tradeoffs in this decision; every change must balance priorities across HIV, TB, malaria and broader health needs,” Feldbaum said. 

“The decision the Board made responsibly protects HIV and malaria investments and funding to lower income countries, where there remain substantial unmet needs, while significantly increasing the proportion of funding directed to meet important TB needs with a successful Replenishment.”

New Global Fund strategy focuses on communities  

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2023 – 2028 Global Fund Strategy Framework Overview

To end HIV, TB, and malaria as public health threats by 2030, the Global Fund has said it will focus more attention on community-based services in the coming years.

The strategy has three stated objectives. These include: people-centered health systems; engaging with communities so no one is left behind; and maximizing health equity, gender equality, and human rights. 

Especially important is the need to protect and advance health equity, gender equality, and human rights in the face of co-occurring pandemic and other humanitarian crises. 

“The COVID-19 pandemic, and efforts to control it, have exacerbated human rights and gender-related barriers,” said Roslyn Morauta, Vice-Chair of the Board of the Global Fund, in a statement at the close of this week’s meeting. 

“At the same time, humanitarian crises from Myanmar to Afghanistan to Ethiopia, and most recently in Ukraine, further threaten our community partners and put human rights, disease responses and lives at risk. These crises have underscored the need for strong and well-resourced community systems and responses. Planning the implementation of the 2023 – 2028 Strategy provides an important opportunity to respond strongly to the challenges we face.”

Image Credits: Stop TB Partnership, Global Fund .

More Effective Responses to Health & Environmental Emergencies through Peacebuilding panelists.

One-half of the countries facing serious climate threats also are located in conflict zones – and that single fact alone illustrates the symbiotic relationship of climate and conflict, and their inter-related impacts on health.  

This was a key message of the Geneva Health Forum panel on ‘Effective Responses to Health and Environmental Emergencies through Peacebuilding’, Thursday 5 April, on the Forum’s closing day.

Environmental degradation negatively impacts economic growth, food security, and through those drivers, public health. All of this, in turn, exacerbates conflict and impedes peace-building efforts by driving instability and displacement, once more worsening people’s health in a vicious cycle. 

“Incorporating the lens of climate risk, and how you factor it into your response is extremely important during most emergencies,” said Micaela Serafini of the International Committee of the Red Cross (ICRC), a co-host of the panel. 

Factoring in climate to humanitarian responses 

climate change
Environmental emergencies such as deforestation often overlap with conflict.

If one superimposes a map of conflict with one of environmental degradation, including drought and deforestation, there would be significant overlap, said Elhadj As Sy, Former IFCJ Secretary General noted.  

“If you take the combination of environmental degradation and demographic pressure, we are already creating the conditions for conflict because we are fighting over resources, no longer over diamonds and gold.” 

Livelihood impact diseases from wild animals and livestock devastate rural communities 

Pig farming in Malaysia. Nipah virus passes from pigs to people.

The increased competition for natural resources, such as water and pastures for animals to graze, is a major driver of the migration of people and their livestock, which in turn leads to the ‘transboundary movement of diseases’.

Many of the new diseases to have emerged in recent decades, out of environmental degradation and deforestation, are zoonoses that can also be described as ‘livelihood impact diseases’.  They include the bat-borne Nipah virus that also infects pigs and people in South East Asia, as well as rift valley fever, brucellosis, and avian influenza, which affect livestock and poultry. They impact rural communities, firstly animals and then people – both directly and indirectly.

For rural communities, the direct impacts of infections are only “the tip of the iceberg, ” said Dominique Burgeon, Director Food and Agriculture Organization (FAO) Liaison Office at UN Geneva. “The diseases are devastating to their livelihoods, which means it also has an impact on food security, and therefore on health and especially the health and nutrition of children in these communities, who are highly dependent on milk and dairy products,

Dominique Burgeon Director, FAO Liaison Office at UN Geneva

With 60% of new human diseases originating from animals, the complex relationship between animal health, environmental health, and human health needs to be considered more deeply, he and other panelists stressed.  

Burgeon referred to ‘One Health’ as a framework for understanding the linkages. One Health, is defined as an “integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.”

Both conflict and climate change have big impacts on animals, through loss of pasture land and water sources for example, Burgeon said: “When it comes to animal health, and therefore going towards human health, conflict can have a huge impact.  

Conversely, strategies for promoting better animal health can help ease conflicts, by reducing the need for people to migrate to keep their animals alive.

“We see that animal health can be a pathway for peace, because at the end of the day, what we see is that those communities are highly dependent on livestock,” Burgeon concluded.  

Humanitarian organizations need to look at their own carbon footprint

Micaela Serafini, International Committee of the Red Cross (IFCJ).

Along with promoting more sustainable environments in fragile conflict zones, the humanitarian sector’s own climate footprint also needs greater consideration, Serafini said.  

“How do you factor in climate risks in your health response?” asked Serafini. “It’s essential to construct or support a system to become resilient to climate events that can overturn whatever investment in health you wanted, or what you were able to do.

