“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 .

WHO Director General Dr Tedros Adhanom Ghebreyesus

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

This follows the six-week lockdown of 25 million residents of the Chinese city of Shanghai and restrictions on the movement of people in Beijing, with reports of people being separated from their children, being forced into sparse government quarantine facilities, and running out of food.

“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.

Transitting to another strategy will be very important,” he added. “We have discussed this issue with Chinese experts and we indicated that the approach will not be sustainable considering the behaviour of the virus. I think a shift will be very important.”

However, last week China’s ruling Communist Party’s supreme Politburo Standing Committee vowed to “unswervingly adhere to the general policy of ‘dynamic zero-Covid,’ and resolutely fight against any words and acts that distort, doubt or deny our country’s epidemic prevention policies”, according to CNN.

We need to balance the control measures against the impact they have on society, the impact they have on the economy, and that’s not always an easy calibration,” said Dr Mike Ryan, WHO Executive Director of Health Emergencies, who praised China for its low death toll of around 15,000.

There was a need to show “due respect to individual and human rights” and to  “balance the control measures against the impact they have on society”, added Ryan.

Ryan stressed the importance of countries “having the ability to adjust according to the circumstances, according to what you see in the data, and according to the best benefit for your population”, and that Dr Tedros has been involved in in-depth discussions with Chinese colleagues to find an exit strategy for China’s zero-COVID policy.

WHO’s lead on COVID-19, Dr Maria van Kerkhove, added that, in the light of the evolution of the virus to the more transmissable Omicron and its sub-lineages, it was “really not possible” to find all cases and stop all transmissions.

“But what we need to do is drive transmission down because the virus is circulating at such an intense level,” said Van Kerkhove, adding that WHO had the responsibility to give member states the best advice possible.

Biden’s Global COVID-19 Summit

The Global COVID-19 Summit hosted by US President Joe Biden on Thursday comes amid a surge in the virus in 50 countries, constrained access to antiviral treatments, and no agreement on a patent waiver on COVID vaccines, according to the World Health Organization (WHO).

Omicron lineage BA.2 is driving most of the global surge, while sublineages BA.4 and BA.5 are driving cases in South Africa, WHO Secretary-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Tuesday.

“The relatively high population immunity from vaccination and previous waves is keeping COVID-19 hospitalisation and death rates at a comparably low level compared to previous waves. But this is not guaranteed for places where vaccination coverage is low,” warned Tedros.

He also called for leaders attending the global summit to “agree to end the stalemate at the World Trade Organisation on the temporary waiver of intellectual property on COVID-19 tools”. 

“Last week, we estimated that almost 15 million people have already died of COVID-19 Are we waiting for a worse pandemic to strike before we activate the waiver?”

The summit provides “another opportunity to focus minds on the job at hand”, including “to prepare for the worst so that countries are in the best position to respond to what comes next”.

No equitable access to antivirals

Tedros added that WHO also hoped that the summit would result in “antivirals and tests being shared fairly around the world”. 

WHO is concerned that countries are unable to access the antivirals such as Pfizer’s Paxlovid, which cuts severe disease by 85% in vulnerable people – but only if they get access to it early.

Tedros called on Pfizer to expand access to Paxlovid by increasing the geographical scope of its voluntary licencing agreement signed with the Medicines Patent Pool (MCC) as “too many countries, including most of Latin America, cannot access the drug at the moment”. 

Pfizer’s agreement with the MPP limits the licenses to companies producing for 95 low- and middle-income countries.

Tedros also called for the price to be affordable, and the removal of contractual requirements such as indemnification and liability obligations that are hampering access.

WHO Chief Scientist Dr Soumya Swaminathan added that access to antivirals was following the same inequitable path as vaccine access had earlier in the pandemic.

Dr Soumya Swaminathan

While Pfizer was “awash” with doses, many had been pre-booked by high-income countries while generic versions produced by companies licensed by the MPP were only expected in 2023, she said.

“The available supplies should be shared more equitably through the ACT Accelerator, as we had requested for vaccines so that high-risk people around the world can have access to the drug,” said Swaminathan. 

“And secondly, the geographic restrictions that have been imposed actually need to be removed so that the generic production will eventually be able to reach across the world for people regardless of the income status.”

However, Ryan, WHO’s head of Health Emergencies, said that the summit was aimed at fixing all the problems in the supply chain system relating to COVID-10 vaccines, treatment and tests.

“We need commitment from all states to continue vaccinating and to work on vaccine hesitancy, to work on logistics, to work on the last mile and to work on cold chains to ensure that these life-saving products are actually delivered,” said Ryan.

The WHO and partners including Gavi, CEPI and UNICEF, issued an appeal on Tuesday for more funding for the ACT-Accelerator, which has only raised just over 10% its our financing needs.

True leadership needed to bring peace  

The WHO was short of $100 million to meet the health needs of Ukraine and neighbouring countries that are hosting refugees, said Tedros, who visited the country over the weekend.

“These funds will support access to essential services, including trauma care for six million people,” said Tedros.

“But what Ukraine really needs more than anything else is peace. And so again, we continue to call on the Russian Federation to stop this war.”

Tedros also accused the Ethiopian government of deliberately starving people in Tigray “in one of the longest blockades in history”, while barring journalists from travelling to the area.

