Shelves stand empty in a Wuhan supermarket in an earlier lockdown.

China administered the world’s first oral aerosol COVID-19 vaccine boosters in Shanghai on Wednesday, as new lockdown measures were imposed on Wuhan, the supposed birthplace of the pandemic.

Chinese vaccine manufacturer CanSino Biologics said in a media statement that the inclusion of its vaccine in Shanghai’s booster vaccination program marked “the start of the rollout of the world’s first inhaled COVID-19 vaccine, Convidecia Air”.

The inhaler, approved as a booster for adults last month by the National Medical Products Administration of China, “provides a non-invasive option that uses a nebulizer to change liquid into an aerosol for inhalation through the mouth”, according to the company.

“Convidecia Air is needle-free and can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” it added. The aerosol vaccine is based on Sinovac (marketed as CoronaVac).

The Chinese-developed Sinovac uses a modified version of an adenovirus to deliver inactive parts of SARS CoV2 to a person’s immune system to prime it recognise and attack the virus when it becomes infected. This is followed by a second vaccine to boost the immune system a few weeks later.

Results from a clinical trial that compared the oral aerosol vaccine to an injectable version of Sinovac, published in The Lancet in August, found that the aerosol elicited 6.7 to 10.7 more neutralising antibodies than the injection after two to four weeks.

However, Sinovac is less efficacious against COVID-19 than mRNA vaccines, and there are some early indications that it offers very little protection against the latest variants.

Nasal sprays

Meanwhile, there are other clinical trials of SARS-CoV-2 vaccines delivered through the mucosa, but these are all nasal sprays.

Researchers at Yale University in the US recently published a pre-print paper reporting early success in mice using a vaccine booster strategy, “prime and spike”.

Noting that protection offered by mRNA vaccines weakens fairly fast, particularly in the nasal mucosa and respiratory tract, in those already vaccinated (“primed”), they tested an intranasal “spike” to “elicit mucosal immune memory within the respiratory tract”. 

Their trial found that “prime and spike” induced a robust immune response in animals that protected against SARS-CoV-2 infection. 

Indian company Bharat has also developed an intranasal vaccine for Covaxin, which it says has been successful in animal studies although it has not yet submitted results for peer review.

Wuhan locks down

Meanwhile, China has locked down Wuhan’s central Hanyang district after COVID cases were found, as China persists with a zero-tolerance approach almost three years after the virus was first reported in the city, and about 900,000 residents were told to stay at home, according to Bloomberg.

This follows the re-election of Chinese President Xi Jinping – the architect of the “zero-COVID” strategy – for a third five-year term as leader of the country’s ruling communist party.

China’s zero-COVID strategy has resulted in lockdowns of entire cities. People living in districts where COVID-19 cases are detected are obliged to stay indoors for seven days and take a daily test.

The lockdowns have had a negative effect on the country’s economy, with a 1.7% contraction in sales last month largely as a result of quarantines in various parts of the country.

Meanwhile, a 14-year-old girl teenager, Guo Jingjing, died in a quarantine facility earlier this month, according to the BBC.

She apparently developed a fever two days after being taken to a facility in Ruzhou, and her family posted videos on social media of her shaking and convulsing on a bed. Her father, Guo Lele, said in a video on Douyin (Chinese TikTok) that the facility had not provided her with any help.

However, the videos and most references to the incident have since been removed.

Image Credits: Studio Incendo.

Testing for antimicrobial resistance at the Liverpool School of Tropical Science.

The World Health Organization (WHO) has raised the alarm over drug-resistant fungi as it released its first-ever priority list of fungal pathogens at risk from antimicrobial resistance (AMR). Nineteen species of fungi have been identified by the global health agency as representing “the greatest threat to public health” due to their growing drug resistance.  

Meanwhile,  a new report by a civil society coalition warned that unmitigated use of anti-fungal and antibacterial drugs on crop and animal production is fueling the fires of AMR – with too little action by countries and the UN system.

Speaking to media Tuesday, Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, said that WHO had compiled a list of piority fungal pathogens to put the issue on the public agenda and identify the areas for further research and development on fungal diseases.

Underlining the need for more documentation and surveillance on the fungal infections and diseases, Dr Getahun said, “ “We want the documentation of what’s happening currently … to dictate or to guide, while waiting for the evidence to be complete, what public health actions can be taken, particularly in raising awareness around these fungal infections.” 

Of the 19 species of fungi identified as priority pathogens, four pathogens were labelled as having “critical priority”. Those include Aspergillus fumigates, which causes respiratory infections in humans.  Others are Cryptococcus neoformans, Candida auris, which can cause bloodstream infections, wound infections and ear infections, and Candida albicans (thrush).  

Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, explaining the risk posed by drug-resistant fungi
Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, at the virtual press briefing on Tuesday.

The WHO report highlights how common fungal infections are becoming increasingly resistant to available treatments, raising risks particularly for people with low immunity. “Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection,” the report stated. During the Covid-19 pandemic, many health agencies also reported spikes in drug-resistant bacteria in samples collected from patients. 

While bacterial antimicrobial resistance (bacterial AMR) has received increasing attention from researchers and health ministries, information and data on fungal AMR is nowhere close. This is reflected in the fact that currently there are only four classes of antifungal medicines available to treat pathogenic fungal diseases. With few more treatment candidates in the clinical pipeline, WHO has warned that drug-resistant fungal pathogens are spreading far and wide across the globe due to many factors including unchecked use of antifungal agents in agriculture and aquaculture and climate change. 

All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance by GBD
region, 2019

Role of azoles in fungal AMR

Rice fields are one type of agriculture where azoles are widely used.

Meanwhile, the new report on AMR released Monday by a civil society coalition carried an even stiffer warning abou the role of agrobusiness in spurring AMR – through rampant use of antifungal, antiboitic and antiviral agents on livestock and crops.

The report was co-authored by Nicoletta Dentico of the Society for International Development and the Geneva-based AMR Think-Do Tank.

The report, Untangling Antimicrobial Resistance, highlights, in particular, the role played by the widespread use of fungicides belonging to the azole family on agricultural crops – in the process fostering more drug resistant strains of Aspergillus fumigates, one of the pathogens on WHO’s priority list as a hazard for human health.

While antifungals may be regarded as key to food security, wanton use is increasing drug resistant mutations of fungi, and thus “selective pressure on human pathogens”, especially in regions where regulations against the on the use of fungicides are weak, the SID report added. 

Aspergillus fumigates causes an “environmentally acquired respiratory illness,” with Europe reporting the highest number of cases from the fungus. A 2021-study described how Aspergillus fumigatus has been spreading in all continents across the world, except Antarctica. 

Uncontrolled release of drug-laced effluents by industry, agriculture, households and the health sector is another pathway by which AMR resistance is growing silently, but steadily – particularly in parts of the world lacking good sewage treatment systems, the report states.

Not enough data on drug-resistant fungi

Deaths from drug resistant bacteria such as S. pneumonia and K. pneumonia have been mapped recently – but similar work is lacking for fungal agents.

Another issue faced in coming to grips with the surge of fungal AMR, is the lack of data, WHO officials said at their briefing. There are no systematic requirements for countries’ reporting on the use of antimicrobial or antifungal agents in human health or agriculture – or for reporting on AMR hotspots that emerge from overuse.  Whatever data may be collected by WHO, it is not harmonised with data collected by FAO or OIE.  Without data, it is tough to know where fungal drug resistance is growing, and what is the global burden of diseases from related deaths.