“What is it we leave behind once the emergency has finished? How conscious are we of our own [carbon] footprint?” 

Image Credits: Jami Dwyer, GHF, KeWynn Lee, GHF.

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President Biden announces licenses between the NIH and the WHO Covid-19 Technology Access Pool (C-TAP) at the US Global COVID-19 Summit.

The United States National Institute of Health (NIH) has finalized an agreement with WHO’s COVID-19 patent sharing facility (C-TAP) to share the patent rights on 11 government-funded coronavirus medicine and vaccine technologies – in what is perhaps the most significant agreement to date with WHO to share closely-guarded pharma know-how.  

The announcement was made today by US President Biden at the opening of the second Global COVID-19 Summit, co-hosted by the United States, Belize, Germany, Indonesia and Senegal which raised a total of $3 billion toward various forms of pandemic preparedness and response. 

That included a total of $960 million in commitments from the US and other developed countries toward the creation of a new Pandemic Preparedness and Health Security Fund to be housed by the World Bank.

The new $200 million US contribution comes in addition to $250 million pledged last year, said US Secretary of Health and Human Services, Xavier Becerra, speaking at the Summit. Creation of a standing fund was recommended last year by The Independent Panel, whose critical review had noted that a standing pool of finance needs to be readily available to spur faster pandemic response. 

The pledges should provide the seed money needed to formally create the new Financial Intermediary Fund (FIF), said World Bank President David Malpass, speaking at the summit.  “I’m hopeful that this will be enough to give us critical mass and we can work with the G-20 and get the steps done to take the FIF to our board in June,” he said.

‘Hope to be ready on TRIPS waiver’ by June

World Trade Organization Director General Dr Ngozi Okonjo-Iweala speaking at the Second COVID-19 Summit

But the World Trade Organization’s Director General Dr Ngozi Okonjo-Iweala said more would be needed to really operationalize the finance facility effectively.

“Today’s commitments are good but they are just a down payment on the $10 billion a year needed to seed this fund,” she said  “So we hope to see more commitments coming, while now the task remains to operationalize the FIF.”

Meanwhile, Iweala expressed hopes that the WTO would finally be ready to present a compromise draft proposal for a “TRIPS” waiver on intellectual property for COVID vaccines to the Ministerial Council (MC-12) when it convenes in June.

“We hope to have a workable compromise, that is being debated right now, and we hope it will be ready in June,” she told the Summit.

Negotiations over the long-deadlocked initiative to waive the so-called TRIPS agreement on Trade Related Aspects of Intellectual Property Rights, was originally proposed by India and South Africa in 2020, but languished for months before a breakthrough just last week, when WTO published an “outcome document“, negotiated by the four-member “Quad” leading negotiations.

Although unfinished, that text represented a significant bridging of once deeply-divided positions between developed countries led by the United States and the European Union, and developing countries, led by India and South Africa. The evolving agreement would allow countries that export less than 10% of the world’s total COVID vaccine supplies to apply the “waiver” to the generic production of vaccines for domestic use as well as for export, with minimal transaction costs.

While China, a large COVID vaccine exporter, initially objected to explicit the 10% clause, China’s WTO Ambassador, Li Chenggang suggested to an informal meeting of the TRIPS Council this week that it could voluntarily abstain from taking advantage of the waiver if explicit mention of the 10% rule was dropped – clearing away another obstacle to final approval.

Developed countries pledge $2 billion in immediate pandemic response

Tanzania, once COVID vaccine hesitant, now aspires to 70% coverage.

At the Summit, global leaders also pledged over $2 billion more in funding for immediate COVID response; much of it to be funneled into the WHO co-sponsored Act Accelerator (ACT-A), for procurement of vaccines, treatments, tests and health system capacity-building. That included a CAD 735 million donation from Canada and over $300 million from Spain, along with pledges by Australia, Austria, Sweden, Italy, South Africa and Thailand, to donate over 130 million more vaccine doses to low-income countries.

And the African Union, as well as 16 low-and-middle income countries individually, also said they would invest more domestic resources in health systems, pandemic preparedness and COVID vaccine campaigns – along with new product R&D and manufacturing. The pledges included one by Africa’s most populous nation, Nigeria, to train 10,000 more frontline healthcare workers by December 2022 on basic infection prevention and control along with supporting more laboratory capacity for genomic sequencing, and a 70% COVID vaccination goal.

Tanzania, once the most vaccine-hesitant country on the continent, pledged to vaccinate 70% of all eligible Tanzanians against COVID by fall 2022. Rwanda also pledged to reach the 70% goal by the year’s end as well as doubling booster coverage from 30-60% of those eligible.   

LMICs seeking know-how not donations 

However, it is vaccine know-how, not vaccine and medicines donations that low- and middle income countries stress that they are seeking now – and the NIH deal with C-TAP goes at least a step in that direction, long-sought by WHO.  Significantly, the new US deal opens the way for generic manufacture of at least some components of patented mRNA vaccine technology.  