“Only one convoy of 17 trucks of humanitarian assistance crossed into Tigray last week getting food and water and sanitation supplies. Current supplies of food are too little to sustain life. The health system has collapsed. People are starving to death and it is intentional,” said Tedros.

People in Yemen were experiencing food insecurity and reduced humanitarian funding related to the Ukraine conflict, while conflict in the Sahel and the Horn of Africa were also experiencing food insecurity driven by conflict. 

“Across the world, there are too many lives being lost right now due to a deep multi-dimensional crises that spiralling downward. We need true leadership across the world to work collectively for peace,” appealed Tedros.

 

Image Credits: CGTN.

The Regional Committee meeting of European Member States denounces the Russian invasion of Ukraine in a virtual session Tuesday.

By an overwhelming vote of 43 to three with just two abstentions, WHO’s European member states approved a resolution condemning Russia for its invasion of Ukraine. 

The resolution, approved Tuesday in a special session of the WHO Regional Committee of member states, is a prelude to the tough global debate that can be expected at the World Health Assembly convening on 22-28 May in Geneva. 

The resolution, co-sponsored by some 36 WHO European member states including the European Union,  “condemns in the strongest terms Russia’s military aggression against Ukraine, including attacks on health care facilities in Ukraine.”

The resolution also calls on the WHO office to consider relocating the European Office for Noncommunicable Diseases (NCDs) out of Russia.

The strong show of regional support for Ukraine was reflected by the fact that even Hungary, led by the hard-line Prime Minister Victor Orban with pro-Russian leanings, joined as a co-sponsor.

Israel, which had tried to straddle the fence in the early days of the Russian invasion due to fears over Russian recriminations via proxy forces in Syria, also voted “Yes”.  

Switzerland, while not a co-sponsor, broke ranks with its traditional position of diplomatic neutrality to vote “Yes” on the resolution – after doing so in a previous vote on a measure denouncing Ukraine at the United Nations General Assembly.  

Equally notable was the fact that Serbia, an EU candidate country with strong Moscow ties, absented itself from the vote, along with Azerbaijan. Armenia and Khazazhstan formally abstained. 

The only three countries to vote against the resolution were Russia, its military ally Belarus, and Tajikistan.  

Russia protests moves 

Russia’s Deputy Health Minister Andrey Plutnitskiy, at the European Regional Committee meeting.

Geopolitics  always has played a shadow role in WHO and with even greater vigour recently- from the US criticism of China over the origins of the COVID pandemic to the withdrawal of the United States from the WHO under the administration of former President Donald Trump. 

Smaller, but highly strategic regional scrambles also chronically shadow the deliberations – including Ethiopia’s bloody war in Tigray, the recent coup in Myanmar, and longstanding disputes over China’s claims to Taiwan and Israel’s occupation of Palestinian West Bank and Gaza. 

But against all of these, the Ukraine crisis is likely to take things to a new level in the upcoming WHA. Today’s session foreshadows what may be hours of debate and a long roll-call over the same resolution when it is considered by all 194 WHO member states. The warm-up was already evident today as Russia described the resolution’s passage as a “huge moment of harm”:  

“This resolution….  is aimed at destroying the collaboration in the sphere of health care in the European Region. It’s a huge moment of harm for the system of global health care,” said Russia’s Deputy Health Minister Andrey Plutnitskiy, protesting the decision after it was made by a lengthy roll call – a last resort in WHO meetings when member states cannot reach consensus. 

In the debate preceding the vote, he maintained that  the Russian invasion is aimed at protecting Russian-speaking minorities in the Donetsk and Luhansk regions of Ukraine where Russian-speaking populations are persecuted and health facilities had been attacked – something that Norway labeled as a “false narrative”.    

As for the conflicts broader implications, Plutnitskiy said Ukraine’s recent remarks about how the invasion is impeding vital grain deliveries and would exacerbate world food shortages “is not a topic covered by the WHO mandate.”

Ukraine’s rebuttal – delivered in Russian

Ukraine’s representative to the WHO European Regional Committee meeting – makes remarks in Russian.

Speaking in Russian, Ukraine’s representative rebutted Russia’s claims that Ukraine had been persecuting its Russian-speaking population, saying “No one is persecuting anyone in Ukraine and I will speak in Russian to be heard in Russian.

“What the Russian Federation is doing is a violation of all international normas and standards. What has been said by the deputy minister of health ofthe Russian Federation is a lie.

“You can come to Ukraine at any time and I will take you to a hospital that provides medical assistance to all who need it, including Russian military personnel who have been injured.. and ended up in our hospitals.

“But you can never go to a hospital where our captives are being held because the Russian authorities will not allow this. Just like they will not allow Ukranian humanitarian corridors to get through with medication such as insulin.””

Country after country denounces attacks and impacts on health services

France’s representative to the WHO European Regional Committee meeting, speaking on behalf of the European Union

Meanwhile, a long line-up of other member states took time to denounce the invasion, which WHO now says has included some 200 confirmed attacks on health facilities since it began in late February: 

“We are meeting here today in a state of emergency to look at the heart-wrenching consequences of the unprovoked and unjustified invade military intervention of the Russian Federation,” said France, speaking on behalf of 27 EU member states. 

“The United Kingdom stands united with partners in condemning Russia’s outrageous attack on Ukraine,” added the UK’s representative at the meeting. 

