As Uganda’s Ebola Death Toll Rises, New Site Improves Testing Turnaround Times 07/10/2022 Paul Adepoju Health workers in full protective gear to treat Ebola patients,. Four health workers have already died in the Ebola outbreak in Uganda and, while rapid tests are still not available, authorities have managed to cut the testing turnaround time from 24 to six hours, according to the World Health Organization (WHO) Africa region and Africa Centres for Disease Control. Meanwhile, the US is routing all citizens who have been in Uganda in the 21 days before their arrival to five US airports – New York, Newark, Atlanta, Chicago or Washington – for “enhanced screening”, the US Embassy in Uganda announced on Thursday. At separate briefings on Thursday, the WHO AFRO and Africa CDC attributed the shortened testing time to the establishment of a new test facility at the epicenter of the outbreak that is capable of conducting real-time polymerase chain reaction (RT-PCR), as well as the availability of more testing reagents. However, the genomic sequencing data available at present has not yet enabled health authorities to identify origin of the disease or Patient Zero. The outbreak was declared on 20 September, but public health experts suspect that it started in early September, several weeks before the first confirmed case was seen at a government health facility. As of 5 October, the WHO reported 63 probable cases and 29 deaths. Ten health workers are confirmed infected, for of whom have died. Dr Yonas Tegegn Woldemariam, WHO Representative in Uganda, reported that about 77% of the listed contacts have been reached. “I believe we are proceeding fast in responding to this disease outbreak. We started with three districts but it has now gotten to two additional districts but we relate these new district cases to the original districts where either a health worker or a positive case have had contact with original cases,” said Woldemariam. Initially, samples were being sent to the Uganda Virus Research Institute (UVRI) which is 160km from the epicenter of the outbreak, but the new on-site laboratory facility. “I am positive that we could control this in reasonably good time,” he said. Uncertainties remain At the WHO AFRO press briefing on Thursday, Professor Pontiano Kaleebu, director of the Medical Research Council at UVRI, said that the current strain “is the nearest to the Ebola virus we had here in Luweero (an agro-pastoralist district in central Uganda) in May 2011. It is very close to that strain but there are few mutations in the virus.”. While the virus was first identified in Sudan, it has since spread and Uganda has had at least two previous outbreaks. Kaleebu admitted that the sequencing data was not sufficient to convincingly identify the index case or the origin of infection. “Doing that will require an extensive multidisciplinary approach that involves everyone including ecologists. This is already underway and we will be looking at the whole picture to identify connections. But we need to also be aware that if the index patient has died and was not tested, we may not be able to specifically pinpoint that case,” Kaleebu told Health Policy Watch. Meanwhile, a range of organisations is assisting Uganda to respond to the outbreak, including Medicins sand Frontieres, which has set up an isolation facility in the Mubende district. Highly impressed with the new Ebola Isolation facility put up by @MSF at Madudu HC III in response to #EbolaOutbreakUG in Mubende District. Thank you MSF, @UNICEFUganda, @WHOUganda, @USAIDUganda, @CDCgov and all other partners for a great job done. MSF, you rock! pic.twitter.com/h8BznDboNC — Dr. Jane Ruth Aceng Ocero (@JaneRuth_Aceng) October 6, 2022 Image Credits: Naomi Nolte IFRC emergency communication coordinator. Launch Event: Self-Care Readiness Index 2.0 06/10/2022 Editorial team The second iteration of the Self-Care Readiness Index (SCRI) will be released later this month during the Global Self-Care Federation World Congress 2022. Self-Care Readiness Index 2.0 The congress takes place on the 19th and 20th of October 2022, in Cape Town, South Africa. The Self-Care Readiness Index 2.0 builds on the 2021 report, analysing another 10 countries to provide an even more in-depth understanding of the state of healthcare and self-care around the world. The Congress will touch on a wide variety of self-care and healthcare related topics and will be joinable both in person and remotely. The Index will be presented alongside a discussion on Redefining the Global Self-Care Agenda, featuring remarks from Judy Stenmark, Director General of the Global Self-Care Federation (GSCF), Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J, Sarah Onyango, Secretariat Director at Self-Care Trailblazer Group and Mario Ottiglio, Managing Director of High-Lantern Group, and will feature contributions from key global actors in the health arena. The discussion will be chaired by Dr Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health, South Africa, and Alain Main, former Chairperson of the Global Self-Care Federation (GSCF). Opening remarks will be given by Dr Princess Nothemba (Nono) Simelela, Assistant Director-General for Family, Women, Children and Adolescents at WHO. Healthcare professionals, policymakers, health economists, regulators, academia, media and other parties interested in discourse around self-care and reforming the healthcare system are invited to attend the event on the 19th of October at 8:30am SAST, which will include a moderated panel discussion and questions and answers from the audience. “The SCRI shows us that self-care is practiced differently and is included in healthcare systems a variety of ways around the world,” Stenmark said. “But despite these differences, similarities abound – notably around the fundamental benefits brought to individuals, providers, and wider healthcare systems. Self-care cannot be ignored any longer – it is a hugely beneficial part of healthcare for all actors.” The Index serves as a research and policymaking tool that explores key enablers of self-care in support of designing a better model for healthcare systems overall. The creation of the Index is spearheaded by the Global Self-Care Federation but is also supported by the WHO as part of a broader three year collaboration. Self-care remains an emerging topic amongst healthcare discourse – in both national and international conversations. The Index helps to close the current knowledge and practice gap, as well as reinforcing the overall need to adopt self-care globally to facilitate the achievement of Universal Health Coverage and greater health of the world’s population. “No matter how we see it included, the benefits remain clear,” Stenmark added. “Self-care needs to be an integrated part of every healthcare system.” The SCRI 2.0 launch event will be livestreamed via GSCF’s YouTube channel and open for all global attendees to join. Image Credits: Global Self-Care Federation . Entrenching Equity in a Future Pandemic Treaty 06/10/2022 Kerry Cullinan Equity of access to medicines for the world’s most vulnerable groups is key to a pandemic treaty. While there is unanimous agreement that equity is the essential ingredient in any future pandemic treaty ‘recipe’, World Health Organization (WHO) member states are unclear about how can it be incorporated practically. This emerged from an informal consultation on how to “operationalise and achieve” equity convened on Wednesday by the WHO intergovernmental negotiation body (INB), which has been charged with shaping the treaty or instrument to pandemic-proof the world. It is the second of four informal consultations planned before the INB reconvenes in December to negotiate a draft agreement to be presented to member states. The first focused on legal issues, while the third – taking place on Friday – will consider the thorny question of intellectual property. The fourth, on 14 October, will consider “One Health”. Poor countries fighting for crumbs Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University Expert panellists sketched the all-too-familiar picture: WHO member states in poorer countries being unable to get access to vaccines, personal protective equipment (PPE) and other essentials at the height of the COVID-19 pandemic. Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University said that her country had the highest per capita COVID deaths in the world. “Even though we had the economic resources, what was really tragic and dramatic was the fact that we could not access any of the products that were needed as an emergency,” said Garcia. “I’m talking about PPE; and we only had access to vaccines very late, which means that a lot of people died, when in other countries vaccines were already available.” Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance, said that the number one equity measure in a “binding treaty” should be to ensure manufacturing capacity across all regions. “Countries and all groups must ensure that, as well as quickly detecting and responding to threats together, the key medical countermeasures – PPE, diagnostics, treatments, and vaccines – are manufactured and shared equally,” said Alakija. “We have to take this opportunity to enshrine rules and procedures so that all lives are treated equally, not just those in the global North. “We cannot end up in a situation where rich countries are able to gobble up supply and poor countries are left fighting over crumbs, as we did for much of 2021.” Resources for developing country manufacturers Mohga Kamal-Yanni, senior health advisor for the People Vaccine Alliance, said that the WHO had produced an equitable access framework in 2020, before there were vaccines, which showed which parts of the population should be prioritised once there were f vaccines, starting with health workers globally. “It was supposed to be health workers across the whole world, but what happened is that the framework was used within countries, but not across countries,” said Kamal-Yanni. “Rich countries did not look at this globally, they looked at it nationally. So, in fact, you can define equity and you can actually put up practical mechanisms to help ensure equity, but, how do you implement it? How do you get the political will for it to be implemented?” Rajinder Kumar Suri, CEO of the Developing Country Vaccine Manufacturers Network (DCVMN), said that one of the most critical challenges during COVID-19 was funding. “It is of utmost importance to create innovative financial mechanisms and organise funds in advance to avoid any such a reoccurrence,” said Suri, who represents 42 manufacturers. Suri also pointed out that, although there was $5.6 billion available for product development, only 5% was allocated to the developing country vaccine manufacturers. “But when we look at the total production volumes, almost 60% of the global production was contributed by developing countries,’ said Suri. MSF Access Campaign senior legal and policy adviser, Yuanqiong Hu Yuanqiong Hu, senior legal and policy advisor for Medicins sans Frontieres (MSF) Access Campaign highlighted barriers to access to vaccines – including the liability agreements manufacturers required all countries to sign that slowed down access. “The lack of true international solidarity, collaboration and collective vision about how the future of equity issue can only be addressed politically,” she added. Some of the “enforceable mandatory measures” that MSF suggests for entrenching equity include ensuring that life-saving medical products – vaccines, therapeutics, diagnostics and other tools – are developed, produced and provided as “global public goods”. “We think there should be clear and enforceable mechanisms to establish obligations for member states and to regulate and behaviours of private and public sectors,” she added. At the end of the consultation, INB co-chair Precious Matsoso highlighted some of the other points made by panellists and member states, including the importance of considering “existing instruments” – a number of people felt that the International Health Regulations could be adjusted to meet the challenges of future pandemics. “We need a binding, pragmatic document that commits countries to work together, meaning we need to push for collaboration in a responsive and cost-effective way,” Matsoso concluded. Image Credits: Peter Biro/EU Civil Protection and Humanitarian Aid. WHO’s African mRNA Hub to Begin Animal Trial on COVID Vaccine 05/10/2022 Megha Kaveri Lab technicians at Afrigen, a Cape Town firm that is part of the WHO mRNA Vaccine Hub in South Africa. The mRNA Vaccine Technology Transfer Hub in South Africa will start animal studies on its first COVID-19 vaccine candidate in October, a senior World Health Organization official said Wednesday. If all goes according to plan, human clinical trials will begin towards the end of 2023. “We did start this (mRNA vaccine hub) with a longer term view, beyond COVID-19. The idea was not to come up, necessarily, with a vaccine for COVID-19 though that would be a proof of principle. But it is going to take time,” World Health Organization (WH)O Chief Scientist Dr Soumya Swamination said at the global health body’s weekly media briefing. The WHO’s ambitious project is hosted by the South African company Afrigen Biologics, and aims to equip low and middle income countries (LMICs) with the skills to manufacture mRNA vaccines. Over 15 other global sites have been chosen to manufacture mRNA vaccines to address the massive vaccine inequity between the wealthy and the LMICs exposed by the COVID-19 pandemic. While over 60% of the world population have been fully vaccinated against SARS-CoV-2, only around 24% of the population in low income countries have received their first dose of the vaccine. African countries currently import over 90% of their vaccines, lacking the capacity to develop and manufacture vaccines locally. Local manufacture of vaccines will enable the easy distribution to nearby countries, which will also address the accessibility and coverage gap. Scientists from across the world have also been receiving bio-manufacturing training in South Korea, supported by WHO. This training will equip them with the technical know-how to manufacture advanced vaccines in their own countries. “The idea is to build this network, capacity, put the technology in the hands of scientists in these companies, who will then make products that are needed for their own populations,” Swaminathan added. South African regulatory body ranked ‘stable and well-functioning’ The WHO also announced that it has ranked South Africa’s vaccine regulatory system at the ML-3 level in its global classification system for medical products regulatory authorities. This is the second highest level in this system, and means that the country has “a stable, well-functioning and integrated regulatory system” that ensures the quality, safety and efficacy of vaccines produced, imported or distributed in the country. “This is an important new step, not only for South Africa, but for the region towards self-sufficiency in vaccines and medicines,” WHO Regional Director for Africa Dr Matshidiso Moeti said in a press release. Indian company under WHO radar Meanwhile, an Indian pharmaceutical company, Maiden Pharmaceuticals Limited, is under investigation for allegedly manufacturing contaminated cold and cough syrups, according to the WHO. The medicines have been linked to acute kidney injuries and 66 deaths among children in The Gambia. “Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” according to WHO’s medical product alert issued on Wednesday. “While the contaminated products have so far only been detected in The Gambia, they may have been distributed to other countries. WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients,” WHO Chief Dr Tedros Adhanom Ghebreyesus said. Image Credits: Rodger Bosch for MPP/WHO. Coca-Cola is ‘Already Sponsoring’ Obesity – Why is it Sponsoring Egypt’s COP27? 05/10/2022 Kerry Cullinan The announcement by Egypt’s Ministry of Foreign Affairs that Coca-Cola will sponsor the 27th Annual United Nations Climate Change Conference of the Parties (COP27) has been widely condemned by climate and health activists. The #COP27 Presidency announces The @CocaCola Company as a Supporting Sponsor to COP27. For more information: https://t.co/JDyhS2N79A pic.twitter.com/XRhjoA4i2b — COP27 (@COP27P) September 29, 2022 “Coca-Cola is already a de facto sponsor of the global obesity epidemic,” Katie Dain, CEO of the NCD Alliance, told Health Policy Watch. “The health of the planet deserves better.” Meanwhile, a range of climate activists and organisations including Greepeace and Extinction Rebellion, as well as politicians and have described the sponsorship as “greenwashing”. In 2021, the Coca-Cola Company and PepsiCo were ranked as the world’s top plastic polluters for the fourth consecutive year, according to Break Free From Plastic’s global Brand Audit report. In 2019, the company admitted that it used three million tonnes of plastic packaging in one year. Left: pyramid of 225,000 plastic bottles on an island in Nile, collected by 60 fishermen over 45 days this year Right: Egypt signs agreement with Coca-Cola, biggest plastic polluter in history, as sponsor for #COP27 climate talks No wonder emissions keep rising#ClimateCrisis pic.twitter.com/ScymAWnm1Y — Assaad Razzouk (@AssaadRazzouk) October 1, 2022 What’s inside the bottles? However, less attention has been placed on the impact of what is inside Coca-Cola’s plastic bottles. Egyptians consume large quantities of sugary drinks, a known cause of obesity – and obesity is the source of a significant proportion of the country’s health problems. Largely as a result of diets high in sugar, salt and fat, Egypt has the highest obesity rate in the African continent and it has the 18th highest rate globally, according to the World Health Organization (WHO). The next highest African country is South Africa, which is ranked 30th. Between 2015 and 2019, the carbonated soft drinks market in Egypt grew by 27%, and from 2020, has been increasing annually by 19%, according to market research. By 2025, the market is estimated to be worth $4.08 billion. By 2019, almost 40% of adult Egyptians were obese, according to the “100 million health” survey, which was conducted by Egyptian authorities in 2019 and screened 49.7 million adult Egyptians. Almost half of women (49.5%) and 29.5% of men were obese. Diabetes in 85% of cases in Egyptian women and 62% in men are “attributable to obesity” – over 7.7 million people – according to a recent report. In addition, according to the report, “about 13 million adults suffered from sleep apnea and about 8.5 million suffered from fatty liver due to obesity” while “hypertension caused by obesity affected about 6 million adults” in 2020. These have all had an impact on the deaths of Egyptians. COP27, to be hosted from 6-18 November in the Egyptian city of Sharm-El Sheikh, is supposed to provide a platform for governments, the private sector and civil society to discuss solutions to climate change. This is the first of the COPs to be held in Africa, and a key focus is on how low and middle-income countries should be compensated for damage from high emitters of greenhouse gas. At the event to announce its COP27 sponsorship last week, Coca-Cola said “Climate is a key area of focus as The Coca-Cola Company works towards its 2030 Science Based Target of an absolute 25% emissions reduction and its ambition to be net zero carbon globally by 2050.” “Through the COP27 partnership, the Coca-Cola system aims to continue exploring opportunities to build climate resilience across its business, supply chain and communities, while engaging with other private sector actors, NGOs, and governments to support collective action against climate change,” according to the company. Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Launch Event: Self-Care Readiness Index 2.0 06/10/2022 Editorial team The second iteration of the Self-Care Readiness Index (SCRI) will be released later this month during the Global Self-Care Federation World Congress 2022. Self-Care Readiness Index 2.0 The congress takes place on the 19th and 20th of October 2022, in Cape Town, South Africa. The Self-Care Readiness Index 2.0 builds on the 2021 report, analysing another 10 countries to provide an even more in-depth understanding of the state of healthcare and self-care around the world. The Congress will touch on a wide variety of self-care and healthcare related topics and will be joinable both in person and remotely. The Index will be presented alongside a discussion on Redefining the Global Self-Care Agenda, featuring remarks from Judy Stenmark, Director General of the Global Self-Care Federation (GSCF), Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J, Sarah Onyango, Secretariat Director at Self-Care Trailblazer Group and Mario Ottiglio, Managing Director of High-Lantern Group, and will feature contributions from key global actors in the health arena. The discussion will be chaired by Dr Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health, South Africa, and Alain Main, former Chairperson of the Global Self-Care Federation (GSCF). Opening remarks will be given by Dr Princess Nothemba (Nono) Simelela, Assistant Director-General for Family, Women, Children and Adolescents at WHO. Healthcare professionals, policymakers, health economists, regulators, academia, media and other parties interested in discourse around self-care and reforming the healthcare system are invited to attend the event on the 19th of October at 8:30am SAST, which will include a moderated panel discussion and questions and answers from the audience. “The SCRI shows us that self-care is practiced differently and is included in healthcare systems a variety of ways around the world,” Stenmark said. “But despite these differences, similarities abound – notably around the fundamental benefits brought to individuals, providers, and wider healthcare systems. Self-care cannot be ignored any longer – it is a hugely beneficial part of healthcare for all actors.” The Index serves as a research and policymaking tool that explores key enablers of self-care in support of designing a better model for healthcare systems overall. The creation of the Index is spearheaded by the Global Self-Care Federation but is also supported by the WHO as part of a broader three year collaboration. Self-care remains an emerging topic amongst healthcare discourse – in both national and international conversations. The Index helps to close the current knowledge and practice gap, as well as reinforcing the overall need to adopt self-care globally to facilitate the achievement of Universal Health Coverage and greater health of the world’s population. “No matter how we see it included, the benefits remain clear,” Stenmark added. “Self-care needs to be an integrated part of every healthcare system.” The SCRI 2.0 launch event will be livestreamed via GSCF’s YouTube channel and open for all global attendees to join. Image Credits: Global Self-Care Federation . Entrenching Equity in a Future Pandemic Treaty 06/10/2022 Kerry Cullinan Equity of access to medicines for the world’s most vulnerable groups is key to a pandemic treaty. While there is unanimous agreement that equity is the essential ingredient in any future pandemic treaty ‘recipe’, World Health Organization (WHO) member states are unclear about how can it be incorporated practically. This emerged from an informal consultation on how to “operationalise and achieve” equity convened on Wednesday by the WHO intergovernmental negotiation body (INB), which has been charged with shaping the treaty or instrument to pandemic-proof the world. It is the second of four informal consultations planned before the INB reconvenes in December to negotiate a draft agreement to be presented to member states. The first focused on legal issues, while the third – taking place on Friday – will consider the thorny question of intellectual property. The fourth, on 14 October, will consider “One Health”. Poor countries fighting for crumbs Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University Expert panellists sketched the all-too-familiar picture: WHO member states in poorer countries being unable to get access to vaccines, personal protective equipment (PPE) and other essentials at the height of the COVID-19 pandemic. Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University said that her country had the highest per capita COVID deaths in the world. “Even though we had the economic resources, what was really tragic and dramatic was the fact that we could not access any of the products that were needed as an emergency,” said Garcia. “I’m talking about PPE; and we only had access to vaccines very late, which means that a lot of people died, when in other countries vaccines were already available.” Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance, said that the number one equity measure in a “binding treaty” should be to ensure manufacturing capacity across all regions. “Countries and all groups must ensure that, as well as quickly detecting and responding to threats together, the key medical countermeasures – PPE, diagnostics, treatments, and vaccines – are manufactured and shared equally,” said Alakija. “We have to take this opportunity to enshrine rules and procedures so that all lives are treated equally, not just those in the global North. “We cannot end up in a situation where rich countries are able to gobble up supply and poor countries are left fighting over crumbs, as we did for much of 2021.” Resources for developing country manufacturers Mohga Kamal-Yanni, senior health advisor for the People Vaccine Alliance, said that the WHO had produced an equitable access framework in 2020, before there were vaccines, which showed which parts of the population should be prioritised once there were f vaccines, starting with health workers globally. “It was supposed to be health workers across the whole world, but what happened is that the framework was used within countries, but not across countries,” said Kamal-Yanni. “Rich countries did not look at this globally, they looked at it nationally. So, in fact, you can define equity and you can actually put up practical mechanisms to help ensure equity, but, how do you implement it? How do you get the political will for it to be implemented?” Rajinder Kumar Suri, CEO of the Developing Country Vaccine Manufacturers Network (DCVMN), said that one of the most critical challenges during COVID-19 was funding. “It is of utmost importance to create innovative financial mechanisms and organise funds in advance to avoid any such a reoccurrence,” said Suri, who represents 42 manufacturers. Suri also pointed out that, although there was $5.6 billion available for product development, only 5% was allocated to the developing country vaccine manufacturers. “But when we look at the total production volumes, almost 60% of the global production was contributed by developing countries,’ said Suri. MSF Access Campaign senior legal and policy adviser, Yuanqiong Hu Yuanqiong Hu, senior legal and policy advisor for Medicins sans Frontieres (MSF) Access Campaign highlighted barriers to access to vaccines – including the liability agreements manufacturers required all countries to sign that slowed down access. “The lack of true international solidarity, collaboration and collective vision about how the future of equity issue can only be addressed politically,” she added. Some of the “enforceable mandatory measures” that MSF suggests for entrenching equity include ensuring that life-saving medical products – vaccines, therapeutics, diagnostics and other tools – are developed, produced and provided as “global public goods”. “We think there should be clear and enforceable mechanisms to establish obligations for member states and to regulate and behaviours of private and public sectors,” she added. At the end of the consultation, INB co-chair Precious Matsoso highlighted some of the other points made by panellists and member states, including the importance of considering “existing instruments” – a number of people felt that the International Health Regulations could be adjusted to meet the challenges of future pandemics. “We need a binding, pragmatic document that commits countries to work together, meaning we need to push for collaboration in a responsive and cost-effective way,” Matsoso concluded. Image Credits: Peter Biro/EU Civil Protection and Humanitarian Aid. WHO’s African mRNA Hub to Begin Animal Trial on COVID Vaccine 05/10/2022 Megha Kaveri Lab technicians at Afrigen, a Cape Town firm that is part of the WHO mRNA Vaccine Hub in South Africa. The mRNA Vaccine Technology Transfer Hub in South Africa will start animal studies on its first COVID-19 vaccine candidate in October, a senior World Health Organization official said Wednesday. If all goes according to plan, human clinical trials will begin towards the end of 2023. “We did start this (mRNA vaccine hub) with a longer term view, beyond COVID-19. The idea was not to come up, necessarily, with a vaccine for COVID-19 though that would be a proof of principle. But it is going to take time,” World Health Organization (WH)O Chief Scientist Dr Soumya Swamination said at the global health body’s weekly media briefing. The WHO’s ambitious project is hosted by the South African company Afrigen Biologics, and aims to equip low and middle income countries (LMICs) with the skills to manufacture mRNA vaccines. Over 15 other global sites have been chosen to manufacture mRNA vaccines to address the massive vaccine inequity between the wealthy and the LMICs exposed by the COVID-19 pandemic. While over 60% of the world population have been fully vaccinated against SARS-CoV-2, only around 24% of the population in low income countries have received their first dose of the vaccine. African countries currently import over 90% of their vaccines, lacking the capacity to develop and manufacture vaccines locally. Local manufacture of vaccines will enable the easy distribution to nearby countries, which will also address the accessibility and coverage gap. Scientists from across the world have also been receiving bio-manufacturing training in South Korea, supported by WHO. This training will equip them with the technical