“But it doesn’t mean that it’s not a problem,” Dr Getahun pointed out. “That is why we have identified the priority pathogen list. And that is why we are actually encouraging more research, more surveillance, to understand the actual extent. Then we will be able to have appropriate estimates about global [burden].”

“Currently, fungal infections receive less than 1.5% of all infectious disease research funding. Consequently, the evidence base is weak, and most treatment guidelines are informed by limited evidence and expert opinion. Tackling the problems posed by invasive fungal disease will require increased research funding, targeted at the key priorities, new antifungal medicines and improved diagnostics,” the report added. 

While a recent Lancet study estimated that drug-resistant bacterial infections directly cause around 1.3 million deaths every year, and are associated with the deaths of some five million people every year, no such numbers are available for drug-resistant fungi. “We do need surveillance to identify the real burden and direct the public health as it is.”

Coordination between WHO, FAO, OIE and UNEP – hope or smokescreen?

Stefano Prato, top left, describes the economic model that has locked in farmers to overuse of drugs critical to human health. Nicoletta Dentico, lower left, moderates.

Recognizing the growing AMR threats from animal production and crop cultivation, WHO in April 2022 signed a Memorandum of Understanding (MoU) with Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and United Nations Environment Programme (UNEP) to collaborate on so-called One Health, approaches encouraging more judicious use of available drugs and chemical agents. 

Getahun, who is also director of the Quadripartite joint secretariat, told Health Policy Watch that under the MoU, the agencies – dubbed the Quadripartite – are working more closely together to identify those antibiotics that are critical to human and veterinary health. “[This was done] in order to ensure that these antimicrobials are not prescribed without the necessary veterinary or physiotherapy, you know, indications for plants.”

However, Getahun acknowledged that this work is in its early stages.

Speaking at the launch of the civil society report on AMR at Geneva’s South Centre, SID managing director Stefano Prato criticized the Quadripartite’s work as largely “theatrical” lacking normative teeth.  Meanwhile, veterinarians and farm extension advisors often receive huge financial incentives from encouraging farmers’ over-use of antibiotics, antivirals, antifungal agents and other drugs, driving uncontrolled use of such products.

“In many countries vets are really the ones who prescribe, earn and enjoy income and profits from the prescription of antiviral or antibiotics at the farm level,” observed Prato, who is both a veterinarian and an economist by training.”

In addition, developing countries have become locked into monoculture systems of industrial crop production, which typically require large drug and chemical applications – in order to generate cash crops for export.  Shifting out of that model to more sustainable agriculture systems that can supply more nutritious foods locally, is now extremely difficult because of their foreign debt burden, Prato said.

“Many countries that are locked into that export-driven model are also exposed to significan foreign debt… That means that they need the income and the currencies that are related to their export of commodities, because they need to repay those currencies”

“And so the conflicts of interest are so entrenched, not only at the global level but also at the national and micro level,” he said.

As for the new collaborations between WHO, FAO OIE and UNEP, Prato observed: “Without a proper governance structure, there will be no solution… it will end up being some kind of policy entertainment..theatrical red carpet solutions.”

-Updated 26 October with correction to the names of the report co-authors.

Image Credits: Flickr – UK Department for International Development, WHO, The Lancet, Creative Commons Zero, E. Fletcher/Health Policy Watch.

Exercise is an essential part of health.

Most countries are failing dismally to promote physical exercise despite inactivity playing a major role in heart disease, obesity and diabetes, according to the World Health Organization (WHO).

The WHO’s newly released Global status report on physical activity 2022 measures the extent to which governments are implementing recommendations to increase physical activity across all ages and abilities. 

Data from 194 countries shows that less than half the countries have a national physical activity policy, and only 30% have physical activity guidelines for all age groups. Just over 40% of countries have roads designed to enable safer walking and cycling.  

“We need more countries to scale up implementation of policies to support people to be more active through walking, cycling, sport, and other physical activity. The benefits are huge, not only for the physical and mental health of individuals, but also for societies, environments, and economies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, “We hope countries and partners will use this report to build more active, healthier, and fairer societies for all.”  

The economic burden of physical inactivity is significant and the cost of treating new cases of preventable non-communicable diseases (NCDs) will reach nearly $300 billion by 2030, according to the WHO. 

To help countries increase physical activity, WHO’s Global action plan on physical activity 2018-2030 offers 20 policy recommendations, including policies to create safer roads to encourage more active transport, provide more programmes and opportunities for physical activity in key settings, such as childcare, schools, primary health care and the workplace. 

The report calls for countries to prioritize physical activity as key to improving health and tackling NCDs, integrate physical activity into all relevant policies, and develop tools, guidance and training to improve implementation. 

“It is good for public health and makes economic sense to promote more physical activity for everyone,” said Dr Ruediger Krech, Director Department of Health

Exercise and COVID-19 vaccine

Meanwhile, a South African observational study of over 190,000 people suggests that regular physical activity may have boosted the efficacy of the Johnson & Johnson (J&J) COVID-19 vaccine. 

The study, published in the British Journal of Sports Medicine on Wednesday, was conducted by the health insurance company, Discovery Health, and its wellness programme, Vitality, in collaboration with Witwatersrand Sport and Health Research Group and the South African Medical Research Council (SAMRC).

It drew on the anonymised medical records, and recordable activity tracker data for 196,444 healthcare workers vaccinated with the J&J vaccine, who were clients of both a Discovery Health Administered Scheme and a Vitality wellness programme.

Those who were fully vaccinated and had high weekly levels of physical activity were nearly three times less likely to be admitted to hospital than those who were vaccinated but in the low physical activity category. 

“We set out to test the hypothesis that regular physical activity enhances the immune-boosting effect of COVID-19 vaccines, reducing severe outcomes in vaccinated people (measured by hospital admission),” explains Discovery Health’s analytics actuary, Shirley Collie. 

“The risk of hospital admission among fully vaccinated healthcare workers was reduced by 60% in the group who engaged in low levels of physical activity, and by 72% and 86% in the medium and high physical activity groups, respectively.” 

However, Professor Glenda Gray, President of the South African Medical Research Council, cautions that more research is needed to understand why exercise enhances the vaccine’s effects.

“For now, we suggest this may be a combination of enhanced antibody levels, improved T-cell immunosurveillance and psychosocial factors,” said Gray.

Image Credits: WHO/A. Loke.

Polio
Representatives from Rotary International and the government of the Philippines sign the agreement that starts Rotary International’s first polio project, 1979.

A historic window of opportunity to eradicate polio could be slipping away, World Health Organization (WHO) Europe leaders warned at a press conference marking World Polio Day on Monday. 

Since the 1980s, global polio cases have fallen by 99.9% and if polio were to be eradicated, it would join smallpox as only the second disease to be consigned to history.

“Polio is on the verge of becoming a story of the past,” said Dr Hans Kluge, WHO Europe Regional Director. “We stand on the cusp of eradicating the virus, but progress and the European region’s polio free status remain vulnerable.” 

The European region has been free from wild polio for two decades. But over the past year, circulation of vaccine-derived polio virus – a strain mutated from the weakened virus contained in the oral polio vaccine – has been confirmed in Israel, Ukraine, and the United Kingdom. This weakened variant can only spread in pockets of under-immunized communities, highlighting the need to reinforce vaccination efforts.