France, condemned what it described as “deliberate attacks on health care,” and cited the “devastating impact” of harm done including: “restricted or impossible access to health services for millions of people… . the impact on maternal and newborn health; on people living with HIV AIDS, prevention of treatment of NCDs for the elderly; as well as mental health.  

“This aggression also heightens the risk of emergence and spread of infectious diseases given its impact on vaccination rates, access to water sanitation, and hygiene. It also raises the risk of human trafficking, gender based violence, food insecurity and potential nuclear, chemical biological hazards.”

Said Israel’s Health Minister Nitzan Horowitz: “The Russian ongoing attack is a serious violation of international order,” adding “it has severely restricted access to medicines, facilities and health services for the Ukrainian population. The war has also disrupted vaccination campaigns. Israel is concerned about the impact this has on efforts to tackle non- communicable diseases and chronic infectious diseases such as HIV/AIDS and tuberculosis… in addition to mental health and psychological needs.”

Not about politics but about lives 

Hans Kluge at the WHO Regional Committee meeting Tuesday

WHO’s Regional Director Hans Kluge meanwhile, said that he intended to visit Ukraine this coming weekend, for the third time in as many months, “to further scale up our response.”

Against the tense political overlay of the meeting, Kluge stressed that the need to “rise above politics is stronger than ever.

“We resolved to put health at the center of the [COVID] recovery” but meanwhile, “we still have a very acute phase” of the pandemic…. 

“When we discuss and debate the real lives of real people are on the line – millions of children, women and men – and we should never lose sight of that.” 

drug control
Judy Chang, Executive Director of the International Network of People who Use Drugs (INUD) and other speakers at the Geneva Health Forum discussion on obstacles facing people using drugs during COVID-19 and the implications for health and human rights.

Policies initiated to control the COVID-19 pandemic increased the difficulties for people who use drugs when seeking health treatment, leading drug experts to conclude that treatment programmes need to be integrated into community care.

Ruth Dreifuss, former President of Switzerland and founding member of the Global Commission on Drug Policy, noted that people who use drugs were discriminated against directly during the AIDS epidemic of the 1980s and indirectly in the COVID-19 pandemic.

People who use drugs are considered a “key population” group to be targeted for treatment in the AIDS response and there is inherent discrimination in that phrase, she said. 

“The discrimination and the associated prohibition against key populations contributed to the AIDS pandemic,” she told the Geneva Health Forum’s session on Drugs and drug policies in times of Covid-19: obstacles and implications for health and human rights.

For COVID-19, however, she said the lockdown measures indirectly disenfranchised drug users.

“Lockdowns made them invisible and denied access to services. We believe the new pandemic made it difficult to keep the gains of the past 30 years,” she added.

Tensions heightened between public health and criminal injustice  

Judy Chang, executive director of the International Network of People who Use Drugs (INUD)

Judy Chang, Executive Director of the International Network of People who Use Drugs (INUD), added that policies such as the mass incarceration of people who use drugs highlighted tensions between public health and criminal injustice.

For instance, social distancing that is essential in reducing the spread of COVID-19 is in sharp contrast to mass incarceration. Harm reduction services were shut down during lockdowns, leaving no access to health and social services for drug users, said Chang.

Drugs also increased in price and were reduced both in quality and quantity. 

“Authorities had no idea of what to do with people who use drugs during a pandemic,” said Chang. 

With lockdowns and other forms of movement restrictions forming the initial core of the global COVID response, global health players are now increasingly leaning towards prioritizing strengthening community-led approaches.

Earlier, Health Policy Watch reported that The Global Fund now sees integrated health systems as key to preparing for future pandemics. 

Naomi Burke-Shyne, Executive Director, Harm Reduction International

This also holds true for harm reduction interventions targeting drug users. Naomi Burke-Shyne, Executive Director of Harm Reduction International, noted that identifying harm reduction as an essential social service is crucial for stakeholders developing drug policies to ensure they are applicable in pandemics.

“These conversations are so interesting because we can look at policy in terms of how harm reduction services can benefit from stepping up community leadership,” she added.

Pandemic gains in Switzerland and Prague

Daniele Zullino

But in the wake of the COVID-19 pandemic, Switzerland’s drug policy reform crusaders achieved gains they’d been requesting for about 20 years, according to Professor Daniele Zullino, from the Division of Addictology at Geneva University Hospitals’ Department of Psychiatry.

“Regarding physical visitation, we were able to negotiate with the Federal Office of Public Health to reduce this from twice daily to once weekly. There is now a realisation that the over-incarceration of people who use drugs is fuelling this pandemic and other pandemics,” he said.

Pavel Bém, former mayor of Prague and a member of the Global Commission on Drug Policy, said that the Czech government also came to understand that its initial COVID-19 law that directed citizens and residents to stay at home with their families could not be obeyed by homeless drug users who had no relatives.

“We’ve seen the flexibility of civil societies and movements, and the emergence of new services including provisional outdoor shelters for homeless people using substances,” he said.

Doctors are also now treating drug users via online consultations and they are now providing comorbidity services for clients. 

Pavel Bém, former mayor of Prague

There is also the introduction of street medicines that benefits homeless drug users in the country.

“I’m aware of the negative effects of this crisis but I’ve seen enormous progress,” he said.

Next steps

Antons Mozalevskis, Technical Officer for Key Populations at WHO’s Global HIV, Hepatitis and STI Programmes, said the global drug problem will need to be addressed “in a more unison way via collaborations with relevant organizations”.