know-how to manufacture advanced vaccines in their own countries. “The idea is to build this network, capacity, put the technology in the hands of scientists in these companies, who will then make products that are needed for their own populations,” Swaminathan added. South African regulatory body ranked ‘stable and well-functioning’ The WHO also announced that it has ranked South Africa’s vaccine regulatory system at the ML-3 level in its global classification system for medical products regulatory authorities. This is the second highest level in this system, and means that the country has “a stable, well-functioning and integrated regulatory system” that ensures the quality, safety and efficacy of vaccines produced, imported or distributed in the country. “This is an important new step, not only for South Africa, but for the region towards self-sufficiency in vaccines and medicines,” WHO Regional Director for Africa Dr Matshidiso Moeti said in a press release. Indian company under WHO radar Meanwhile, an Indian pharmaceutical company, Maiden Pharmaceuticals Limited, is under investigation for allegedly manufacturing contaminated cold and cough syrups, according to the WHO. The medicines have been linked to acute kidney injuries and 66 deaths among children in The Gambia. “Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” according to WHO’s medical product alert issued on Wednesday. “While the contaminated products have so far only been detected in The Gambia, they may have been distributed to other countries. WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients,” WHO Chief Dr Tedros Adhanom Ghebreyesus said. Image Credits: Rodger Bosch for MPP/WHO. Coca-Cola is ‘Already Sponsoring’ Obesity – Why is it Sponsoring Egypt’s COP27? 05/10/2022 Kerry Cullinan The announcement by Egypt’s Ministry of Foreign Affairs that Coca-Cola will sponsor the 27th Annual United Nations Climate Change Conference of the Parties (COP27) has been widely condemned by climate and health activists. The #COP27 Presidency announces The @CocaCola Company as a Supporting Sponsor to COP27. For more information: https://t.co/JDyhS2N79A pic.twitter.com/XRhjoA4i2b — COP27 (@COP27P) September 29, 2022 “Coca-Cola is already a de facto sponsor of the global obesity epidemic,” Katie Dain, CEO of the NCD Alliance, told Health Policy Watch. “The health of the planet deserves better.” Meanwhile, a range of climate activists and organisations including Greepeace and Extinction Rebellion, as well as politicians and have described the sponsorship as “greenwashing”. In 2021, the Coca-Cola Company and PepsiCo were ranked as the world’s top plastic polluters for the fourth consecutive year, according to Break Free From Plastic’s global Brand Audit report. In 2019, the company admitted that it used three million tonnes of plastic packaging in one year. Left: pyramid of 225,000 plastic bottles on an island in Nile, collected by 60 fishermen over 45 days this year Right: Egypt signs agreement with Coca-Cola, biggest plastic polluter in history, as sponsor for #COP27 climate talks No wonder emissions keep rising#ClimateCrisis pic.twitter.com/ScymAWnm1Y — Assaad Razzouk (@AssaadRazzouk) October 1, 2022 What’s inside the bottles? However, less attention has been placed on the impact of what is inside Coca-Cola’s plastic bottles. Egyptians consume large quantities of sugary drinks, a known cause of obesity – and obesity is the source of a significant proportion of the country’s health problems. Largely as a result of diets high in sugar, salt and fat, Egypt has the highest obesity rate in the African continent and it has the 18th highest rate globally, according to the World Health Organization (WHO). The next highest African country is South Africa, which is ranked 30th. Between 2015 and 2019, the carbonated soft drinks market in Egypt grew by 27%, and from 2020, has been increasing annually by 19%, according to market research. By 2025, the market is estimated to be worth $4.08 billion. By 2019, almost 40% of adult Egyptians were obese, according to the “100 million health” survey, which was conducted by Egyptian authorities in 2019 and screened 49.7 million adult Egyptians. Almost half of women (49.5%) and 29.5% of men were obese. Diabetes in 85% of cases in Egyptian women and 62% in men are “attributable to obesity” – over 7.7 million people – according to a recent report. In addition, according to the report, “about 13 million adults suffered from sleep apnea and about 8.5 million suffered from fatty liver due to obesity” while “hypertension caused by obesity affected about 6 million adults” in 2020. These have all had an impact on the deaths of Egyptians. COP27, to be hosted from 6-18 November in the Egyptian city of Sharm-El Sheikh, is supposed to provide a platform for governments, the private sector and civil society to discuss solutions to climate change. This is the first of the COPs to be held in Africa, and a key focus is on how low and middle-income countries should be compensated for damage from high emitters of greenhouse gas. At the event to announce its COP27 sponsorship last week, Coca-Cola said “Climate is a key area of focus as The Coca-Cola Company works towards its 2030 Science Based Target of an absolute 25% emissions reduction and its ambition to be net zero carbon globally by 2050.” “Through the COP27 partnership, the Coca-Cola system aims to continue exploring opportunities to build climate resilience across its business, supply chain and communities, while engaging with other private sector actors, NGOs, and governments to support collective action against climate change,” according to the company. Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Entrenching Equity in a Future Pandemic Treaty 06/10/2022 Kerry Cullinan Equity of access to medicines for the world’s most vulnerable groups is key to a pandemic treaty. While there is unanimous agreement that equity is the essential ingredient in any future pandemic treaty ‘recipe’, World Health Organization (WHO) member states are unclear about how can it be incorporated practically. This emerged from an informal consultation on how to “operationalise and achieve” equity convened on Wednesday by the WHO intergovernmental negotiation body (INB), which has been charged with shaping the treaty or instrument to pandemic-proof the world. It is the second of four informal consultations planned before the INB reconvenes in December to negotiate a draft agreement to be presented to member states. The first focused on legal issues, while the third – taking place on Friday – will consider the thorny question of intellectual property. The fourth, on 14 October, will consider “One Health”. Poor countries fighting for crumbs Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University Expert panellists sketched the all-too-familiar picture: WHO member states in poorer countries being unable to get access to vaccines, personal protective equipment (PPE) and other essentials at the height of the COVID-19 pandemic. Dr Patricia Garcia, former Peruvian Health Minister and professor of public health at Cayetano Heredia University said that her country had the highest per capita COVID deaths in the world. “Even though we had the economic resources, what was really tragic and dramatic was the fact that we could not access any of the products that were needed as an emergency,” said Garcia. “I’m talking about PPE; and we only had access to vaccines very late, which means that a lot of people died, when in other countries vaccines were already available.” Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance, said that the number one equity measure in a “binding treaty” should be to ensure manufacturing capacity across all regions. “Countries and all groups must ensure that, as well as quickly detecting and responding to threats together, the key medical countermeasures – PPE, diagnostics, treatments, and vaccines – are manufactured and shared equally,” said Alakija. “We have to take this opportunity to enshrine rules and procedures so that all lives are treated equally, not just those in the global North. “We cannot end up in a situation where rich countries are able to gobble up supply and poor countries are left fighting over crumbs, as we did for much of 2021.” Resources for developing country manufacturers Mohga Kamal-Yanni, senior health advisor for the People Vaccine Alliance, said that the WHO had produced an equitable access framework in 2020, before there were vaccines, which showed which parts of the population should be prioritised once there were f vaccines, starting with health workers globally. “It was supposed to be health workers across the whole world, but what happened is that the framework was used within countries, but not across countries,” said Kamal-Yanni. “Rich countries did not look at this globally, they looked at it nationally. So, in fact, you can define equity and you can actually put up practical mechanisms to help ensure equity, but, how do you implement it? How do you get the political will for it to be implemented?” Rajinder Kumar Suri, CEO of the Developing Country Vaccine Manufacturers Network (DCVMN), said that one of the most critical challenges during COVID-19 was funding. “It is of utmost importance to create innovative financial mechanisms and organise funds in advance to avoid any such a reoccurrence,” said Suri, who represents 42 manufacturers. Suri also pointed out that, although there was $5.6 billion available for product development, only 5% was allocated to the developing country vaccine manufacturers. “But when we look at the total production volumes, almost 60% of the global production was contributed by developing countries,’ said Suri. MSF Access Campaign senior legal and policy adviser, Yuanqiong Hu Yuanqiong Hu, senior legal and policy advisor for Medicins sans Frontieres (MSF) Access Campaign highlighted barriers to access to vaccines – including the liability agreements manufacturers required all countries to sign that slowed down access. “The lack of true international solidarity, collaboration and collective vision about how the