“The fight against polio has demonstrated the wonders of immunization, but this is not something we can take for granted,” Kluge said. “We are so close to the prospect of a polio free world. Choosing to leave the fight now would be a tragedy for future generations.”

Journey to eradication: from dream to reality

Polio
The 1979 agreement between Rotary International and the Philippine Ministry of Health for a joint multi-year effort to immunize children against polio

In 1979, a member of Rotary International issued a challenge to their peers in the Philippines chapter to eliminate polio from the island nation. It would take years of work, but the initiative was successful. The last case of wild polio in the Philippines was recorded in 1993. 

The challenge was then put to Rotary’s 1.4 million members globally. With representatives in over 200 countries, the goal became global eradication of the disease. Since the start of the 1979 vaccination campaign in the Philippines, Rotary International has invested $2.6 billion in the fight against polio.

“The thought was ‘if we can do it here, can we do it everywhere?‘” explained Rotary international president Jennifer Jones in her opening statement at the Monday press conference. “We started to speak with health professionals and organizations around the world, but it wasn’t seen as being a possibility at all.”

In 1988, the WHO, UNICEF and the Centers for Disease Control and Prevention, came together to form the Global Polio Eradication Initiative (GPEI). Later, the Bill and the Melinda Gates Foundation joined and GPEI became the largest international public health initiative in history.

Just last week, GPEI secured $2.6 billion in commitments at the World Health Summit, which is over half of its funding target of $4.8 billion set out in its 2022-2026 Strategy. This money is needed to provide vaccinations and essential healthcare services to over 370 million children worldwide. In total, over $19 billion has been invested into the programme since its launch.

The global effort has led to a reduction in polio cases by 99.9%.  “We are closer than we’ve ever been,” Jones said.

Endemic regions making progress

The mountains of North Waziristan, Pakistan.

Two years ago, wild polio was eradicated from endemic reservoirs in India and the African continent, and efforts in the last two endemic countries – Pakistan and Afghanistan – are trending in the right direction. But with the finish line in sight, the last mile is proving difficult.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” said Dr Zulfi Bhutta, professor at Aga Khan University in Pakistan. “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere.”

Waziristan, a mountainous region of Pakistan on its Afghan border, faces high levels of vaccine hesitancy that have led to it becoming polios’ most resilient reservoir. The surrounding mountains – once strongholds of the Taliban – are a fitting backdrop for the disease to take its final stand.

The return of the Taliban from these very mountains to the levers of power in Afghanistan have complicated progress in reaching its unvaccinated communities. But negotiations to allow vaccinators better access to the country are underway.

Children pay the price of low-vaccination

Vaccine-derived polio strains are only a threat to the under-immunized. Too often, this means the heaviest burden falls on children.

“The occurrence of vaccine-derived polio around the globe clearly indicates one thing: we have left our children behind by not getting them vaccinated,” said Dr Siddhartha Datta, WHO Europe’s Regional Immunization Advisor. “It is extremely important that every child gets the vaccine doses which are part of the national vaccination schedule.”

Hundreds of children have already been paralyzed this year due to the spread of a vaccine derived strain amongst non-immune people in parts of Africa, Asia and Europe.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. 

Polio anywhere is a threat everywhere

The re-emergence of polio in non-endemic regions highlights the difficulties of eradicating diseases in an increasingly interconnected world.  

“Polio is still a plane ride away,” Carol Pandak, the Chicago-based director of Rotary’s PolioPlus program told Bloomberg. “We’re sticking with the fight until we finish the job and keep our promise to the children of the world.”

But while cases in non-endemic countries are cause for anxiety, there is no need to panic, Jones explained.

“Seeing cases outside of the endemic areas is concerning, but we don’t need to fear-monger,” she said. “We should utilize the opportunity to raise awareness of what polio is and why it’s important to eradicate.”

COVID-19 has also taken a toll on polio immunization programmes. Across the WHO’s European region, coverage of the third dose of polio vaccine fell by 1% between 2019 and 2020. In 2021, only 25 out of 53 of the region’s countries had reached the 95% polio vaccination coverage rate recommended by the WHO.

“It is paramount that we ensure high vaccination coverage in all population groups,” said Kluge. “Until polio is eradicated, every country will remain at risk.”

COVID remains a threat, and forecasting is shaky

WHO Europe Director Hans Kluge at a press conference marking World Polio Day.

Last week marked 1000 days since the first cases of COVID-19 arrived in Europe. Entering the third pandemic winter, the continued evolution of the virus driven by a range of sub-lineages of the Omicron variant remains a concern.

An autumn surge has led to a tripling of cases in the European region since early September. In the second week of October, the region accounted for nearly 60% of new global cases and 42% of deaths.

“We are much better prepared, and the surge has not led to previous ICU admission or severe disease levels,” Kluge noted. “But the virus has surprised us more than once, and forecasting is tricky.”

WHO Senior Emergency Officer Dr Catherine Smallwood echoed the difficulty of projecting how the disease will develop through the winter.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” she explained. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

Image Credits: Rotary International, Rizwan Ullah Wazir.

IFPMA Director-General Thomas Cueni

The Biotechnology Innovation Organization (BIO) and Developing Countries Vaccine Manufacturers’ Network (DCVMN) have thrown their weight behind the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) proposal to improve access to vaccines in future pandemics.

The proposal, known as the Berlin Declaration, outlines how the pharmaceutical industry would reserve an allocation of real-time production of vaccines for priority populations in lower-income countries in future global pandemics.

In exchange, the industry wants their intellectual property protected, and for governments to “guarantee the immediate and unhindered sharing of emerging pathogens and their associated data to all researchers”, as well as committing to unrestricted trade, no export bans, and expedited processes for import and export during a pandemic.

The three pharma associations –  representing vaccines innovators as well as manufacturers – announced their agreement on Monday following a meeting in India hosted by DCVMN.  They called upon the G20, G7 and multilateral organizations to implement their part of the proposed bargain, etched out by the Berlin Declaration. 

“By supporting the vision for equitable access in pandemics, vaccine innovators and manufacturers acknowledge that while innovation, business-to-business voluntary collaboration and manufacturing scaling up succeeded in an unprecedented way during COVID-19, efforts to achieve equitable access were not fully realised,” the three bodies acknowledged.

“The three trade bodies invite the G7, G20, as well as multilateral organizations and other decision-makers to accept this practical solution and include it in their future pandemic preparedness response plans, whilst impressing upon governments that for the proposal to succeed the health systems in lower-income countries need to be better prepared to absorb and deliver vaccines and treatments, while high-income countries need to provide the necessary political and financial support,” according to the statement.

Industry ‘power-grab’?

Manufacturing COVID-19 vaccine at a Pfizer facility.

However, the People’s Vaccine Alliance once again denounced the industry’s offer.  A policy brief on the Berlin Declaration, issued by the alliance last week described it as “a continuation of a consistent ‘third way’ campaign by the biopharmaceutical industry to maintain exclusive intellectual property (IP) protections and monopoly control over the medical technologies needed to defeat the pandemic”.

The alliance, which is made up of over 100 civil society organisations, has taken issue with a number of clauses including the declaration’s insistence on IP protection, pointing out that  “decades of publicly funded research” was behind the development of mRNA vaccines.

​​“Waiting for pharmaceutical companies to voluntarily supply life-saving medicines and vaccines to people in developing countries has not worked in the AIDS pandemic, it has not worked in the COVID-19 pandemic, and it will not work in future pandemics,” said Winnie Byanyima, executive director of UNAIDS and co-chair of the People’s Vaccine Alliance, in a media release.