Chang asked the global health body to step up and take a leading role that enthrones evidence in the enactment and update of drug policies.

She noted that drug use is complex and multifaceted, and the billions of dollars spent on the drug war are multiple times more than what is spent on harm reduction services. While governments send drug users to prisons, harm reduction services in prisons are still lagging behind.

She also called COVID-19 an “opportunity for community-led engagement.”

“Relying on health systems is not enough. Look at health within the bigger frame of dignity. COVID exposed the rigidity and lack of flexibility in health systems. We should not rollback progress made with COVID but see it as an opportunity to move forward,” she concluded.

Image Credits: Paul Adepoju/HPW.

Midwife vaccinates a man during a COVID-19 vaccine campaign in Madagascar.

A third shot of the Pfizer mRNA COVID-19 vaccine boosted vaccine effectiveness against infection, which had been diminished five to six months after the second vaccine dose, according to a study of over 12,000 healthcare workers released this week by Nature.

The study was conducted in Israel by Sheba Medical Center and involved 12,413 health workers (HCWs). It was released on the heels of an earlier report by a separate research team at Ben-Gurion University who reported in Science of the Total Environment that, based on wastewater sampling, they predict a resurgence of the Delta variant and reports in the US media that the Centers for Disease Controls and Prevention is anticipating a COVID-19 surge in the winter.

South Africa also appears to have entered a fifth COVID wave, reporting a sustained rise in infections in recent weeks. Only 31% of the South African population is fully vaccinated, according to Our World in Data – and nearly all of those only with two doses.

The report is the first to present real-world data on vaccine effectiveness, safety and immunogenicity within a large cohort of HCWs in a large tertiary center. However, conducting the study among HCWs means that it does not represent the general population.

Immunogenicity of third Pfizer vaccine

The Sheba team assessed immunogenicity, vaccine effectiveness and safety of the third Pfizer dose in a prospective cohort study of healthcare workers, which it has been tracking since the onset of the country’s vaccination campaign in December 2020.

The study found that anti-RBD immunoglobulin G (IgG) levels were increased 1.7-fold after a third dose compared with following the second dose; avidity increased from 61% to 96% – a 6.1-fold increase in neutralization tithers; and that there were 1.1 breakthrough cases per 10,000 days in the three-dose cohort versus 5.8 per 10,000 days in the two-dose cohort.

No serious adverse effects were reported in either case.

Specifically, in the first arm of the study, researchers assessed serological tests of samples from vaccinated HCWs at three different points and compared them: after they received the second dose, before receiving the third dose and after receiving the third dose.

Of 4,526 HCWs who were eligible for this part of the study, 1,047 serum samples from pre- and post-third dose time posts were evaluated. A 31-fold increase in IgG and neutralizing antibodies was observed after the third vaccine dose compared to after receiving the second dose and a 41-fold increase after the third vaccine dose compared to immediately before – five to six months after the second vaccine.

There was also a minor but significant increase in T cell activation, the study showed.

Secondly, the team compared antibody levels of breakthrough cases following the third vaccine dose compared to matched, non-infected controls.

“To investigate any added effect of the third vaccine dose on humoral response, we compared IgG and neutralizing antibodies at their peak levels following the second vaccine dose to that of the third dose,” they wrote in their paper.

“IgG and neutralizing antibody results were available for 3,477 and 664 HCWs, respectively, after the second vaccine dose and for 1,232 and 692 HCWs after their third vaccine dose. A linear mixed model was used to examine the differences in immunogenicity across age, sex and number of comorbidities, comparing post-second dose IgG levels and neutralizing antibody titers. The estimated geometric mean titer (GMT) for IgG following the second dose, in binding antibody units (BAUs), was 1,586 (95% CI, 1,458–1,709), and for IgG following the third dose, it was 2,745. Thus, a 1.7-fold increase in IgG levels occurred after the third dose in comparison to after the second dose.

“Neutralizing antibody levels after the second and third vaccine doses were 646 and 3,948, respectively. The neutralizing titer after the third dose was thus 6.1-fold greater than that of the second dose,” they concluded.

Finally, in a third arm, Sheba compared COVID-19 infections among HCWs with two vaccines given at least five months previous compared to those who received three doses. There was data available for 12,290 individuals who had not been previously infected and were eligible for a third shot. In total, 407 HCWs tested positive for COVID-19 via a PCR test: 368 in the two-dose cohort and 39 in the three-dose cohort.

“After adjustment for gender, age and time (weekly period), estimated vaccine effectiveness against PCR-confirmed infection regardless of symptoms of the third dose relative to two doses was 85.6%,” the team wrote.

The safety arm, in which adverse events among those vaccinated with the third dose were assessed via electronic questionnaire resulted in no difference from a second shot.

The study was conducted when the Delta variant was dominant in Israel, and the researchers highlighted that the results could change with other variants of concern. Nonetheless, they said, “our immunogenicity data can be of great importance once vaccine penetration and correlates of protection levels are determined.”

Image Credits: Samy Rakotoniaina/MSH, ABC7 News.

Pro-abortion protests have erupted in the US.

The global anti-abortion movement will get a boost if the US supreme court dismantles the 1973 landmark court case, Roe v Wade, that legalised abortion – but bans are ineffective in stopping abortions, succeeding only in making them unsafer.