Those include technologies for producing the stabilized spike protein used in the leading COVID-19 mRNA vaccines produced by Pfizer and Moderna, as well as research tools for vaccine, therapeutic and diagnostic development as well as early-stage vaccine candidates and diagnostics. 

The US deal with WHO for sharing the 11 COVID-19 technologies also includes the Geneva-based non-profit Medicines Patent Pool (MPP), which has experience in the actual negotiation of licenses with generic manufacturers to supply WHO-approved treatments to low- and middle-income countries. 

Both WHO and the MPP welcomed the agreement, which would make these technologies more accessible to people in low- and middle-income countries and help to overcome the pandemic. 

“I welcome the generous contribution NIH has made to C-TAP and its example of solidarity and sharing,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Sharing and empowering lower-income countries

Lab technicians at work in Cape Town’s Afrigen Vaccines & Biologics, part of the WHO-supported mRNA Vaccine Technology Transfer hub created in Cape Town.

“Whether it’s today’s pandemic or tomorrow’s health emergency, it’s through sharing and empowering lower-income countries to manufacture their own health tools that we can ensure a healthier future for everyone,” said Tedros, just before appearing at the Global COVID-19 Summit, hosted by The White House on Thursday. 

“We are honored to sign these public health-driven license agreements with NIH under the auspices of C-TAP with the goal of providing equitable access to life-saving health products for the most vulnerable in the world,” said Charles Gore, MPP Executive Director.

The first major donation to the C-TAP, the WHO COVID-19 Technology Access Pool came from Spain in Nov. 2021 for a serological antibody test that checks for the presence of anti-SARS-CoV-2 antibodies. 

The longstanding WHO effort to build a repository of treatments, tests and vaccines available to any country on an open license had, until now, failed to gain much buy-in from either governments, researchers or industry. 

WHO has since refocused more of its efforts on building a series of technology transfer hubs that aimed to train researchers and jump-start manufacturing of vaccines and other innovations – including a hub for mRNA Technology Transfer, based in Cape Town and a Global BIomanufacturing Workforce Training Hub in the Republic of Korea.  

US pledges to ‘do its part’ with licensing agreement 

Word that the US would be sharing COVID technologies first came in March, announced by US Secretary of Health and Human Services Xavier Becerra at a virtual meeting with other ministers of health.

“Sharing our scientific knowledge and health technologies with C-TAP to foster the development of crucial medical countermeasures is another step we are taking to assist our global partners in our shared fight against this devastating disease,” remarked Becerra. 

Said Biden in announcing the deal: “The United States will continue to do its part.”  

Image Credits: Luis Gil Abinader/Twitter , Rodger Bosch for MPP/WHO.

Testing blood pressure as part of NCD prevention.

The upcoming World Health Assembly (WHA) has the biggest focus on non-communicable diseases (NCDs) in a decade – and offers an opportunity to ensure that NCDs are integrated into future responses to pandemics and other health emergencies.

This is according to Katie Dain, CEO of the NCD Alliance, who urged attendees at a high-level NCD briefing before the WHA on 22 May, to highlight solutions in order to encourage countries that it is possible to address NCDs.

This comes in the wake of statistics from the World Health Organization (WHO) NCD Progress Monitor 2022 that show COVID-19 has pushed back countries’ gains against cardiovascular disease, cancer and diabetes in particular.

WHO’s NCD Progress Monitor

Bente Mikkelsen, the WHO’s NCD director, said that 70-90% of the 14.9 million “excess deaths” recorded during COVID-19 were likely to be people living with NCDs.

“Most governments now recognise that people living with NCDs are among the most vulnerable,” said Mikkelsen – but added that NCD treatment needed to be assured during humanitarian disasters.

“The United Nations Office for Coordination Humanitarian Affairs estimated 235 million people needed humanitarian assistance and protection last year, and we know that there it is as much as two to three times more common to have heart attacks and strokes in humanitarian emergencies than in pre-emergency circumstances,” said Mikkelsen.

The WHO is supplying NCD kits to 10,000 people in Ukraine, and the NCD team was now part of the daily coordination of the response in that country, she added.

“There is no health security without including NCDs into primary health care, into universal health care,” she concluded.

NCDs as part of new pandemic instrument

Precious Matsoso, Co-Chair of the Intergovernmental Negotiating Body on a pandemic instrument

Dain said that the current negotiations in Geneva on an instrument to address future pandemics offered the opportunity to “link NCDs to health security and pandemic preparedness”.

She called for a broader definition of health security that took into account the underlying burdens caused by NCDs.

Precious Matsoso, who is co-chair of the Intergovernmental Negotiating Body that is negotiating the WHO’s new pandemic preparedness instrument, appealed for simpler implementation guidelines for countries.

Matsoso said that there were at least five major conventions relating to NCDs as well as a number of high-level agreements – and it was “not practical” for countries to implement all of these.