future of equity issue can only be addressed politically,” she added. Some of the “enforceable mandatory measures” that MSF suggests for entrenching equity include ensuring that life-saving medical products – vaccines, therapeutics, diagnostics and other tools – are developed, produced and provided as “global public goods”. “We think there should be clear and enforceable mechanisms to establish obligations for member states and to regulate and behaviours of private and public sectors,” she added. At the end of the consultation, INB co-chair Precious Matsoso highlighted some of the other points made by panellists and member states, including the importance of considering “existing instruments” – a number of people felt that the International Health Regulations could be adjusted to meet the challenges of future pandemics. “We need a binding, pragmatic document that commits countries to work together, meaning we need to push for collaboration in a responsive and cost-effective way,” Matsoso concluded. Image Credits: Peter Biro/EU Civil Protection and Humanitarian Aid. WHO’s African mRNA Hub to Begin Animal Trial on COVID Vaccine 05/10/2022 Megha Kaveri Lab technicians at Afrigen, a Cape Town firm that is part of the WHO mRNA Vaccine Hub in South Africa. The mRNA Vaccine Technology Transfer Hub in South Africa will start animal studies on its first COVID-19 vaccine candidate in October, a senior World Health Organization official said Wednesday. If all goes according to plan, human clinical trials will begin towards the end of 2023. “We did start this (mRNA vaccine hub) with a longer term view, beyond COVID-19. The idea was not to come up, necessarily, with a vaccine for COVID-19 though that would be a proof of principle. But it is going to take time,” World Health Organization (WH)O Chief Scientist Dr Soumya Swamination said at the global health body’s weekly media briefing. The WHO’s ambitious project is hosted by the South African company Afrigen Biologics, and aims to equip low and middle income countries (LMICs) with the skills to manufacture mRNA vaccines. Over 15 other global sites have been chosen to manufacture mRNA vaccines to address the massive vaccine inequity between the wealthy and the LMICs exposed by the COVID-19 pandemic. While over 60% of the world population have been fully vaccinated against SARS-CoV-2, only around 24% of the population in low income countries have received their first dose of the vaccine. African countries currently import over 90% of their vaccines, lacking the capacity to develop and manufacture vaccines locally. Local manufacture of vaccines will enable the easy distribution to nearby countries, which will also address the accessibility and coverage gap. Scientists from across the world have also been receiving bio-manufacturing training in South Korea, supported by WHO. This training will equip them with the technical know-how to manufacture advanced vaccines in their own countries. “The idea is to build this network, capacity, put the technology in the hands of scientists in these companies, who will then make products that are needed for their own populations,” Swaminathan added. South African regulatory body ranked ‘stable and well-functioning’ The WHO also announced that it has ranked South Africa’s vaccine regulatory system at the ML-3 level in its global classification system for medical products regulatory authorities. This is the second highest level in this system, and means that the country has “a stable, well-functioning and integrated regulatory system” that ensures the quality, safety and efficacy of vaccines produced, imported or distributed in the country. “This is an important new step, not only for South Africa, but for the region towards self-sufficiency in vaccines and medicines,” WHO Regional Director for Africa Dr Matshidiso Moeti said in a press release. Indian company under WHO radar Meanwhile, an Indian pharmaceutical company, Maiden Pharmaceuticals Limited, is under investigation for allegedly manufacturing contaminated cold and cough syrups, according to the WHO. The medicines have been linked to acute kidney injuries and 66 deaths among children in The Gambia. “Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” according to WHO’s medical product alert issued on Wednesday. “While the contaminated products have so far only been detected in The Gambia, they may have been distributed to other countries. WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients,” WHO Chief Dr Tedros Adhanom Ghebreyesus said. Image Credits: Rodger Bosch for MPP/WHO. Coca-Cola is ‘Already Sponsoring’ Obesity – Why is it Sponsoring Egypt’s COP27? 05/10/2022 Kerry Cullinan The announcement by Egypt’s Ministry of Foreign Affairs that Coca-Cola will sponsor the 27th Annual United Nations Climate Change Conference of the Parties (COP27) has been widely condemned by climate and health activists. The #COP27 Presidency announces The @CocaCola Company as a Supporting Sponsor to COP27. For more information: https://t.co/JDyhS2N79A pic.twitter.com/XRhjoA4i2b — COP27 (@COP27P) September 29, 2022 “Coca-Cola is already a de facto sponsor of the global obesity epidemic,” Katie Dain, CEO of the NCD Alliance, told Health Policy Watch. “The health of the planet deserves better.” Meanwhile, a range of climate activists and organisations including Greepeace and Extinction Rebellion, as well as politicians and have described the sponsorship as “greenwashing”. In 2021, the Coca-Cola Company and PepsiCo were ranked as the world’s top plastic polluters for the fourth consecutive year, according to Break Free From Plastic’s global Brand Audit report. In 2019, the company admitted that it used three million tonnes of plastic packaging in one year. Left: pyramid of 225,000 plastic bottles on an island in Nile, collected by 60 fishermen over 45 days this year Right: Egypt signs agreement with Coca-Cola, biggest plastic polluter in history, as sponsor for #COP27 climate talks No wonder emissions keep rising#ClimateCrisis pic.twitter.com/ScymAWnm1Y — Assaad Razzouk (@AssaadRazzouk) October 1, 2022 What’s inside the bottles? However, less attention has been placed on the impact of what is inside Coca-Cola’s plastic bottles. Egyptians consume large quantities of sugary drinks, a known cause of obesity – and obesity is the source of a significant proportion of the country’s health problems. Largely as a result of diets high in sugar, salt and fat, Egypt has the highest obesity rate in the African continent and it has the 18th highest rate globally, according to the World Health Organization (WHO). The next highest African country is South Africa, which is ranked 30th. Between 2015 and 2019, the carbonated soft drinks market in Egypt grew by 27%, and from 2020, has been increasing annually by 19%, according to market research. By 2025, the market is estimated to be worth $4.08 billion. By 2019, almost 40% of adult Egyptians were obese, according to the “100 million health” survey, which was conducted by Egyptian authorities in 2019 and screened 49.7 million adult Egyptians. Almost half of women (49.5%) and 29.5% of men were obese. Diabetes in 85% of cases in Egyptian women and 62% in men are “attributable to obesity” – over 7.7 million people – according to a recent report. In addition, according to the report, “about 13 million adults suffered from sleep apnea and about 8.5 million suffered from fatty liver due to obesity” while “hypertension caused by obesity affected about 6 million adults” in 2020. These have all had an impact on the deaths of Egyptians. COP27, to be hosted from 6-18 November in the Egyptian city of Sharm-El Sheikh, is supposed to provide a platform for governments, the private sector and civil society to discuss solutions to climate change. This is the first of the COPs to be held in Africa, and a key focus is on how low and middle-income countries should be compensated for damage from high emitters of greenhouse gas. At the event to announce its COP27 sponsorship last week, Coca-Cola said “Climate is a key area of focus as The Coca-Cola Company works towards its 2030 Science Based Target of an absolute 25% emissions reduction and its ambition to be net zero carbon globally by 2050.” “Through the COP27 partnership, the Coca-Cola system aims to continue exploring opportunities to build climate resilience across its business, supply chain and communities, while engaging with other private sector actors, NGOs, and governments to support collective action against climate change,” according to the company. Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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WHO’s African mRNA Hub to Begin Animal Trial on COVID Vaccine 05/10/2022 Megha Kaveri Lab technicians at Afrigen, a Cape Town firm that is part of the WHO mRNA Vaccine Hub in South Africa. The mRNA Vaccine Technology Transfer Hub in South Africa will start animal studies on its first COVID-19 vaccine candidate in October, a senior World Health Organization official said Wednesday. If all goes according to plan, human clinical trials will begin towards the end of 2023. “We did start this (mRNA vaccine hub) with a longer term view, beyond COVID-19. The idea was not to come up, necessarily, with a vaccine for COVID-19 though that would be a proof of principle. But it is going to take time,” World Health Organization (WH)O Chief Scientist Dr Soumya Swamination said at the global health body’s weekly media briefing. The WHO’s ambitious project is hosted by the South African company Afrigen Biologics, and aims to equip low and middle income countries (LMICs) with the skills to manufacture mRNA vaccines. Over 15 other global sites have been chosen to manufacture mRNA vaccines to address the massive vaccine inequity between the wealthy and the LMICs exposed by the COVID-19 pandemic. While over 60% of the world population have been fully vaccinated against SARS-CoV-2, only around 24% of the population in low income countries have received their first dose of the vaccine. African countries currently import over 90% of their vaccines, lacking the capacity to develop and manufacture