“Any regression in protection of the right to abortion would not only stand to damage the global perception of the United States; it would also set a terrible example that other governments and anti-rights groups could seize upon around the world in a bid to deny the rights of women, girls and other people who can become pregnant,” said Agnès Callamard, Amnesty International’s Secretary-General.

Callamard added that even predominantly Catholic countries like Argentina, Ireland, Mexico and Colombia had decriminalised and legalised abortion, but there “are grim signs that the US is out of step with the progress that the rest of the world is making in protecting sexual and reproductive rights”.

Colombia legalised abortion until 24 weeks of pregnancy in February, Mexico’s supreme court decriminalised abortion last year, while Argentina legalised abortion in 2020, and Ireland in 2019. There are signs that Chile and Brazil might also open access to abortion. 

However, Catholic Poland restricted access to abortion in 2020. And if Roe v Wade is overturned, US women and girls in states that do restrict abortion will be in a similar position as women in most countries in Africa, the Middle East, Latin America and South-East Asia.

World Population Review

Nearly half of all pregnancies, totalling 121 million each year, are unintended, according to the State of World Population 2022 report, released last month by UNFPA, the United Nations sexual and reproductive health agency.

Over 60% of unintended pregnancies end in abortion and an estimated 45% of all abortions are unsafe, accounting for five to 13% of all maternal deaths recorded, according to the report. 

A 2020 Lancet study found that unintended pregnancies in high-income countries were 34 pregnancies per 1000 women, 66 pregnancies per 1000 women in middle-income countries and 93 pregnancies per 1000 women in low-income countries.

Yet attempts to ease restrictions on abortion – even when a pregnancy threatens the health of a woman or girl or it was the result of rape – face fierce opposition in poorer countries, often with the support of the same US rightwing Christian evangelical and Catholic groups that have mobilised against Roe v Wade.

These anti-abortion organisations are also often against contraception, comprehensive sexuality education for children and LGBTQ rights.

Malawi in sub-Saharan Africa, is an example. It has a high maternal mortality rate, and an estimated 6-18% of these deaths are the result of unsafe abortions. But when Members of Parliament tried to introduce a Bill to expand access to abortion in 2020, US-based Catholics sponsored campaigns to stop this.

US global funding under threat?

 The US is a major global funder of sexual and reproductive health (SRH) services – but the Helms Amendment has prohibited any US foreign aid for abortion since 1973. 

But US support for SRH tends to yoyo widely, depending on which party is in power.

In 1984, Republican US President Ronald Reagan introduced what has become known as the global gag rule, which outlawed US funding to any non-governmental organisations that provide abortions, information, counselling, referrals or advocacy.

While every US Democratic Administration has rescinded the gag law when coming into power, the huge policy swings have badly affected sexual and reproductive services in countries that are dependent on foreign aid as they are unable to maintain consistent services. 

The anti-abortion movement was massively boosted during the Trump Administration, with key posts going to officials that opposed abortion – and this momentum also propelled the Trump appointment of anti-abortion supreme court judges who are due to strike down Roe v Wade.

The Trump administration’s anti-abortion stance was a point of commonality with Russian arch-conservatives.

In October 2020, two weeks before the US election where it was ousted, the Trump Administration mobilised 34 of the world’s most conservative countries to support the Geneva Consensus Declaration.This declares that “there is no international right to abortion, nor any international obligation on the part of states to finance or facilitate abortion”.

Egypt, Uganda, Brazil, Hungary and Indonesia co-sponsored the declaration, which was also signed by Russia, Belarus, ​​Democratic Republic of Congo, Iraq, Libya, Pakistan, South Sudan and Sudan.

While Trump’s defeat has taken the wind out of the Declaration, it has provided a rallying platform for anti-abortion countries – supported by a host of conservative largely US-based Christian organisations.

The arch-conservative Catholic organisation, Ordo Iuris, based in Poland appears to have taken over co-ordinating the Declaration and activities seem to have dried up since Russia’s war in Ukraine.

However, the removal of abortion rights in one of the biggest democracies in the world is already galvanising right-wing groups opposed to abortion who are poised to enjoy their biggest victory in decades.

Image Credits: Gayatri Malhotra / Unsplash.

Dr John Nkengasong at one of the weekly Africa CDC media briefings that became a centrepiece of African Union response during the COVID pandemic.

African leaders have applauded the US move to appoint John Nkengasong as head of the U.S. President’s Emergency Plan for AIDS Reliefs (PEPFAR) – saying he’ll reinvigorate the programme that has been a flagship for the global battle against the AIDS pandemic for nearly decades. 

But they also said the loss of Nkgengasong as head of the African Union’s Centers for Disease Control (Africa CDC), would be a blow to the Organization that he built from a virtual unknown into a full-fledged AU health agency during his five-year tenure. 

“The reward for good work is more work. Our ‘loss’ is the ‘world’s’ gain,” said Ifedayo Adetifa, Director-General of the Nigeria Centre for Disease Control (NCDC), reacting to Nkengasong’s Senate confirmation.

Prof Christian Happi, Director of the African Center of Excellence for the Genomics of Infectious Diseases (ACEGID) said the HIV/AIDS ecosystem is now “looking forward to a more impactful PEPFAR” under Nkengasong’s leadership.