“We need one instrument to integrate all these into a comprehensive response,” said Matsoso, who is South Africa’s former Director-General of Health.

She cited five main pillars to ensure a comprehensive response to NCDs, including proper governance, NCD prevention, adequate financing, and meaningful community engagement.

New Presidential Group offers political leadership

Kwaku Agyemang-Manu, Ghana’s Minister of Health

Political leadership to address NCDs was gathering momentum, following the launch last month in Ghana of a Presidential Group and NCD Compact, Ghana’s health minister, Kwaku Agyemang-Manu, told the briefing.

“The compact is expected to provide the framework for the successful management and control of NCDs,” said Agyemang-Manu, who also outlined Ghana’s $110million plan to address NCDs.

“The compact is a turning point in our fight against NCDs. It will galvanise action to ensure the support from heads of state have committed to closing the implementation gap to address the prevention and control of NCDs,” said the minister.

Agyemang-Manu, Dain and the University of Washington’s David Watkins stressed that it was still possible for low- and middle-income countries to reduce the burden of NCDs by one-third by 2030.

Watkins and colleagues recently published a paper in the Lancet outlining how this could be achieved.

“There’s a widespread belief in the global health and development community that tackling NCDs is too expensive and that it isn’t feasible in countries with very limited resources. Our report thoroughly debunks this idea,” says Watkins.

The paper focuses on 21 interventions – both clinical and policy-based – to reduce NCD-related mortality, which is the United Nations Sustainable Development Goal 3.4.

Image Credits: NCD Alliance.

Nurses are on the frontline of the COVID-19 response

The International Council of Nurses (ICN) published a toolkit on Thursday in honour of International Nurses Day (IND) to help countries turn global goals and strategies established by the World Health Organisation (WHO) into action on the countr.

Each year, International Nurses Day is observed on 12 May, Florence Nightingale’s birthday.

“We have the WHO recommendations, which have been agreed by the member states. We know what to do. We need to move on from the talk and see action to support our nurses – and that is exactly what ICN’s IND toolkit provides,” said ICN president Dr Pamela Cipriano.

The toolkit is titled, “Nurses: A Voice to Lead.” It is meant to be a roadmap to help implement WHO-recommended policies and priorities including those contained in WHO’s: Global Strategic Directions for Nursing and Midwifery: 2021-2025; the WHO State of the World’s Nursing and the International Centre for Nurse Migration’s Sustain and Retain in 2022 and Beyond.

In addition, the report specifically looks at the role that nurses play in addressing global health challenges and securing global health.

“The value of nurses has never been clearer not only to our healthcare systems but also to our global peace and security,” said ICN Chief Executive Officer Howard Catton. “Nor could it be any clearer that not enough is being done to protect nurses and other health workers, tragically underscored by the more than 180,000 health worker deaths due to COVID-19. We should not shy away from calling out that this is a question of policy and politics because the policies to rectify this lamentable situation do exist, but they are not being implemented.”

He added that “the scale of the world-wide nursing shortage is one of the greatest threats to health globally, but governments are not giving it the attention it deserves. Access to healthcare is central to safe, secure, economically successful and equitable societies, but it cannot be achieved unless there are enough nurses to provide the care needed.”

Two strategic priorities: Health & wellbeing

Nurses are on the frontline of the COVID-19 response.

The toolkit specifically focuses on two strategic priorities that have become even more pressing over the course of the COVID-19 pandemic: investing in and prioritising the safety of health care workers and caring for the health and wellbeing of nurses.

“Nurses have given their all in the fight against COVID-19, Ebola, in disaster areas and in war zones,” said Cipriano. “Yet, they continue to face under-staffing, lack of protection, heavy workloads and low wages. It is time now to take real action to address workplace safety, protect nurses and safeguard their physical and mental health.”

The report notes nurses’ heightened risk of exposure to COVID-19; it cites WHO data showing that while nurses account for less than 3% of the global population, they represented around 14% of COVID-19 cases and as many as 35% in some countries.

The situation was similar in the 2014-2016  Ebola outbreak in West Africa, when, according to WHO, the risk of infection among health workers was 21 to 32 times higher than in the general adult population.

ICN said nurses are 16 times more likely to experience violence in the workplace compared to other service workers.

Taking action by investing and prioritising the safety of nurses could not only improve retention of nurses, it would lead to improved patient safety and outcomes and make health systems stronger and more resilient, ICN notes.

The report also highlights how nurses feel “overwhelmed” and “stretched past their limits,” facing daily anxiety as a result of work-related stress. In the US alone, 64% of nurses felt overwhelmed and 67% reported difficulty in sleeping, the American Nurses Foundation reported in 2020.

“They have been asked to make complicated choices and decisions over a long period of time and are experiencing high levels of chronic exposure to acute psychologically traumatic events,
as well as high workloads, violence in the workplace and burnout,” the report said. “It is time to fully recognise and address the inherent occupational stresses and burdens that nurses bear on behalf of societies.”