vaccines locally. Local manufacture of vaccines will enable the easy distribution to nearby countries, which will also address the accessibility and coverage gap. Scientists from across the world have also been receiving bio-manufacturing training in South Korea, supported by WHO. This training will equip them with the technical know-how to manufacture advanced vaccines in their own countries. “The idea is to build this network, capacity, put the technology in the hands of scientists in these companies, who will then make products that are needed for their own populations,” Swaminathan added. South African regulatory body ranked ‘stable and well-functioning’ The WHO also announced that it has ranked South Africa’s vaccine regulatory system at the ML-3 level in its global classification system for medical products regulatory authorities. This is the second highest level in this system, and means that the country has “a stable, well-functioning and integrated regulatory system” that ensures the quality, safety and efficacy of vaccines produced, imported or distributed in the country. “This is an important new step, not only for South Africa, but for the region towards self-sufficiency in vaccines and medicines,” WHO Regional Director for Africa Dr Matshidiso Moeti said in a press release. Indian company under WHO radar Meanwhile, an Indian pharmaceutical company, Maiden Pharmaceuticals Limited, is under investigation for allegedly manufacturing contaminated cold and cough syrups, according to the WHO. The medicines have been linked to acute kidney injuries and 66 deaths among children in The Gambia. “Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” according to WHO’s medical product alert issued on Wednesday. “While the contaminated products have so far only been detected in The Gambia, they may have been distributed to other countries. WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients,” WHO Chief Dr Tedros Adhanom Ghebreyesus said. Image Credits: Rodger Bosch for MPP/WHO. Coca-Cola is ‘Already Sponsoring’ Obesity – Why is it Sponsoring Egypt’s COP27? 05/10/2022 Kerry Cullinan The announcement by Egypt’s Ministry of Foreign Affairs that Coca-Cola will sponsor the 27th Annual United Nations Climate Change Conference of the Parties (COP27) has been widely condemned by climate and health activists. The #COP27 Presidency announces The @CocaCola Company as a Supporting Sponsor to COP27. For more information: https://t.co/JDyhS2N79A pic.twitter.com/XRhjoA4i2b — COP27 (@COP27P) September 29, 2022 “Coca-Cola is already a de facto sponsor of the global obesity epidemic,” Katie Dain, CEO of the NCD Alliance, told Health Policy Watch. “The health of the planet deserves better.” Meanwhile, a range of climate activists and organisations including Greepeace and Extinction Rebellion, as well as politicians and have described the sponsorship as “greenwashing”. In 2021, the Coca-Cola Company and PepsiCo were ranked as the world’s top plastic polluters for the fourth consecutive year, according to Break Free From Plastic’s global Brand Audit report. In 2019, the company admitted that it used three million tonnes of plastic packaging in one year. Left: pyramid of 225,000 plastic bottles on an island in Nile, collected by 60 fishermen over 45 days this year Right: Egypt signs agreement with Coca-Cola, biggest plastic polluter in history, as sponsor for #COP27 climate talks No wonder emissions keep rising#ClimateCrisis pic.twitter.com/ScymAWnm1Y — Assaad Razzouk (@AssaadRazzouk) October 1, 2022 What’s inside the bottles? However, less attention has been placed on the impact of what is inside Coca-Cola’s plastic bottles. Egyptians consume large quantities of sugary drinks, a known cause of obesity – and obesity is the source of a significant proportion of the country’s health problems. Largely as a result of diets high in sugar, salt and fat, Egypt has the highest obesity rate in the African continent and it has the 18th highest rate globally, according to the World Health Organization (WHO). The next highest African country is South Africa, which is ranked 30th. Between 2015 and 2019, the carbonated soft drinks market in Egypt grew by 27%, and from 2020, has been increasing annually by 19%, according to market research. By 2025, the market is estimated to be worth $4.08 billion. By 2019, almost 40% of adult Egyptians were obese, according to the “100 million health” survey, which was conducted by Egyptian authorities in 2019 and screened 49.7 million adult Egyptians. Almost half of women (49.5%) and 29.5% of men were obese. Diabetes in 85% of cases in Egyptian women and 62% in men are “attributable to obesity” – over 7.7 million people – according to a recent report. In addition, according to the report, “about 13 million adults suffered from sleep apnea and about 8.5 million suffered from fatty liver due to obesity” while “hypertension caused by obesity affected about 6 million adults” in 2020. These have all had an impact on the deaths of Egyptians. COP27, to be hosted from 6-18 November in the Egyptian city of Sharm-El Sheikh, is supposed to provide a platform for governments, the private sector and civil society to discuss solutions to climate change. This is the first of the COPs to be held in Africa, and a key focus is on how low and middle-income countries should be compensated for damage from high emitters of greenhouse gas. At the event to announce its COP27 sponsorship last week, Coca-Cola said “Climate is a key area of focus as The Coca-Cola Company works towards its 2030 Science Based Target of an absolute 25% emissions reduction and its ambition to be net zero carbon globally by 2050.” “Through the COP27 partnership, the Coca-Cola system aims to continue exploring opportunities to build climate resilience across its business, supply chain and communities, while engaging with other private sector actors, NGOs, and governments to support collective action against climate change,” according to the company. Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Coca-Cola is ‘Already Sponsoring’ Obesity – Why is it Sponsoring Egypt’s COP27? 05/10/2022 Kerry Cullinan The announcement by Egypt’s Ministry of Foreign Affairs that Coca-Cola will sponsor the 27th Annual United Nations Climate Change Conference of the Parties (COP27) has been widely condemned by climate and health activists. The #COP27 Presidency announces The @CocaCola Company as a Supporting Sponsor to COP27. For more information: https://t.co/JDyhS2N79A pic.twitter.com/XRhjoA4i2b — COP27 (@COP27P) September 29, 2022 “Coca-Cola is already a de facto sponsor of the global obesity epidemic,” Katie Dain, CEO of the NCD Alliance, told Health Policy Watch. “The health of the planet deserves better.” Meanwhile, a range of climate activists and organisations including Greepeace and Extinction Rebellion, as well as politicians and have described the sponsorship as “greenwashing”. In 2021, the Coca-Cola Company and PepsiCo were ranked as the world’s top plastic polluters for the fourth consecutive year, according to Break Free From Plastic’s global Brand Audit report. In 2019, the company admitted that it used three million tonnes of plastic packaging in one year. Left: pyramid of 225,000 plastic bottles on an island in Nile, collected by 60 fishermen over 45 days this year Right: Egypt signs agreement with Coca-Cola, biggest plastic polluter in history, as sponsor for #COP27 climate talks No wonder emissions keep rising#ClimateCrisis pic.twitter.com/ScymAWnm1Y — Assaad Razzouk (@AssaadRazzouk) October 1, 2022 What’s inside the bottles? However, less attention has been placed on the impact of what is inside Coca-Cola’s plastic bottles. Egyptians consume large quantities of sugary drinks, a known cause of obesity – and obesity is the source of a significant proportion of the country’s health problems. Largely as a result of diets high in sugar, salt and fat, Egypt has the highest obesity rate in the African continent and it has the 18th highest rate globally, according to the World Health Organization (WHO). The next highest African country is South Africa, which is ranked 30th. Between 2015 and 2019, the carbonated soft drinks market in Egypt grew by 27%, and from 2020, has been increasing annually by 19%, according to market research. By 2025, the market is estimated to be worth $4.08 billion. By 2019, almost 40% of adult Egyptians were obese, according to the “100 million health” survey, which was conducted by Egyptian authorities in 2019 and screened 49.7 million adult Egyptians. Almost half of women (49.5%) and 29.5% of men were obese. Diabetes in 85% of cases in Egyptian women and 62% in men are “attributable to obesity” – over 7.7 million people – according to a recent report. In addition, according to the report, “about 13 million adults suffered from sleep apnea and about 8.5 million suffered from fatty liver due to obesity” while “hypertension caused by obesity affected about 6 million adults” in 2020. These have all had an impact on the deaths of Egyptians. COP27, to be hosted from 6-18 November in the Egyptian city of Sharm-El Sheikh, is supposed to provide a platform for governments, the private sector and civil society to discuss solutions to climate change. This is the first of the COPs to be held in Africa, and a key focus is on how low and middle-income countries should be compensated for damage from high emitters of greenhouse gas. At the event to announce its COP27 sponsorship last week, Coca-Cola said “Climate is a key area of focus as The Coca-Cola Company works towards its 2030 Science Based Target of an absolute 25% emissions reduction and its ambition to be net zero carbon globally by 2050.” “Through the COP27 partnership, the Coca-Cola system aims to continue exploring opportunities to build climate resilience across its business, supply chain and communities, while engaging with other private sector actors, NGOs, and governments to support collective action against climate change,” according to the company. Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Weak Systems and Lack of Investment in New Antibiotics Are Key Global Health Threats 05/10/2022 Kerry Cullinan Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics. But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health. This was according to global health leaders who were discussing how to attract better investment in health at an event organised by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday. One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D. A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission. “Under the innovative medicines initiative, we’ve been funding a large programme to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens. The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added. John Reeder, director of TDR, the Special Programme for Research and Training in Tropical Diseases and Director of the Research for Health Department at the World Health Organization (WHO), also favoured special incentives to develop new antibiotics. “We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realising profits against quite high investment,” said Reeder. “We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said. He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships. The drug, Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi. “We need to think about the model and how we involve pharma but not just rely on them,” said Reeder. He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance. “It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Reeder. “Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Reeder. Jeremy Farrar, Wellcome Trust “Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust. “We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.” Farrar added that the world has not valued antibiotics or vaccines highly enough. “We’ve regarded antibiotics are something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner. “If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.” Farrar also favours “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”. Dr Tedros Primary health as the foundation WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries. “When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros. “More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.” Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”. “National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritise investments in healthcare before the next crisis strikes.” Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries. “The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10,5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totalling just over a 10th of that amount. That’s not sustainable funding.” [Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.] Image Credits: Flickr: Rumi Consultancy/World Bank. WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Sets 2030 as Deadline to Find Cure for Alzheimer’s Disease 04/10/2022 Megha Kaveri Alzheimer’s disease is the most common type of dementia found in elderly people. The World Health Organization (WHO) has pushed the deadline to find a cure for Alzheimer’s disease from 2025 to 2030. The earlier deadline had been decided on at the 2013 G8 Dementia Summit. Alzheimer’s disease is the most common form of dementia and makes up 60-70% of the global dementia cases. WHO’s A Blueprint for Dementia Research, which was launched on Tuesday, identifies gaps in dementia research and sets time-bound goals to tackle the disease. It found that most countries were behind on the targets set in 2017 on public health response to dementia. Dementia is a non-communicable disease that mainly affects older people. It is estimated that over 55 million people are living with dementia across the world, of which around 60% live in low and middle income countries. Every year, around 10 million new cases of dementia are reported globally. At this rate, it is expected that by the year 2030, 78 million people will be living with dementia – growing to 139 million people by 2050. The blueprint summarises the current state of dementia research across six themes including drug development, clinical trials, care and support. It also pinpoints existing knowledge gaps in research and recommends 15 goals with a time-bound action plan. According to the blueprint, WHO wants member-states to formulate a disease-modifying therapy for Alzheimer’s Disease by 2030. The WHO also directs member states to develop capacity to conduct clinical intervention trials for dementia, especially in low and middle income countries by 2027. WHO Chief Scientist Dr Soumya Swaminathan pointed out that, at present, dementia research accounts for less than 1.5% of the total health research output in the world, despite the disease being the seventh leading cause of death globally. “Sadly, we are falling behind (in) implementing the Global action plan on the public health response to dementia 2017-25. Addressing dementia comprehensively requires research and innovation to be an integral part of the response.” At the G8 Dementia Summit in 2013, countries had vowed to increase funding for research and to identify a cure or a disease-modifying therapy by the year 2025. In 2017, all 194 WHO member states adopted the Global Action Plan on the Public Health Response to Dementia. This plan reiterated their commitment to fighting dementia. However, as per the Global Status Report on the Public Health Response to Dementia published by WHO in 2019, only 26% of the member states of the global health body have a plan to address dementia in their countries. In addition, only 21% of the WHO’s member states have an awareness campaign for dementia. The metrics on diagnosis and reporting mechanisms across member states also remains grim. The report, therefore, concluded that the world, as a whole, is far behind in both finding a cure for dementia and in achieving the targets set for 2025. “We can achieve progress in dementia research by strengthening and monitoring the drivers of research highlighted in the Blueprint so that they become the norm for good research practice,” Dr Ren Minghui, WHO’s Assistant Director General UHC/Communicable & Non Communicable Diseases said. Image Credits: Photo by Steven HWG on Unsplash. One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
One World, One Health – Tackling the Superbug Challenge 04/10/2022 Dame Sally Davies Bacterial culture prepared for testing new antibiotic candidates. Humans, animals, plants and the environment we all share face escalating risks from antimicrobial resistance (AMR), with the potential for irreversible damage ever more likely. Both our health and the health of the planet are at stake, says a leading champion for more action. We know what to do. One Health thinking has been with us for as long as the European Health Forum Gastein, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative by underlining the interplay between human behaviour, public health and economic development as never before. What’s required now is for the global community to put health – human, animal and environmental – at the core of policy-making. The G7 summit in Elmau a few months ago recognised this imperative with a commitment “to work in partnership to strengthen health systems worldwide and step up our efforts in pandemic prevention, preparedness and response under the One Health approach”. The G7 leaders included AMR in their final communiqué, promising to “spare no efforts to continue addressing this silent pandemic.” A threat with more deadly potential than COVID-19 As the United Kingdom’s Special Envoy on AMR, I see it as my duty to educate the world about this threat that we all face from the increasing prevalence of drug-resistant microbes – including bacteria, viruses and parasites. This is a pandemic which has the potential to be more deadly than COVID-19. It is already associated with five million deaths a year, making AMR the third-leading underlying cause of death globally. According to a ground-breaking study in The Lancet, published in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019. The 'silent pandemic' is not silent anymore. New data, published in today’s #Lancet, show the true global cost of #AMR. We must use these data as a warning signal to spur on action at every level. #AMRSOS 👉 https://t.co/PsGjirim7N pic.twitter.com/o3YEPvcmIb — Prof. Dame Sally Davies (@UKAMREnvoy) January 20, 2022 Meanwhile, a landmark O’Neill Review study has predicted that the death toll from AMR could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now. Disproportionately affects the most vulnerable Tragically, AMR disproportionately impacts the most vulnerable in our world, with much of the burden of AMR deaths occurring in sub-Saharan Africa where access to antibiotics and drugs is generally more constrained as is the laboratory capacity to detect drug-resistant microbes. Lives and livelihoods are at stake, with the World Bank estimating that as many as 24 million more people could be forced into extreme poverty unless we collectively intervene. Without antibiotics, I’ve said (with English understatement), “we would be in a really dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die and so would we humans in rising numbers, as our ability to produce food for the world’s growing population stalls. This is not some sci-fi scenario gorily filmed by Ridley Scott, but a clear and present danger to us all. So, the time to act is overdue. Because, as one colleague has put it: “The superbugs are beating us at a competition we can’t afford to lose.” Fixing market failures Antibiotics being distributed at a pharmacy in India. There are hurdles to be overcome but they are not insuperable with sufficient public health leadership and political will. First and foremost, we need to fix a profound and protracted market failure. There has been no new class of antibiotics discovered in four decades. Chillingly, the World Health Organization (WHO) has identified that the clinical pipeline of antibiotics is insufficient to address resistance because so few drugs in development are truly innovative, or address the most dangerous classes of pathogens. A lack of incentives means that, unfortunately, the