Nkengasong will “bring immense skills to the important challenge of ending AIDS”, added Charlotte Watts, Chief Scientific Advisor, UK Foreign Commonwealth and Development Office.

But Aggrey Aluso Odhiambo, Health and Rights Program Manager at the Open Society Initiative for Eastern Africa, also lamented the loss to Africa CDC – attributing its meteoric rise on the public health scene to Nkengasong’s transformative leadership. 

“I hope your successor will sustain the Africa CDC vision of an African new public health order,” he said.

Long road to finding an Africa CDC replacement 

Nkengasong before the US Senate during hearings on his PEPFAR nomination.

Nkengasong’s appointment reflects his “public health statesmanship and technical coordination of the African Union’s response to the COVID-19 pandemic as head of the Africa CDC, said  Moussa Faki Mahamat, Chairperson of the African Union Commission. 

The Africa CDC experience “will stand him in exceptionally good stead as he gears up to lead PEPFAR,a key programme in fighting the global HIV/AIDS pandemic,” Mahamat added. 

During the pandemic, Nkengasong became the public face of Africa’s response to a wave of crisis on the continent – beginning with woefully inadequate access to basic PPE for doctors and nurses to be followed by the dire shortage of vaccines on the continent – the most severe anywhere – in the initial months of vaccine rollout.  

Now, as the focus shifts to the longer-term tasks associated with rebuilding health systems and routine services, Nkengasong’s departure will leave a gap, his colleagues acknowledge, that will be difficult to fill.  The search for his replacement is expected to take several months. 

Confirmation last Thursday 

The US Senate last Thursday confirmed Nkengasong by voice vote to head PEPFAR with the title of “Ambassador at Large, Coordinator of United States Government Activities to Combat HIV/AIDS Globally”. 

“HIV/AIDS remains a serious threat globally,” he tweeted following the Senate confirmation, describing PEPFAR as a “hugely impactful” programme.

Nkengasong’s PEPFAR leadership journey officially began on 4 January 2022 when his nomination was officially received in the Senate and was referred to the Committee on Foreign Relations.

On March 15, the committee held a hearing, the outcome of which was favourable; that paved the way for the Senate’s consideration and confirmation. 

With his exit from Africa CDC imminent, he told Health Policy Watch in March that the next priorities for Africa CDC should be leveraging gains made during the period of COVID-19 response to further strengthen systems across the African Union’s 55 member states, so as to also be better positioned to fight future pandemics. 

“The continent has been extremely innovative in developing platforms that are continuously being used to fight this COVID pandemic, but we need to focus our energy on developing them to fight other diseases,” he said.

PEPFAR’s long history of involvement in Africa 

PEPFAR has a long history of involvement in Africa, dating back to its inception in 2003 by the late president George W Bush, at the height of the HIV/AIDS pandemic. Africa, as the pandemic epicenter at the time, also became the biggest beneficiary of PEPFAR investments, which globally amount to over $100 billion to date. The plan claims it has saved 21 million lives, prevented millions of HIV infections, and is now supporting countries end the HIV epidemic altogether – all while significantly strengthening global health security.

In Nkengasong’s opening testimony before the US Senate on Tuesday, March 15, 2022, the Cameroonian-born virologist who also holds US citizenship, said he will draw upon his three decades of experience with research and public health to advance PEPFAR’s mission.

“If confirmed, I would be stepping into this role at a critical moment when the world is confronted with dual global pandemics.  We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results. But we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response,” he told senators.

PEPFAR under Nkengasong – integrated health systems approach

As Director of the Africa CDC, Nkengasong underlined that PEPFAR’s investments in health systems over the past 19 years helped strengthened—and in some cases, helped establish—the fundamental health infrastructure, including laboratories, surveillance systems, and human resources, in the countries it supports. 

While previous HIV prevention, treatment and control efforts were premised upon building ‘vertical’ systems as semi-independent entities, the goal has now shifted, Nkengasong also said. PEPFAR’s future efforts must now ensure that these HIV services and systems are well integrated into national health systems, sustainably financed, and resilient to respond not only to HIV/AIDS but also other diseases.  

“For this to happen, it is my belief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspectives and needs, taking account of their insights, their knowledge of local contexts, and their reservoirs of expertise. 

For such systems to be sustainable and keep infectious disease in check, we must act collectively to support the capabilities of local leaders and regional institutions and work in respectful partnership and accountability with them,” he said.

See our previous Health Policy Watch story on Nkengasong and Africa CDC here: 

Nkengasong’s PEPFAR Prospects and Hopes for Africa CDC 

 

Image Credits: Paul Adepoju.

Dr Tedros visited Kyiv in Ukraine over the weekend.

Russia’s war on Ukraine and its impact on healthcare in the region is the focus of a special session of the World Health Organization (WHO) Europe on Tuesday, as the latest figures show over 200 verified attacks on health facilities.

Ukraine, backed by 38 other member countries including Germany and the UK, requested the session to discuss the attacks on health facilities, the disruption of healthcare including routine vaccinations, the impact of the war on healthcare in the region strained by refugees, and the danger of radiation and chemical events.

Also on the table at the session is a resolution to sanction Russia, a member of WHO Europe, for its attack on Ukraine. This is may result in the relocation of the WHO’s European Office for the Prevention and Control of Noncommunicable Diseases from Moscow, which has been requested by the Ukraine health ministry.