The results of doing so, according to ICN, would be both improved health of nurses and improved health outcomes.

Four policy areas: Education, jobs, leadership and service delivery

The toolkit also specifically looks at the four policy areas of the SDNM: education, jobs, leadership and service delivery.

Education

“The pandemic has highlighted the complex work of nurses and their ability to meet the increasing health demands of patients, to work with new technology, and with a multidisciplinary team,” writes ICN, underlining the additional challenge of attracting people into the nursing profession and to retaining the current workforce.

Nearly all WHO member states reported pandemic-related disruption to health services and 66% of them said that health workforce-related factors are the most common causes of service disruptions, WHO said.

These challenges can be met by investing in nursing education: increased retention in the nursing workforce; increasing the domestic supply of nurses relieves over reliance on internationally educated nurses; and well-educated nurses progress into senior leadership positions, ICN stresses.

Nursing shortage of 13 million in coming decade

The world could experience a shortage of 13 million nurses within the next 10 years as older nurses retire, and as many as 10% leave the profession due to the “COVID effect.”

Ensuring nursing jobs are filled will not only allow countries to meet their citizens’ health needs, but would improve the job satisfaction and morale of other nurses.

Leadership, career progression and service delivery

“Nursing leadership is needed at all levels and across all settings to provide effective and relevant health services for patients and their families, individuals and communities,” notes ICN in the toolkit’s executive summary. “Nursing leadership is as important to the delivery of quality care as technical skills at the bedside. Now more than ever, we need nurses to lead the development and implementation of individual care plans, new and innovative models of care, integrated and team-based care, organizational policies and plans, research and innovation board decision-making and legislation.”

In addition, the report said, nurses need career advancement opportunities, which can be achieved through providing them with the knowledge, skills and capabilities of the profession and enabling career progression in clinical, leadership and academic roles.

What are the benefits? Improved quality, safety and person-centered care, according to ICN, as well as a better working environment and increased job satisfaction.

“Nurses are catalysts for positive transformation to repel the forces that threaten global health and to build strong healthcare systems,” concluded Cipriano. “We have seen the evidence and
understand the need for investment and protection. Now is the time for action.”

Dear reader, as you join Health Policy Watch on International Nurses Day, please help us deepen and expand our field coverage of the challenges faced by nurses and the broader global health workforce, as well path-finding solutions. Click here to learn more. 

Image Credits: Acumen Public Affairs, Public Services International/Madelline Romero.

Alcohol is injurious to health.

The alcohol industry’s use of sophisticated digital media tools that transcend borders has prompted the World Health Organization to call for more effective cross border regulation.

The WHO is particularly concerned about how the marketing is targeting young individuals and heavy drinkers, according to a report released on Tuesday.

Someone dies every 10 seconds as a result of alcohol, accounting for 5% of all deaths in the world, according to the report.

Further, 13.5% of these alcohol-related deaths are among individuals aged 20-39 years. 

“Despite the clear risks to health, controls on the marketing of alcohol are much weaker than for other psychoactive products. Better, well enforced and more consistent regulation of alcohol marketing would both save and improve young lives across the world.” said Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, in the preface to the report. 

The WHO report said that the use of digital media has tapped into markets in different countries regardless of the social, economic or cultural environment. For instance, it notes that the advertising and packaging of ‘0.0% alcohol’ beer in Malaysia, a country which has strict prohibition on alcohol use due to its religious identity, attempts to normalise the ‘alcohol experience’ for abstainers, something which could also induce them to try genuine alcohol products later. 

Targeted messaging – ‘women’s empowerment’

The report notes, the cross-border sponsorship of festivals and other public events also influence the frequency and volume of drinking, as well as contributing to the social acceptance of alcohol as part of cultural and social norms. This, along with brand placement of alcoholic beverages in movies and shows further underscores the need for the regulation of branded content. 

Targeted advertising, especially of alcohol, has been further exacerbated by the deployment of social media influencers in promoting alcohol to specific, targeted audiences. A 2018 WHO report found that almost half the countries surveyed then had no regulation in place for the advertising of alcohol over the internet and social media. 

“The rising importance of digital media means that alcohol marketing has become increasingly cross-border”, said Dag Rekve of the Alcohol, Drugs and Addictive Behaviours Unit at the World Health Organization. “This makes it more difficult for countries that are regulating alcohol marketing to effectively control it in their jurisdictions. More collaboration between countries in this area is needed.”

Other than young people, key demographic targets for digital alcohol marketing include women and heavy drinkers. Companies portray ‘women empowerment’ as symbolised through images of women drinking. WHO said that alcohol-dependent individuals frequently reported a stronger urge to drink alcohol when confronted with alcohol-related cues; however they rarely have an effective way to avoid exposure to the content of the advertising or promotion. 

Needs: more multi-lateral and bilateral collaboration on rules  

The report concludes that to combat cross-border advertising, greater bilateral and multilateral cooperation between states is important in augmenting national regulatory efforts.  But this requires greater national awareness and consensus, first of all. 