small start-ups that are the engines behind innovations can easily fall at the last hurdle or simply go bust – so new antibiotic discoveries never reach the patients who need them most. We must redouble our efforts to find solutions that draw companies back to antibiotic development. The AMR Action Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s biggest pharmaceutical companies. Designated for small and medium biotech firms with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a great start. Now, we need more than this promising initiative. More ‘pull’ incentives The G7 has also committed to exploring ‘pull’ incentives to enable new antibiotics to come to market, and ensure that they are accessible to those who need them most, whilst guaranteeing responsible and appropriate use. I am proud that England has led the way with its pilot scheme involving a subscription payment model for new antibiotics, with robust stewardship requirements. Following this model, the UK Government will start paying drug companies a fixed fee for supplying antibiotics. This will help tackle the growing global crisis over resistance to drugs and ensure that the treatments are accessible to patients enrolled in the National Health Service. A similar model could be adopted in the US in the form of the Pasteur Act before Congress which also offers upfront funding of up to $3 billion. One Health and AMR Inspecting a pig’s health in Busia in western Kenya. Of course, the scope of fighting AMR in the One Health context involves many interventions across a range of sectors. It involves steps to foster more rational, appropriate use of existing drugs for both human and animal health. It also involves the need to prevent zoonotic diseases from leaping the human-animal barrier as a result of ecosystem degradation and poor food safety practices. Similarly, more prudent use of antibiotics and other drugs is critical in the plant health and animal health sector, alongside that of human health. And at the same time, One Health thinking goes way beyond AMR to include the ways we foster healthier, more sustainable development that prevents disease from ever occurring While the term has been with us for two decades or more, One Health concepts have yet to be fully integrated into public health policy-making, as experience with the COVID pandemic and earlier outbreaks such as Ebola has underlined. Last year, I convened The Trinity Challenge, bringing together the private sector and academia, united by the common aim of developing insights and actions to contribute to a world better protected from global health emergencies. Over 340 applicants from over 60 countries shared their creative ideas, and I am proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, empowers farmers to identify and report zoonotic diseases that could potentially pass from animals to humans, triggering another pandemic. Hopefully, we will see more approaches like this in the future. To close the gaps in prevention, preparedness and response, we need a sustained exit from silo thinking and collaboration across countries and sectors. One Health thinking must come with One World policy-making that treats issues such as global food security, animal well-being and environmental sustainability as one paramount priority. We are, truly, all in this together. Dame Sally Davies Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. She was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She served as a member of the World Health Organisation (WHO) Executive Board from 2014-2016, and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR), reporting in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR, serving alongside prominent figures from around the world to advocate for action on AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009. Image Credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith. How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
How Can We Ensure that Health is a Reality for Migrants and Refugees? 04/10/2022 Maayan Hoffman After Eugen Ghita arrived in Greece from his native Romania, he did not have a legal residency document, which meant that he did not have access to any kind of public services, including healthcare. “The first two years health was equivalent to having money,” he recalls, sharing his experience during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “For this reason, it was very difficult to stay healthy in the first six months because there was no program for us as economic refugees.” Today Ghita serves as Human Rights Monitor and President of the Roma Lawyers Association. One billion migrants Lack of documentation, language and cultural barriers and the restrictive policies that more and more governments are implementing represent some of the biggest challenges for migrants and refugees to access healthcare, as Aslanyan discusses with his guest Reem Mussa, Humanitarian Advisor and Coordinator of the Forced Migration Team at Médecins Sans Frontières. Often, the consequences are very severe. “The WHO World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally,” says Aslanyan. “The report highlights migration and displacement as key influential determinants of health and well-being and urges for collective action to ensure that health is a reality for all refugees and migrants.” Mussa emphasises that there are several types of migrants, including those who move countries for study or work purposes. However, those who are in the most vulnerable conditions are usually those who pay the highest price for lack of healthcare. “We know that there’s a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labour migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive,” he says. Separating border control and healthcare services According to Mussa, in order to encourage those in need to seek care – especially those who lack proper documentation – one of the key elements is to maintain a strict separation between border control and healthcare services. Providing primary health care is also essential. “If you exclude people from the health care system, you’re only going to see them when they end up in the emergency room and that becomes a challenge,” he notices. The health journey of refugees and migrants is global health – Global Health Matters podcast Aslanyan and Mussa discuss how many governments are implementing increasingly restrictive policies, including policies that have proven to cause highly negative health outcomes, such as offshore processing. On the other hand, Mussa emphasises how the way many countries have been willing to welcome and care for the influx of refugees from Ukraine is an example of what can be done for migrants and asylum seekers when there is the political will. “People that arrived from Ukraine were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived,” he says. “That’s very key.” Image Credits: Global Health Matters, TDR, Global Health Matters Podcast, TDR. Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. 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Shionogi and the Medicines Patent Pool Reach Agreement on COVID-19 Antiviral Pill 04/10/2022 Kerry Cullinan Shionogi’s ensitrelvir The Medicines Patent Pool (MPP) has signed a voluntary licence agreement with Japanese pharmaceutical company, Shionogi, to enable generic companies to produce its COVID-19 antiviral treatment pill candidate, provided it gets regulatory approval. The pill, ensitrelvir fumaric acid, has already shown efficacy in a phase 2/ 3 trial involving 1,821 COVID-19 patients from Japan, South Korea and Vietnam. Those who were given ensitrelvir once a day for five days recovered 24 hours faster than those who received a placebo, Shionogi announced last week. According to the voluntary licence agreement, the MPP will be able to grant sub-licenses to generic manufacturers to produce the pill for manufacture and supply in 117 low and middle-income countries. “Shionogi will waive royalties on sales in all countries covered by the agreement while COVID-19 remains classified as a Public Health Emergency of International Concern by the World Health Organization (WHO),” according to a statement from the MPP. The agreement, signed on Tuesday at a ceremony at Shionogi’s headquarters in Osaka, is pending regulatory authorisation for the pill. Ensitrelvir is a protease inhibitor created through joint research between Hokkaido University and Shionogi. While clinical trials in Asia through the Phase 2b part of the Phase 2/3 clinical trial in patients with mild and moderate symptoms have been completed, the Phase 2b/3 part of a trial in Asian patients (mainly in Japan) with asymptomatic or mild symptoms is still in progress as it a global Phase 3 trial for SARS-CoV-2 infected patients. “Shionogi is proud to work on such an innovative licence agreement with the Medicines Patent Pool. This licence agreement will allow people in LMICs to have rapid access to ensitrelvir, following appropriate regulatory approvals,’ said Shionogi director Takuko Sawada. MMP executive director Charles Gore said the agreement marked the first with a Japanese company, and it “has the potential to increase the affordable options for people living in LMICs to fight COVID-19 and support our collective efforts to put an end to the pandemic and its unacceptable death toll”. MPP has invited expressions of interest from potential sublicensees based anywhere in the world for sublicences to manufacture and sell ensitrelvir in the licensed territory. It is not the first connection between MPP and Shionogi, however, as dolutegravir, an HIV drug licensed from Shionogi to ViiV Healthcare, has been extensively provided to LMICs through MPP’s agreements with ViiV. Antiviral treatments for COVID-19 are particularly important for many LMICs that have low vaccination rates. The MPP already has voluntary licenses for the two antivirals recommended by the World Health Organization (WHO), with Merck/MSD for molnupiravir and with Pfizer for Paxlovid to help make generic versions of those antiviral drugs available in LMICs. Posts navigation Older postsNewer posts