Over the past three days, WHO Director-General, Dr Tedros Adhanom Ghebreyesus and WHO head of health emergencies, Dr Mike Ryan, have been in Ukraine, where they handed over 20 all-terrain ambulances, generators and blood refrigerators to the country’s Deputy Health Minister, Iryna Mykychak. 

Addressing a media briefing on Sunday weekend, Ryan described “intentional attacks on healthcare facilities” as war crime, adding that he trusted that the United Nations and the International Criminal Court was investigating all transgressions.

 

Tedros also met with other senior government leaders to assess the current health needs in Ukraine and visited health facilities damaged during the war.

“WHO is committed to supporting people in Ukraine in accessing much-needed health services. The donation of 20 ambulances will bring lifesaving care as Ukraine’s health services have been significantly stretched and access to health care remains a challenge for many people,” said Dr Jarno Habicht, Head of the WHO Country Office in Ukraine. 

“One of the health workers we spoke to remembered how during the days of constant shelling in their city, ambulances continued to operate even during curfew to ensure people received the care they needed. We are inspired by the bravery of Ukrainian health workers and hope this donation will contribute to their work.”

“Due to the severe disruption to the Ukrainian health system, including routine immunization activities, there are serious concerns about possible infectious disease outbreaks, including measles outbreaks,” the WHO said in its latest situational report on the crisis.

G7 leaders also resolved over the weekend to impose further sanctions on Russia, including phasing out or banning the import of Russian oil. The US also announced further measures against Russian oligarchs and Russia’s gas company.

Meanwhile, Canadian Prime Minister Justin Trudeau visited to Ukraine on Sunday and met with President Volodymyr Zelenskyy, while US First Lady Jill Biden visited mothers and children to express her solidarity on Mother’s Day.

The Ukrainian war unexpectedly disrupted Monday’s meeting of the World Intellectual Property Organization (WIPO), due to discuss the impact of COVID-19 on various sectors. Numerous delegates walked out of the meeting after Russia claimed it was acting against genocide in Ukraine.

Earlier, Russia had started the meeting by condemning “Nazi activity”, prompting condemnation from Australia, Japan, the US, European and Baltic states –  and an appeal from China for all countries to respect each other’s sovereignty and avoid conflict.

 

 

 

 

 

 

Image Credits: WHO.

WHO Director-General Dr Tedros Adhanom Ghebreyesus speaking at a US press conference in Washington DC. on 7 April, after a series of recent meetings with the US Administration of Joe Biden.

A new WHO White Paper on strengthening Health Emergency Preparedness and Response supports the creation of a “Global Health Emergency Council” under WHO auspices and some “targeted amendments” to existing International Health Regulations governing emergencies.

However, the new White Paper, issued under the name of WHO Director General Dr Tedros Adhanom Ghebreyesus, also avoids taking a clear position on specific elements of reforms to the IHR rules – batting the issue back to member states.

Reform to the IHR rules, which the White Paper describes as “still too slow” to be effective in pandemics, appears to be shaping up as a key issue for debate at the upcoming World Health Assembly, which meets at the end of the month. 

The IHR reforms are seen as the most immediate answer to some of the failures of the COVID-19 pandemic – pending the negotiation and adoption of a new Pandemic treaty, convention or other legal instrument, which will take at least two years, followed by a ratification process. 

The United States is pushing for rapid adoption by the WHA of a proposal for a series of targeted IHR amendments, introducing more time-bound requirements for reporting outbreaks, and greater transparency. 

The US proposal for amended IHR rules would set tight, clear timelines for member states to report suspicious pathogen outbreaks to WHO, and for WHO to report those onwards to other member states and the public. However, it’s unlikely that China and Russia will readily agree to the US proposal – due to the threats they perceive to their sovereignty. 

United States already tabled pinpoint edits to the IHR 

(left) World Health Organization Headquarters in Geneva (right) White House in Washington, DC.

Since US President Joe Biden took office, WHO’s relationship with the US administration has vastly improved, as evidenced by Tedros’ recent trip to Washington D.C., followed by the recent breakthrough agreement to increase fixed, annual member state contributions to WHO – supported by the US.

However, the Director General still must continue to balance the relationship with Washington against the countervailing pressures of other member states.  So a proposal to streamline the IHR reform process, without endorsing specific reforms, may be the best way out for him.

Similar tensions also are evident, reading between-the-lines of the zero draft report by the WHO member state Working Group on Pandemic Preparedness and response – published just a day before the White Paper.  The Working Group report suggests that tough questions on IHR reforms could still be punted down to the autumn, at least. 

The member state draft suggests that an  IHR “Review Committee” might be set up by the WHA to consider a range of member state reform proposals – implying that beyond the United States, other nations are also in the process of drafting plans for IHR reform. The Working Group would then report back by October – with a hoped-for clear set of proposals for IHR overhaul. 

Both the WGPR and DG reports are labeled as “Zero Draft” and “Consultation Draft” respectively, indicating their wide-open nature.  Both contain a much longer laundry list of reform items, ranging from thorny questions around access and equity to more action on “One Health” and global health security, suggesting that it’ll be at least several weeks until it becomes clear what shape and direction talks take at the WHA.  

Director General text proposes “streamlined process on IHR amendments”  

The World Health Assembly meets 22-28 May in Geneva, Switzerland.