At the national level,the WHO says, actions to control, or prohibit, of alcohol marketing need to be integrated into public health strategies to reduce and control the harmful use and effects  of alcohol. 

Such approaches have worked well in the case of tobacco products, where greater attention to cross-border aspects of tobacco production and marketing has led to life-saving reductions in global tobacco use and exposures, WHO notes.

Image Credits: Sophie Carroll/flickr, Free printable signs.

Dr Tedros Adhanom Ghebreyesus, WHO Director General

China has defended its strict “no-COVID” strategy and called WHO “irresponsible” following critical remarks from the head of the World Health Organization.

WHO Secretary-General Dr Tedros Adhanom Ghebreyesus told a media briefing Tuesday that China’s strategy was no longer sustainable in the face of the more infectious but less lethal Omicron.

“When we talk about the zero-Covid strategy, we don’t think that it’s sustainable, considering the behaviour of the virus now and what we anticipate in the future,” Tedros said.

Internally, Chinese officials have censored media reference to what is a rare public criticism of the global health agency of a particular strategy. 

Externally, officials have insisted that there would be no change to its “zero tolerance” policy against COVID. The policy has prevented millions from leaving their homes and working, including in the city of Shanghai, which has been under a strict lockdown for two months. 

china
Shanghai’s current largest fangcang, or makeshift hospital, has set aside 900 beds to treat families with children under the age of 18 infected with COVID-19.

Even more disturbing for human rights advocates, people with confirmed COVID cases are  forced to leave their homes and confined to quarantine centers in both mainland China and Hong Kong, with parents even separated from their young children at times – according to both media and first-hand reports to Health Policy Watch.  

“We hope relevant people can view China’s epidemic prevention and control policy in an objective and rational way, learn more about the facts and refrain from making irresponsible remarks,” Chinese Foreign Ministry Spokesperson Zhao Lijian said at a news briefing Wednesday.

“The Chinese government’s policy of epidemic prevention and control can stand the test of history, and our prevention and control measures are scientific and effective. China is one of the most successful countries in epidemic prevention and control in the world, which is obvious to all of the international community.”

While cases continue to drop in China, they are spread across multiple provinces. On Wednesday authorities reported 1,905 cases including 302 symptomatic ones. The bulk of cases are still being found in Shanghai. 

WHO comments censored on Chinese internet 

China’s ruling Communist Party, which has strictly controlled all discussion about its controversial approach, said it would tolerate no criticism or questioning of the strategy. 

The WHO comments were not reported by state media, and  any references to Tedros and other WHO officials who spoke about the policy were removed from the Chinese internet soon after being posted.   

After the United Nation’s official press account on China’s Twitter-like Weibo posted Tedro’s comments early on Wednesday morning, it drew a wave of sarcastic comments from Chinese users.

“Resolutely fight against any words and acts that distort, doubt or deny our country’s epidemic prevention and control policies! Down with the World Health Organization!” a top reply said.

“Should the UN’s verified account be blocked this time?” another said.

By mid-morning, the post was no longer accessible on Weibo “due to the author’s privacy setting.” It is unclear under what circumstances the setting was changed.

Lifting “zero tolerance” policies in China may overwhelm health system, says Shanghai study 

china
The bulk of cases are still being found in Shanghai.

Chinese experts have defended the policy. One study claimed that if the country were to lift its “zero-COVID” strategies, this would result in a “tsunami” of infection and almost 1.6 million deaths, citing in part China’s low vaccination rates of elderly patients. 

The peer reviewed study conducted by Shanghai’s Fudan University, and published in Nature, said a decision by Chinese authorities to lift such measures could see more than 112 million symptomatic cases of Covid-19, five million hospitalisations, and 1.55 million deaths.

“We find that the level of immunity induced by the March 2022 vaccination campaign would be insufficient to prevent an Omicron wave that would result in exceeding critical care capacity with a projected intensive care unit peak demand of 15.6 times the existing capacity,” the paper said.

More than 88% of Chinese people have been fully vaccinated, but immunization is much lower among the elderly. As of 17 March, only half of people aged over 80 in China have been fully vaccinated, and less than 20% of that vulnerable age group have received a booster. Unlike most countries, elderly people were not originally prioritized in China’s vaccination campaigns.  

The study had used a model of SARS-CoV-2 transmission to follow the March 2022 Omicron outbreak in Shanghai to project COVID-19 burden and potential scenarios. It had also considered  vaccine efficacy, waning immunity, different antiviral therapies, and non-pharmaceutical treatments. 

In order to circumvent increasing infections and deaths that would overwhelm the Chinese healthcare system, they recommended providing vulnerable populations with vaccines and other antiviral therapies and maintaining non-pharmaceutical treatments.

“[These strategies] could be sufficient to prevent overwhelming the healthcare system, suggesting that these factors should be points of emphasis in future mitigation policies,” the paper concluded. 