“Governments negotiating a pandemic treaty need to resist the siren calls of industry. The profiteers of this pandemic must not set the rules that govern the preparations for the next pandemic. The world needs an international agreement that guarantees fair and equitable access to medical products for everyone, everywhere, not a power grab by big pharma,” she added.

The World Health Organization (WHO)’s intergovernmental negotiating body (INB), established to guide member state discussions on developing a pandemic accord for future pandemics, is currently refining the current working draft of the initial agreement, referred to as document A/INB/2/3. This will be presented as a “conceptual zero draft of the accord” at the INB’s third meeting in December.  Framing of equity and medicines access in the zero draft will set the stage for how member states negotiate over these charged issues in their attempts to reach a binding international accord.  

The INB will submit a progress report to the Seventy-sixth World Health Assembly in 2023 and the final accord is expected to be presented for consideration at the Seventy-seventh World Health Assembly in 2024.

Vaccine price hikes

People’s Vaccine Alliance co-chair, UNAIDS Executive Director Winnie Byanyima.

Meanwhile, the People’s Vaccine Alliance also condemned the announcement by Pfizer that it will increase the price of its COVID-19 vaccine fourfold, to around $110-$130 after the US government’s federally-sponsored purchase programme for the vaccine expires at the end of this year.  Currently, the vaccine is sold for $30 a dose to the US government and provided for free.  As of 2023, the vaccine will be provided through the usual US public and private insurance channels, Pfizer said, in a statement that justified its price-hike to weakened demand for the vaccine. 

However, in a statement to Health Policy Watch, a Pfizer spokesperson said that the “company comments made regarding potential future vaccine pricing were specific to the United States.”

The spokesperson added: “We have government contracts in many developed markets outside the US, valid through 2023. And as such, have agreed prices for those markets.  During the pandemic, we priced our vaccine and oral treatment to ensure equitable global access for all countries, regardless of income levels… This tiered pricing, which provides to low and middle-income countries at cost, remains in effect.”

A People’s Vaccine Alliance spokesperson said that at its current US sale price, the vaccine already is priced nearly 30 times above its manufacturing cost – even at current US rates: “Experts have estimated that Pfizer’s vaccine costs just $1.18 per dose to make. Charging $130 per dose would represent a markup of more than 10,000%. This is daylight robbery. Governments must not stand by while companies like Pfizer hold the world to ransom in a global pandemic,” said alliance policy advisor Julia Kosgei.

Cost price estimates, she said. are based on Oxfam analysis of studies of mRNA production techniques, carried out by Public Citizen with engineers at Imperial College. Public Citizen and Imperial College’s analysis suggests that it could cost $9.4 billion to produce 8 billion doses of the Pfizer/BioNTech vaccine ―$1.18 per vaccine.

“While health workers and the vulnerable continue to go unvaccinated in developing countries, Pfizer is shamelessly fleecing the public for ever-greater sums of money. This latest obscene price hike is truly a mask-off moment for one of the great profiteers of this pandemic,” said Kosgei.

Not just about vaccines

Mapping of the MPP-brokered licenses awarded for the manufacture of a generic version of Paxlovid

“This isn’t just about vaccines. Right now, people in developing countries are dying without access to Paxlovid, an antiviral COVID-19 treatment for which Pfizer is charging hundreds of dollars per course. But there is a proposal at the World Trade Organization that would make it easier for poorer countries to produce generic doses. It’s time for governments to stand up to pandemic profiteers and support it.”

With regard to Paxlovid, the Pfizer spokesperson said that the company had established “a comprehensive strategy with governments, international global health leaders and global manufacturers to optimize overall supply and access to all parts of the world. ”

That, the spokesperson said, includes: a voluntary license agreement with the Medicines Patent Pool to allow generic production of the treatment, sublicensed to 38 manufacturers in 13 different countries; agreements with the Global Fund and UNICEF to supply some 10 million treatment courses through their channels; and collaborations with WHO and its partners to enable supply to reach “more vulnerable populations.

In a separate channel, World Trade Organization members are still negotiating over a proposal to extend a limited intellectual property waiver on vaccine manufacture, approved by the WTO in June, to treatments as well. The 17 June agreement calls for a WTO decision on whether to extend the waiver to diagnostics and treatments “no later than six months from the date of this decision.”

Image Credits: Pfizer, Medicines Patent Pool .

Haiti
Child Amputee in Recovery at Jacmel, Haiti, Hospital. UN Photo/Marco Dormino.

Hospitals in Haiti’s capital of Port-au-Prince face the threat of shutting down if fuel supplies for diesel power generators and vital medical supplies aren’t made available soon, Médecins Sans Frontières (MSF) warned Friday. 

“We will not be able to operate our medical facilities for more than a few weeks if we do not have access to fuel,” said Mumuza Muhindo, MSF’s head of activities in Haiti. “In addition, medical equipment, which we also need to continue to treat cholera cases and provide care to the population, is currently blocked at the port.”

Shortages have been exacerbated by the ongoing gang blockade of a key fuel terminal in the country, which has led its neighbour, the Domican Republic, to approve a request to export 20,500 gallons of diesel to Haiti for use principally in hospitals, according to documents seen by Reuters.

As chronic outages continue to hit Haiti’s power grid, fuel is the only way hospitals can ensure consistent electricity. And the Haitian capital’s health services are already on the brink of collapse.

For the last several days, Port-au-Prince hospitals have been forced to reduce their services due to the fuel shortage as the country teeters between prospects of foreign intervention and revolution. 

MSF reports over 100 people a day with cholera like symptoms

Amid the chaos, the re-emergence of cholera, officially confirmed on October 2, poses a growing threat. As of 8 October there were 224 cases officially confirmed, according to WHO.  

Accounting for the breakdown of the government’s ability to operate, experts warn official figures drastically underestimate the scale of the outbreak. Over the last seven days, MSF reported receiving over a hundred patients with cholera-like symptoms in each of its four treatment centers.

Unsafe water is one of the main causes for the spread of cholera, and with no functioning government, escalating violence, and no clear path to a resolution of its political crisis, the resurgence of the disease in Haiti could be disastrous, warned Auguste Ngantsélé, MSF’s Haiti Medical coordinator.

“Without drinkable water, treatment, and good waste management, the risk of a spike in the number of cases is very high and needs to be addressed urgently,” he said.

Additional reports emerged last week of an outbreak in an overcrowded prison where dozens of people were infected, triggering fears that transmission may grow out of control.  

Patients can’t get to hospitals 

Areal view of CIté Soleil, a deeply impoverished area of Port-au-Prince now under gang control.

Even if hospitals in the island’s capital manage to remain open, the roads to treatment are dangerous. Violence on the streets has made every trip through Port-au-Prince perilous, and even seeking access to facilities capable of providing adequate treatment present a life-threatening challenge for patients. 

“In 20 years of working in Haiti, we have never seen something like this,” Fiammetta Cappellini, country representative for the Avsi Foundation told the Guardian. “Violence is everywhere and touches everybody. The most vulnerable people are literally struggling to survive as humanitarian aid is failing to reach people.”

Accounts from doctors on the ground provide grim evidence for Cappellini’s view. 

“Last week, a pregnant woman came to our hospital in Cité Soleil needing an emergency cesarean section. We tried to transfer her to a medical facility where she might find that kind of treatment, but she died”, said MSF doctor Dr. Luxamilda Jean-Louis. “Whether it’s due to insecurity on the roads, or to health structures no longer functioning, events like this happen every day in Port-au-Prince.”