In terms of IHR reform, the Director General’s proposal for a streamlined process of creating amendments to the existing IHR says the following: 

“The inherent tension between the aim to protect health and the need to protect economies by avoiding travel and trade restrictions has been noted by the IHR Review Committee and the IPPPR [Independent Panel on Pandemic Preparedness and Review] as the most important factor limiting compliance with the IHR,” the Director General’s report notes, referring to two independent  reports on pandemic response, highly critical of WHO’s performance as well as of the IHR’s shortcomings, that were issued last year.

Adds the Director General’s White Paper:  

“In addition, too many countries still do not have sufficient public health capacities to protect their own populations, and to give timely warnings to WHO; the global alert system is still too slow; and the current self-reporting mechanism on the implementation of core capacities lacks incentives for compliance with the IHR. The absence of a Conference of the Parties for the IHR is an overarching limitation in their effective application and compliance.” 

“But to build further trust and strengthen global governance for health emergencies, amending certain articles of the IHR, while strengthening their implementation, is necessary. Such targeted amendments should make the instrument more agile and flexible and should facilitate compliance with its provisions,”

A related issue is the need to streamline the process to bring IHR amendments into force, which at present can take up to two years. Ensuring that the IHR can be efficiently and
effectively amended to accommodate evolving global health requirements is key to their continued relevance and effectiveness.

“A targeted amendment to achieve this streamlining has been proposed and is currently being discussed informally. The approval of this proposal at the 75th World Health Assembly will contribute substantially to ensuring that the IHR remains a foundational and relevant global health legal instrument.”

Working Group hedging bets 

Chinese delegate at the virtual World Health Assembly in May 2020: geopolitical tensions will likely make consensus on IHR a challenge at this year’s 2022 Assembly.

The Working Group text, meanwhile, suggests a flexible time-frame for reaching consensus on IHR reforms, stating that it: “Supports the Health Assembly continuing with an inclusive Member State-led process on amending the IHR (2005)… and proposes the following approach for adoption by the Seventy-fifth World Health Assembly”: 

“(a) Decision adopted by Seventy-fifth World Health Assembly that, in overview: – adopts any amendments to the IHR ready for adoption (if any); – agrees a Member State process to convene between the Seventy-fifth and Seventy-sixth World Health Assemblies to take forward work on all proposed IHR-targeted amendments; and – invites the Director-General to convene an IHR Review Committee to make technical recommendations on the proposed amendments referred to in subparagraph (b) below, with a view to informing the work of the Member State process. 

“(b) Proposed amendments to be submitted by 30 June, 2022. All such proposed amendments will be distributed by the Director-General to all States Parties without delay. (c) An IHR Review Committee to be established by the Director-General in accordance with Article 50(1)(a) of the IHR, with particular attention to be paid to the fulfilment of the letter and spirit of Article 51(2). 

“(d) The Member State process, to be convened no later than September 2022, should be aligned with the INB process, as both the IHR and the new instrument are expected to play central roles in pandemic PPR in the future. 

(e) The IHR Review Committee to submit its report to the Director-General by October 2022, with the Director-General transmitting it without delay to the Member State process. The Director-General will also communicate the report to the Executive Board at its 152nd session, in accordance with Article 52(3) of the IHR Independent Panel review.” 

Global Health Emergency Council under WHO leadership

Helen Clark, Co-Chair of the Independent Panel for Pandemic Preparedness and Response, which had proposed a Global Health Threats Council, under the UN General Assembly auspices.

The proposal for a Global Health Emergency Council under WHO auspices, complemented by a World Health Assembly Emergency Committee, is another key element of the Director-General’s White Paper Plan.

It’s clearly intended to head off the creation of a similar body under the UN General Assemnly Secretariat and/or G7 auspices, as had been proposed last year by The Independent Panel report and in some other fora.  

“Several panels have proposed the establishment of a high-level council on global health emergencies, comprising heads of state and other international leaders,” states the Director General’s White Paper.  

“WHO supports this concept and proposes the establishment of a Global Health Emergency Council, linked to and aligned with the constitution and governance of WHO, rather than creating a  parallel structure, which could lead to further fragmentation of the global architecture of HEPR.” 

Unlike IHR reform, the WHO White Paper clearly “puts the WHO foot down” against the creation of other additional structures outside of the Organization that have at times been proposed, one diplomatic observer told Health Policy Watch.

The WHO White Paper does, however, support the creation of a joint WHO and World Bank-managed Financial Intermediary Fund (FIF) as a standing mechanism for funding countries’ pandemic preparedness and response needs.

A number of countries, led by French and Germany, also have supported the idea of linking the funding mechanism to a new peer-review process by member states of countries’ pandemic planning, called a “Universal Health and Preparedness Review (UHPR).

The UHPR initiative is seen as a way of reinforcing the linkage between a country’s real preparedness status and its eligibility to compete for certain types of financial support.

“It’s very interesting as an idea, but not everyone wants to have this clear linkage between reforms and funds dispersed and this peer review process,” the observer said.

Overall, however, the White Paper, “is very broad, but it has the merit that it brings together the points made by the various reform panels, for a more structured discussion of what is doable or not,” the observer added.

“Clearly some proposals are more consensual that others, but at least it’s a good point of departure.”

Image Credits: WHO/P. Virot & LoC/Carol Highsmith, WHO, UNAIDS/Twitter.