In addition to the challenges posed by Omicron,  the leading Chinese-made vaccine products, based upon conventional vaccine technologies that delivered inactivated virus protein to provoke immunity, have been generally seen to be less efficacious than more advanced technologies, such as the mRNA-based vaccines, in published peer-reviewed studies. 

Image Credits: Zhang Meifang/Twitter, yelingxuan369/Twitter.

“Swabbing” a sewage bore near the beach in Israel for SARS-CoV2; a new sewage study finds Delta still circulating cryptically.

While the Omicron COVID-19 variant appears to be diminishing, it is possible that there could be a resurgence of the Delta variant in the coming months in some countries, according to a team of researchers from Ben-Gurion University (BGU) of the Negev studying the prevalence of SARS-CoV2 virus variants in sewage.

The warning comes following last month’s peak in new cases in China, followed by rising coronavirus cases now in South Africa as it heads into chilly weather, while uptake of COVID vaccines remains sluggish.

“Of course, there are a lot of factors involved, but our model indicates there could be another outbreak of Delta or another coronavirus variant this summer,” said BGU’s Prof Ariel Kushmaro, last author on the study.

The study monitoring sewage in Beersheba – Israel’s fourth-most populous metropolitan area – between December 2021 and January 2022 found that while Delta had wiped out the variants that preceded it, Omicron did not eliminate Delta even at the height of the Omicron wave. They then built a model that predicts that while Omicron is burning itself out, Delta is just biding its time.

The findings were published recently in the peer-reviewed journal Science of the Total Environment.

“If the essence of the model predictions … will be proven accurate, the Delta variant has the potential of becoming far more problematic than the Omicron,” the researchers wrote in their paper. “With the expected significant decline in morbidity from all the recovered Omicron cases, the Israeli government and Ministry of Health will most likely remove various restrictions. In the meantime, the Delta, which is still circulating in a population with waning immunity and under fewer restrictions, may reemerge in larger numbers or even produce a new, different variant to generate infections in Israel.”

Sewage – ‘An early indicator’

South Africa is already seeing a surge in new cases in recent weeks. According to Foster Mohale, director of media relations for the Johannesburg, South Africa National Department of Health, there have been peaks of up to 10,000 new cases daily, although the average is somewhat lower.

South Africa also has a wastewater surveillance program – the SAMRC Wastewater Surveillance and Research Programme – which has been monitoring sewage for the virus.

“By testing wastewater weekly, we can measure the SARS-CoV-2 RNA signal and see whether it is increasing or decreasing,” states SAMRC. Added Mohale, “This can be used as an early indicator of COVID-19 case trends within a community.”

However, so far, the predominant variants identified seem to be two Omicron subvariants – BA.4 and BA.5 – and not Delta.  But health officials are still urging people to get vaccinated to ward off possible future threats.

“For now, we are not detecting other variants,” stressed Mohale. “So, we are saying there is no need to panic, and no new variants found in the country. The thing is that it can mutate and change in a short period of time. “We need to raise awareness and encourage the public to continue vaccinating and to get those who are vaccinated [at least five months ago] to take a booster shot.”

South Africa Omicron vs Delta, NICD January 2022

‘Gigabytes of data running just under the city’

Israel and South Africa are two among several dozen of countries around the world engaging in cutting-edge wastewater surveillance for COVID-19. The novel results of Kushmaro’s study are that it now appears that surveillance can be used not only to track the virus in real-time but to help predict the future.

“The idea behind this publication is to show how the data that we can generate from the wastewater can be used later on for predictions,” Kushmaro said. “So, this is the novel thing when we look at the scientific point of view of the publication.”

His team, which specializes in wastewater epidemiology, has been identifying different pathogens in wastewater for decades. The latest study is part of the research they started in March 2020 ton track coronavirus via sewage.

Towns of more than 20,000 people are monitored twice a week using a series of sensors and control units placed in municipal sewage systems, in a model surveillance system. The samples are sent to laboratories where PCR tests suitable for wastewater are conducted. In the event that the results received are positive, an additional test is carried out to quantify the prevalence of Omicron  and other variants. Sample results are fed into a national computer database that can analyze the results based on big data models and AI. The entire process takes about 24 hours.

‘Omicron levels will decrease until eliminated, while Delta variant will maintain its cryptic circulation’

Modeling of future trends was enabled by the development of a new RT-qPCR primers-probe set for even faster and more precise detection of the Omicron variant.

“Characterized as highly specific and sensitive, the new Omicron detection set was deployed on clinical and wastewater samples. In contrast to the expected dynamics, whereupon the Delta variant diminishes as Omicron variant increases, representative results received from wastewater detection indicated a cryptic circulation of the Delta variant even with the increased levels of Omicron variant,” the authors state in their study.

“Based on the initial results, a double susceptible-infected-recovered model was developed for the Delta and Omicron variants,” the paper continued. “According to the developed model, it can be expected that the Omicron levels will decrease until eliminated, while the Delta variant will maintain its cryptic circulation. If this comes to pass, the mentioned cryptic circulation may result in the reemergence of a Delta morbidity wave or in the possible generation of a new threatening variant.