The gangs – who took the opportunity to expand their control over the country after the assassination of its prime minister last year – have gone to extremes to enforce their rule over the capital. 

Last week, the UN Human Rights Office published a report detailing that children as young as 10 have been subjected to sexual violence – including collective rapes for hours in front of their parents or children by more than half a dozen armed elements. 

“Gangs use sexual violence to instil fear, and alarmingly the number of cases increases by the day as the humanitarian and human rights crisis in Haiti deepens,” said acting UN Human Rights Chief Nada Al-Nashif. “The gruesome testimonies shared by victims underscore the imperative for urgent action to stop this depraved behaviour, ensure that those responsible are held to account, and the victims are provided support.”

On Friday, the UN Security Council unanimously approved a sanctions regime for Haiti, targeting gang leaders and those who finance them, in hopes of easing the violence and lawlessness. The resolution specifically sanctions notorious gang leader Jimmy Cherizier, an ex-police officer who is reportedly the most powerful gang boss in the country, known by his alias “Barbeque”.

“We are sending a clear message to the bad actors that are holding Haiti hostage,” said US UN Ambassador and co-pen holder on Haiti, Linda Thomas-Greenfield. “The international community will not stand idly by while you wreak havoc on the Haitian people.”

Thomas-Greenfield added that the US and Mexico are working on a resolution to authorize a “non-UN international security assistance mission” to address security issues and facilitate humanitarian aid. Given Haiti’s past experiences with foreign intrusions, the plan is controversial, and has sparked large protests in the capital.

Haiti’s acting, but unelected prime minister, Ariel Henry, asked for the international community to deploy a “specialized armed force” in the country on October 7. Despite United States acknowledgement of the depths of the Hatian crisis on the international stage, many refugees arriving at its borders fleeing the violence continue to be sent back.

Crises collide: ‘catastrophic’ hunger recorded in Haiti for first time

On the same day of the release of the sexual violence report, the UN’s World Food Programme published its own finding: hunger in Haiti has reached catastrophic levels. 

According to the media release, a record 4.7 million people are facing acute hunger, including 1.8 million facing what the UN describes as “emergency phase” hunger. And, for the first time ever in Haiti, 19,000 people are facing “catastrophic” hunger, and are barely surviving. 

Today, 65% of the residents in Cité Soleil, an extremely impoverished and densely populated neighborhood of Port-au-Prince, are facing high levels of food insecurity.

With armed groups vying for control of this now lawless area of the capital, people have lost access to their jobs, markets, health and nutrition services. Many have been forced to flee or simply hide indoors, the UN said. 

Haiti
The epicenter of Haiti’s 2021 earthquake hit rural areas, leaving a lasting impact on food supplies.

Beyond the chaos of Port-au-Prince, rural communities are not faring much better. Food security has continued to deteriorate in these areas as harvest losses due to light rainfall compounded by the 2021 earthquake that struck the island in August last year hit food supplies. 

“For years, natural hazards and political turmoil have taken a toll on Hatians already in need in both rural and urban areas,” the UN stated. “The onset of the global food crisis, with rising food and fuel prices, has led to growing civil unrest that has plunged Haiti into chaos.”

As the parallel crises of hunger, violence, and cholera collide, whether Haiti’s hospitals survive the fuel shortage will determine the lives of thousands of Haitians. 

A health worker monitors a cholera vaccination campaign in Sinnar, Sudan.

With more cholera outbreaks overstretching the world’s limited vaccine supply, WHO recommends temporarily suspending the standard two-dose regimen to vaccinate more people. Meanwhile, Africa aims to re-energize its COVID-19 vaccine rollout, despite steady decline in public turnout for vaccination. 

A shortage in the global supply of cholera vaccines has forced the World Health Organization to recommend that countries administer only a single vaccine dose – rather than the standard two doses to groups at risk, in order to conserve desperately-needed supplies. 

“The pivot in strategy will allow for the doses to be used in more countries, at a time of unprecedented rise in cholera outbreaks worldwide,” WHO stated in a news release just ahead of a briefing by WHO Africa Region officials Thursday on the regional situation, one of the regions seeing a sharp rise in cholera cases.

Globally, this year, a total of 29 countries have reported cholera cases to WHO. In Haiti, Malawi, Somalia and Syria, large outbreaks of cholera are currently underway, while the Democratic Republic of Congo, South Sudan, and Cameroon are among the other hotspots. In contrast, in the previous five years, fewer than 20 countries worldwide, on average, reported outbreaks.

The global trend is towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks, experts say.

“Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive and reactive campaigns,” reported WHO.  “And an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine. As vaccine manufactures are producing at their maximum current capacity, there is no short-term solution to increase production. The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year.

“This is a short-term solution but to ease the problem in the longer term, urgent action is needed to increase global vaccine production,” WHO concluded.

Recommendation made by group  managing emergency vaccine supplies

Dr Phionah Atuhebwe, Vaccines Medical Officer, WHO African Region

WHO said the recommendation was initially made by its the International Coordinating Group (ICG) expert group, which manages emergency supplies of vaccines.

Defending its decision, ICG said the one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children.  

With a two-dose regimen, when the second dose is administered within 6 months of the first, immunity against infection lasts for 3 years,” it said.

Addressing the WHO AFRO briefing, Dr Phionah Atuhebwe, Vaccines Introduction Medical Officer said the temporary use of the one dose strategy will allow more people to be vaccinated and provide them with protection in the near term. 

“So it means we get more doses for DRC and Cameroon. However, while vaccines are still a critical tool in the prevention of these cholera outbreaks, they’re not the only tool we have. Cholera can be prevented with access to safe water and sanitation and also treated with oral rehydration or antibiotics for severe cases,” she said.

An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from the disease, according to the US Centers for Disease Control.

Africa has administered 70% of the 1 billion doses of COVID-19 vaccine received

Matshidiso Moeti, WHO African Regional Director

Since COVID-19 vaccination began in Africa, the continent has now received more than one billion doses of vaccines out of which it has administered over 70%, according to Africa CDC. Despite this milestone, Matshidiso Moeti, WHO Regional Director for Africa, told Health Policy Watch that Africa is far from the global goal set by WHO for vaccinating 70% of its population. 

In fact, only 8 countries in Africa have vaccinated more than half of their populations, Aurelia Nguyen, Gavi Special Adviser, told Health Policy Watch.

Moreover, COVID-19 vaccination coverage has stagnated in half of African countries, as the number of doses administered monthly declined by over 50% between July and September. Despite this, the continent has made modest progress in vaccinating high-risk population groups, including health workers and the elderly, the officials stated.

“I think it’s clear that we are far from the original targets that have been set as far as coverage with COVID-19 vaccination in the African region is concerned. At a certain point in time early this year, we were saying we need to ramp up seven times the rate at which vaccination was happening in the African region,” Moeti said.

Aurelia Nguyen, Special Adviser, Gavi, the Vaccine Alliance.

While COVID-19 vaccination coverage in Africa is way below global averages, booster coverage is even lower, Nguyen said.

“Programs that address these [issues] will really be where we’re going to save the most lives. And it’s also going to be the part that helps protect the health system overall, as we respond to the pandemic and other diseases,” she said.

Image Credits: Twitter: @WHOSudan, European Centers for Disease Control , Adepoju/Health Policy Watch .

‘He died without feeling a last kiss from his loving mother,’ Ricardo Baptista Leite on his journey from the bedside to the boardroom to create UNITE

BERLIN – Nearly 20 years ago, Ricardo Baptista Leite began his work as a young medical doctor in an infectious disease ward in Portugal – an experience that changed his life. 

“I met patients who couldn’t make it to the hospital because they couldn’t afford public transportation,” he said.  “I diagnosed patients infected with multi resistant tuberculosis; keeping them in isolation, I prayed that the treatment would work that time. 

“I particularly particularly remember a man in his twenties who was in the hospital, and his mother would visit him every day, but she would not go inside the room because she was ashamed that her son was living with HIV. 

“He died without feeling a last hug and kiss from his loving mother. And all because of lack of education, stigma, discrimination, inequities and poverty have led to poor health and deaths across the world.”

Leite, who is now a member of the Portuguese National Assembly, recalled those early days at a ceremony this week where he signed a collaboration agreement between the World Health Organization and the UNITE Parliamentarians Network for Global Health, founded just five years ago.

The aim is to expand outreach to the world’s elected politicians on burning global health priorities, whose direction is ultimately “a political choice” to use the oft-cited mantra of WHO’s Director General Dr Tedros Adhanom Ghebreyesus.

‘Straightforward’ but not simple mission

Parliamentarians from six WHO regions speak about advancing global health goals at a World Health Summit event marking the establishment of official relations between the World Health Organization and the UNITE Network of Parliamentarians for Global Health.

UNITE was only a glimmer in the imagination of Baptista-Leite six years ago when he first proposed the idea of a global health-focused parliamentary intiative at the 2016 World Health Summit.

Established a year later in 2017, it now includes senators and congresspersons from more than 85 countries. Along with gaining formal WHO recognition, UNITE is also leading work with about a dozen other long-standing parliamentary networks under the umbrella of the International Forum on Global Health, to coordinate parliamentarians’ inputs to the WHO’s development of a pandemic treaty.

“Our mission is straightforward,” said Baptista Leite at the WHS event where he signed the MoU on behalf of UNITE with WHO’s Tedros. The ceremonial signing wa followed by a panel discussion with leading MPs from all six WHO regions of the world on the role parliamentarians can play in turning global health policies into reality. 

“We aim to transform scientifically sound recommendations into concrete laws. We ensure that money gets where it is needed through budgets, and we hold governments accountable,” Baptista Leite said, summing it up. 

“We will work together towards achieving a new pandemic treaty or convention to be ratified by parliaments to ensure that all will be done to contain outbreaks and prevent future pandemics. 

“We will actively transform current disease response systems into health ecosystems capable of promoting wellbeing for all and not just for the few. Together we will foster innovation and digital health as a means towards achieving universal health coverage and the SDGs by 2030. And by joining efforts with civil society and patient advocates, we will put citizens front and center. 

“And as we have seen in the COVID pandemic health threats do not recognize borders, and if we do not work together we will indeed fail the people we have been elected to serve, unite and who have come together to ensure that failure is not an option.”

WHO rolling out new parliamentary engagement strategy 

‘As a former parliamentarian myself, I know the critical role parliaments play’ – Tedros at the signing of an MoU recognizing formal relations with UNITE.

While UNITE is a relatively new parliamentary network, and small in comparison to groups like the Interparliamentary Union (IPU), which includes tens of thousands of members worldwide, its added value is its laser-focus on global health. Recognition by WHO can ease collaborations that support WHO’s efforts to reach out more directly to parliamentarians around the world, said Dr Tedros, noting that WHO is just now rolling out a first-ever strategy on parliamentary engagement. 

The WHO strategy includes the creation of a new global network of parliamentary chairs of health committees from all 194 WHO member states “to establish a systematic dialogue with national parliamentary bodies in charge of health and mobilize political support around key global health priorities,” Tedros said.  

“As new members of the WHO partners family, UNITE will support WHO’s engagement with parliaments with a focus on three major areas: equitable access to health with a focus on adequate budget allocation for universal health coverage; sustainable financing for health system strengthening; and strengthening the global health security architecture…especially the implementation of the international accord in countries,” said Tedros at the event.  

While governments’ can approve new WHO initiatives and  policies, it remains up to parliaments to pass the legislation to actually implement them – along with ensuring sufficient budget allocations, Tedros noted.  And that is what makes their role so pivotal.

Speeding up ratification of a new pandemic accord 

This is a key particular concern with regards to any new pandemic treaty or accord.  Even if an accord is approved on schedule by May 2024, it would still have to be ratified by a critical mass of countries in order to take effect as international law and be universally binding. 

And that process could take years, critics have warned. In fact,  the International Health Regulations (IHR), the present-day set of WHO rules on health emergencies, only became legally binding in 2020 – 15 years after the IHR was approved by the World Health Organization member states.  

“As a former parliamentarian myself, I know the critical role parliaments play in driving progress in global health by passing legislation;  keeping governments accountable, allocating adequate funding for health and by representing the needs of the communities they represent,” Tedros added.  

“Over the last few years, WHO has intensified its engagement with parliaments on our key priorities of: universal health coverage, global health security and health promotion, especially for vulnerable groups, including women, children and adolescents. 

“A significant milestone was the adoption by the Interparliamentary Union Assembly of a resolution on Universal Health Coverage in 2019. 

“This is only the first of many milestones we would like to achieve with your support,” said Tedros, turning to Baptista-Leite and the parliamentarians on the panel, including Spain’s José Ignacio Echániz, chair of the advisory group on health at the IPU, a broad-based body representing 46,000 MPs around the world.  

Inherent tensions between parliamentarians and government 

Ghanaian politician Akua Sena Dansua describes experiences serving in parliament and government.

Reaching out to parliamentarians is a delicate, but important task for WHO, in light of the inherent tensions that typically exists between the parliamentary and executive branches of government.  It is with the latter that WHO maintains its formal relations.  But presidents or prime ministers and their cabinet ministers don’t always have the last word either, as anyone watching the hotly-debated US mid-term elections knows. 

Within any presidential or parliamentary democracy, there is typically a wide array of of political parties and constituencies that need to be persuaded to support measures that require legislative action, including spending on new domestic programmes as well as international accords.

Ghana’s Akua Sena Dansua can speak to that issue well, 

“I had the benefit of experience on both sides of the aisle,” recalled Dansua, who moderated a panel discussion that followed the ceremonial signing of the MoU. “I was in opposition for  8 years, and then in government for four years, 

“And during this time, I will say that I had the best time in opposition, because then I had the opportunity to criticize the government of the day – you can shout at the top of your voice. 

“But the government is adamant – they are there to promote their vision, which may not include what you are trying to propose to them. So you can shout the loudest but you will not, unfortunately, [always] get the hearing you deserve.” 

Conversely, when her party was controlling the government, “you have to tow the party line. You have to tow the government’s line. … Even if you have issues to raise, you couldn’t express yourself.”

WHO’s recognition should empower parliamentarians 

Andrew Ullmann, chair of the Health Committee in the German Budestag.

Against those limitations and constraints,  WHO’s engagement can equip parliamentarians with evidence based know-how, enabling them to provide better guidance and leadership on critical health issues, Dansua said. 

“We are happy that WHO has recognized or is recognizing parliamentarians as a very strong partner. What we ask for them is to empower us,  to give us the training, to give us the information and to give us the support that parliamentarians need in their various countries to push the global agenda forward,”  Dansua said. 