“In conclusion, the deployment of wastewater-based epidemiology is recommended as a convenient and representative tool for pandemic containment.”

The Delta variant was considered “cryptic” because it did not diminish as expected but also did not remain dominant, only circulating enough to exist but not to cause an increase in morbidity levels.

“Resulting wastewater data illustrated the very initial Delta-Omicron dynamics occurring in real-time. Despite this, the future development and dynamics of the two variants side-by-side are still mainly unknown,” the authors conclude.

Kushmaro noted to Health Policy Watch, however, that the team’s latest samples were in mid-February. But he said that rising case numbers in parts of the world “hint that coronavirus is still with us… and we have to be prepared.”

‘Vaccination remains the most effective weapon against COVID-19’

South African vaccination rates
South African vaccination numbers – 31% of the population is fully vaccinated.

Mohale said that South Africa is actively deploying a multi-pronged vaccination strategy to help ensure more of the population gets vaccinated.

According to Our World in Data, only 31% of the South African population is fully vaccinated and less than 5% of eligible individuals have opted for a booster shot – despite new data published this week, which showed the much greater benefits of a third shot.

“We are integrating vaccination services into normal health services. So, for example, you can access vaccination services at dedicated vaccination sites, but also in your general health facility,” Mohale said.

In addition, the country has added COVID-19 vaccination to its school health program for children ages 12 and older. And it is offering the shots at large events; unvaccinated people who would otherwise need to present a negative PCR test to enter a sporting event, for example, can forgo the swab and take a jab instead, Mohale added, saying:

“Aside from all other preventative measures, vaccination remains the most effective weapon against COVID-19.”

Image Credits: Kando , Our World in Data, Screenshot.

Vials of Moderna’s COVID-19 vaccine.

Moderna has filed a brief in the United States District Court for the District of Delaware seeking the dismissal of a patent infringement lawsuit that pertains to the production and sale of its COVID-19 mRNA vaccine Spikevax. 

The lawsuit against the U.S-based pharmaceutical giant was filed by Arbutus Biopharma Corporation and Genevant Sciences, which had sued Moderna, claiming that six of their patents involved in the production and sale of Modern’s COVID-19 vaccine were infringed by Moderna.

According to the lawsuit, Arbutus claims that it had developed the lipid nanoparticle encasing used to deliver the Moderna vaccine’s mRNA into human cells which  it has since licensed its patents to Genevant. They claim that Moderna has been practising the patented inventions without its permission through the manufacture and distribution of Spikevax. 

However, Moderna had claimed immunity from any lawsuit for infringement of patent rules, saying that its contract with the US Federal government to produce and supply the vaccine protects it from legal suits over patent rights. 

Moderna claims US government contract included authorization to use patents

Moderna, in its brief, states that the US government gave its “authorization and consent” for Moderna to infringe any third-party patents when manufacturing the vaccine based on a contract it originally signed in 2020 for the production and supply of 100 million doses of its vaccine.

Provisions in the contract stipulate that any claimant of patent infringement should sue or take up the case with the U.S. government, Moderna stated. 

According to Moderna’s legal brief, its contract with the US Government is covered by a US Federal Statute, 28 USC 1498(a), which provides that whenever an invention covered by a U.S. patent “is used or manufactured by or for the United States without a license,” the owner of the patent must sue the government for damages in the United States Court of Federal Claims, rather than the manufacturer, per se. 

“Modern argues that it has a compulsory license from the US government to use third party patents on its COVID 19 vaccine,  under 28 USC 1498(a), so patent holders should sue the federal government for compensation for nonvoluntary use, and not Moderna,” noted Jamie Love, head of Knowledge Ecology International, an NGO which has been advocating for the wider use of such “compulsory licensing” by countries that wish to support wider generic production of COVID vaccines and treatments, as well as pharmaceuticals more generally.

This is not the first time that such a lawsuit has been filed in a US court against Moderna for patent infringement related to its COVID-19 vaccine. In March 2022, Alnylam Pharmaceuticals sued both Moderna and Pfizer, in separate lawsuits, claiming that the companies used a delivery technology for their shots that was invented by Alnylam over a decade ago. 

All three plaintiffs- Arbutus, Alnylam and Genevant– have been clear that they do not seek to halt vaccine production or sales, but only seek damages for the infringements. 

Medicines access advocates are watching the Moderna cases closely to see what kind of precedent they may set for wider use of “compulsory licensing” of patented drugs – which developed countries such as the US have generally discouraged in order to protect IP both at home and abroad.    

“Moderna’s filing is an important reminder of existing flexibilities that the U.S. government can leverage to expand vaccine access,” wrote KEI in a brief on the legal case. “Apparently, at least when doing so is consistent with a company’s legal or financial interests, they are willing to embrace such flexibility.”

Image Credits: Jernej Furman/Flickr, Gavi .