Health can also be a unifying theme amongst disparate political parties, observed another panelist, Andrew Ullmann, chair of the Health Committee in Germany’s Bundestag.

“We as parliamentarians are essential to achieving global health goals because of our ability to enact legislation, harmonize existing laws, create an enabling legislative environment, and eliminate existing legal barriers to existing health care,” Ullmann stressed. 

“We are responsible for budget allocations and keep our governments accountable. For my experience as chair of the subcommittee, I can assure you that German parliamentarians independents, in the governmental coalition or the opposition, are committed to global health.

Germany has also become the first country in the world to create a subcommittee on global health within its parliament, Ullmann noted. 

“The idea was born out of the fact that health challenges go beyond national borders, health and well being need to be understood on a global level,” he said. 

“The effects of infectious diseases such as Ebola or tuberculosis, as well as antibiotic resistance and climate change go far beyond national borders. In order to take this development into account, and to facilitate bridging cooperation exchange between all voluntary bodies involved, the global health committee established this subcommittee, which gives global health policy more visibility and real relevance among the members of the Budestag,” Ullmann added. 

Addressing health versus healthcare

Parliamentarians Andrea Álvarez Marín, Costa Rica and José Ignacio Echániz, Spain, discuss the role of MPs in global health policy-making Tuesday 18 October at the World Health Summit in Berlin.

One other key challenge parliamentarians face is understanding and championing health-based legislation that address the upstream determinants of health, social, commerical or environmental, as compared to healthcare per se, pointed out Andrea Álvarez Marín, an MP from Costa Rica and president of the Costa Rican National Assembly’s social affairs committee. 

“If we focus on the kinds of conversations that we have been having in this summit, all of us usually speak about the social determinants of health and risk factors and the causes of the causes.” she observed. “But if we go to the general public, the general public still thinks of health as access to health care only. 

“And this makes it hard to push legislation and partly explains why recently in our committee on social issues, a cancer treatment bill passed swiftly through – although in my opinion, it will have a low impact, while legislation such as labeling, taxes and food marketing tends to be archived. It’s because other Congress people don’t see these measures as being effective for prevention.”

She said that regional networks of parliamentarians, complementing global networks like UNITE, can also help bridge the knowledge gap.  

“Since 2015, the Pan American Health Organization (WHO/PAHO) has been organizing yearly conferences in which the heads of the [parliamentary] health and social committees come together and discuss best practices, common failures and the most recent evidence, so that among parliamentarians, we can see what worked in other countries and apply it to our own. 

“So I still think that a global network such as the one that was announced today has to be complemented with regional networks, because globally the conversations will be around the main challenges and the main solutions, but these solutions always need to be operationalized on the national level. And by having regional networks, such as the one we have in PAHO, we can get with countries that have a common history and common challenges.” 

Health emergencies intertwined with conflict, economic and food challenges

British MP Liam Byrne speaks at a World Health Summit event on the role of parliamentarians in advancing global health policies on Monday, 17 October.

Recognizing the increasingly complex relationships between social, environmental and economic risks and the health emergencies that they can produce has never been so important,  underlined participants at another UNITE session the day before, focusing on the pandemic accord. 

Today’s global health issues are intertwined more deeply than ever with global challenges of war and peace, migration and climate change, and even the debt crisis, emphasized Liam Byrne, a British MP and former member of Prime Minister Gordon Brown’s cabinet, from 2008-2010.  

“Some 41 countries now face a threat of civil war and conflict and violence. That now means the number of people living in conflict zones has doubled in the last 10 to 15 years; we have something like 20 million refugees around the world, living in the most unspeakable conditions. 

“But that is not the only crisis. Because as countries came out of COVID with debts high and we now face the rising American interest rates, we have something like 40 to 50 countries now facing debt distress. On top of that, there is the food crisis that is now confronting hundreds of millions of people around the world with the threat of starvation,” he added. 

“After millennia of being able to predict the seasons, actually we can’t predict the seasons anymore.…We now face a crisis of farming and food insecurity that threatens the lives of 205 million people. 3.1 billion people now do not have enough money to afford a good diet.

“And 11 million people now die each year because they cannot afford the nutrition that they need. So when you put all of that together, the risks are really clear. 

“We have to be so careful today that we don’t get caught in a vicious cycle of how a pandemic of disease triggers a pandemic of poverty, which in turn triggers future pandemic disease in the years to come. 

“We know that prevention is better than cure. So what do we, as parliamentarians do, sit back and hope it doesn’t happen again?  

“That is why this initiative is so important. We have to insist as representatives of the families of the 6.5 million people who lost their lives in this pandemic, that this never happens again.”

Image Credits: Fletcher/Health Policy Watch , Fletcher/Health Policy Watch.

A precedent-setting agreement to permit an expensive cancer drug to be produced more affordably by generic manufacturers has been signed between the Medicines Patent Pool (MPP) and pharmaceutical company Novartis, enabling much wider access to a medicine that treats a rare blood cancer.

Nilotinib is a twice-daily oral medication used to treat chronic myeloid leukaemia (CML), and it is included on the World Health Organization (WHO) Essential Medicines List. 

In the US, the drug costs almost $9000 for a month’s supply, and is used to treat patients in the early stages of CML and those resistant to an earlier drug called imatinib.

According to the agreement, MPP-selected generic manufacturers will be able to develop, manufacture and supply generic versions of nilotinib to 44 countries, including seven middle-income countries – Egypt, Guatemala, Indonesia, Morocco, Pakistan, the Philippines and Tunisia. 

“There are also other low- and middle-income countries around the world that do not have patents on nilotinib (or where such patents have expired) who will also be able to manufacture and procure generic versions once they become available,” an MPP spokesperson explained to Health Policy Watch.

This is the first agreement MPP has reached on a cancer drug. Charles Gore, the Pool’s executive director, said that “although the remaining patent life [on nilotinib] is relatively short, this voluntary licence in the non-communicable disease space sets a vital precedent that I hope other companies will follow.”

“Access to high-quality cancer medicines is a crucial component of the global health response to the cancer burden,” added Gore, making the announcement on the sidelines of the World Cancer Congress in Geneva.

New coalition brokers deal

“While there has been tremendous progress in new technologies to treat cancer, major challenges persist in many low- and middle-income countries (LMICs) that face inequity in access to new-generation cancer medicines which could allow patients to live better and longer. Advances in treatment, such as nilotinib, have contributed to a greatly improved prognosis for people diagnosed with CML,” MPP said in a statement on Thursday.

Delegates to the cancer congress have already noted that cancer deaths in LMICs are being driven by a lack of access to early diagnosis and treatment for a range of common cancers.

The agreement developed out of the new Access to Oncology Medicines (ATOM) Coalition, which was launched in May and consists of major players in the cancer sector, including pharmaceutical companies.

Lutz Hegemann, Novartis president of global health and sustainability, said that his company was  “proud to be pioneering this new licensing model with MPP in collaboration with the ATOM Coalition”.

In May 2022 Novartis and MPP both joined ATOM, which is being led by the Union for International Cancer Control (UICC) to improve access to essential cancer medicines in LMICs, and to increase the capacity for diagnosing cancer and for the proper handling and supply monitoring of these medicines. 

ATOM co-chair Anil D’Cruz hailed the agreement, saying that it showed “that the combined efforts of the private and public sectors can pave the way to help save millions of lives”.

Gilberto Lopes, ATOM’s other chair, said that “innovative solutions like the one announced today should be an example for others to follow, helping millions more people access essential, life-saving cancer medicines”.

The MPP is a United Nations-backed public health organisation working to increase access to, and facilitate the development of, life-saving medicines for LMICs – mostly by encouraging the generic manufacture and the development of various medicines.

To date, MPP has signed agreements with 18 patent holders for 13 HIV antiretrovirals, one HIV technology platform, three hepatitis C antivirals, a tuberculosis treatment, a cancer treatment, four long-acting technologies, three oral antiviral treatments for COVID-19 and 12 COVID-19 technologies.

Affordable, healthy food options are key to good health.

“The bottom line is that our food environment is deeply unhealthy. And unless we change that, millions of people will suffer from avoidable illness and die early from preventable death,” Dr Tom Frieden, CEO of Resolve to Save Lives, told the World Health Summit in Berlin.

“Voluntary changes are much less likely to result in sustainable positive healthy development than a predictable regulatory framework,” said Frieden, speaking at a session on ‘Transforming Food Systems for Healthy and Sustainable Diets. 

He pointed to five areas that needed targeted action to address malnutrition – micronutrient deficiencies, artificial transfat, excessive sodium, excessive sugar and the higher cost of healthier foods.

“Let’s be clear that simply encouraging people to eat better and exercise more will not only fail, but is essentially a form of blaming the victim.

According to the WHO, 1.9 billion adults in the world are obese and 462 million are underweight. Almost 233 million children under the age of five suffer from some form of malnutrition and around 45% of deaths among children in that age group is linked to undernutrition. 


In 2019, The Lancet Commission on obesity, undernutrition and climate change identified these three issues as the biggest threats to the world, and called for significant funding to address them, including but not limited to agriculture, food production and policy, land use and environment. 

The United Nations Food Systems Summit in New York in 2021 also called for sustainable food systems and healthy diets for all, and Tuesday’s session was aimed at addressing the various commercial determinants involved in achieving this goal. 

Some countries are already reforming their food systems to deliver healthier options to their populations using measures such as investment in agriculture, tax subsidies for companies that produce healthier foods to make them more affordable and regulations ensure processed food adheres to strict health standards. 

More regulation

Government regulation of companies that manufacture processed and unhealthy foods and their marketing strategies can help the cause, according to Frieden.

“We’re not absolving individuals from responsibility. But we’re not absolving society from the responsibility of establishing the structure to make the healthy choice the easier choice either,” added Frieden, explaining that measures like front-of-the-pack warnings, increasing the price of unhealthy food and reducing the price of healthy food have helped. 

Commercial determinants of obesity and chronic diseases are very well-documented and so is the power wielded by influential processed food corporations across the world, said Dr Marion Nestle, professor of nutrition, food studies, and public health at New York University.

Prof Dr Marion Nestle
Dr Marion Nestle speaking at the World Health Summit 2022.

She pointed to the Lancet Commission’s report and stated that big food companies are not social service agencies with public health as the goal: “They’re businesses with stockholders to please. They have to put profits to stockholders as their first priority, no matter what the people in the companies think they would like to do about hunger, malnutrition, chronic disease and climate change,” she said, calling for a regulatory framework that puts all food companies on the same level playing field.

Keep companies out of public policy

One of the Lancet Commission’s recommendations was the reduction in the influence of large commercial interests in public policy development to “enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet”.

Explaining the complicated relationship many governments have with processed food companies, Nestle said that this is a difficult situation. “It’s one that public health advocates have to figure out how to deal with, which means increasing advocacy in civil society,” she said. 

“We ought to be doing what the Lancet Commission suggested, which is keeping food companies out of public policy decisions. They should not be at the table when public health policy is being discussed. They need to be regulated in terms of marketing, and in terms of what the formulation of their products is.”

Secy General IFBA
Rocco Renaldi, secretary-general of the International Food and Beverage Alliance.

However, companies that manufacture and market processed foods play a crucial role in the eco-system and should not be ignored, argued Rocco Renaldi, the secretary-general of the International Food and Beverage Alliance (IFBA).

“We made a commitment on (reducing) sodium…to achieve a global set of sodium targets for our products by 2025, and 2030. These are minimum global targets, you can go further at national level,” he said. 

He was referring to the Nutrition for Growth Summit held in Tokyo in 2021, where the member states of the WHO agreed to a 30% reduction in the global salt intake by 2025. 

While reformulation of products to reduce salt and sugar was important, demonising processed foods is not the answer, he said. “The real answer is how to rebalance the system so that different types of food occupy the right space within that system,” Renaldi argued.

Food financing

Like many other public health challenges, money is a crucial bottleneck in addressing the issue of malnutrition across the world. 

Food financing needs to be envisioned in a different way to achieve these goals, said Dr Geeta Sethi, an advisor at the World Bank. She added that the private sector has deep pockets that will help fund these goals but are deterred by perceived risks. 

“For some reason, we in the food sector have not been able to price risk in a way that allows private finance to come in. This is urgently needed.. the change agents have to be the private finance,” she added. 

“In a nutshell, food systems do not lack financing…the public support for agriculture and food is $700billion a year,” she stated, adding that if food subsidies were a country, they would be the 19th largest economy in the world. “And this is not even considering the massive spending of the private sector, which is around $2 trillion.”

Sustainable food systems

While countries like Indonesia and Bhutan are actively redesigning their food systems and production pathways, countries like Germany, Sweden and Fiji have been successful in creating sustainable food systems that are healthy for their populations. 

“We would like to establish a framework that will be tracking institutional things that are happening in the governments, but also the behavioural change that’s happening in the stakeholders and in the private sector,” Dr Stefanos Fotiou, the director of the UN Food Systems Coordination Hub said. 

The need for political will to address these challenges also came up repeatedly as various ministers shared their experiences in designing and implementing policies around the issue. 

Speaking about her experience in Germany, Dr Doris Heberle, from the federal ministry of food and agriculture said that reducing the intake of salt is not an easy task since it impacts trade-related issues like the shelf-life of food products. 

“But we are going to have more scientific advice and scientific evidence to get better targets for reduction patterns and also to attune those to the target groups which are the most vulnerable,” she added. 

Dr Ifereimi Waqainabete
Dr Ifereimi Waqainabete, Fiji’s Health Minister, at the World Health Summit 2022.

Taking public health decisions when trade is a huge factor in the economy is difficult, said Dr Ifereimi Waqainabete, Fiji’s health minister. He added that small countries like Fiji are pushed to choose between nutritious food that is expensive and cheap food that is less nutritious. 

Waqainabete added that his government had distributed seeds and plants to people during the COVID-19 lockdown to encourage local food production and the regeneration of agriculture.

“We also regenerated our ocean area by bringing back the village system and the tribal system where you have your own ‘parish’ where you fish traditionally and stop fishing at a particular time. And we found that by doing that we’re able to regenerate our ocean,” said Waqainabete.

Sweden’s Ambassador for Global Health, Dr Anders Nordström said his government only procured healthy food for the education and healthcare sectors and this ensured that the most vulnerable received the healthiest options. 

“This has been a policy for a long time… we serve about three million meals every day and this has had a dramatic positive impact. What is interesting is that (the government) has been also putting into those policies that those meals should not just be healthy, they should be affordable.”

Image Credits: Scott Warman/ Unsplash, Megha Kaveri/Health Policy Watch.