pfizer
Paxlovid

Pfizer has so far refused an invitation from the Geneva-based Drugs for Neglected Diseases Initiative (DNDi) to cooperate on a study exploring whether the treatment window of its successful antiviral drug, Paxlovid, could be extended from 5-7 days using another drug compound in addition, Dr Nathalie Strub-Wourgaft, Director of DNDi’s COVID-19 Response, told Health Policy Watch. 

DNDi wants to test if the key active ingredient of Paxlovid, nirmatrelvir, could be offered in combination with an inhaled corticosteroid, budesonide, in order to extend the treatment window of the life-saving COVID treatment by two more days, Strub-Wourgaft said in an interview. 

Extending the treatment window is critical for patients in low-income countries because the currently-approved formulation of Paxlovid must be commenced within 3-5 days of COVID symptoms. 

Meanwhile ANTICOV, a major DNDi-sponsored trial of COVID treatments underway in ten African countries, has revealed that one-half of COVID patients present for treatment after the five day cut-off date.  

ANTICOV clinical trial.

That makes the current Paxlovid combination less than suitable for low- and middle-income country (LMIC) conditions, said Strub-Wourgaft. She is one of the coordinators of the ANTICOV Consortium, a group of 26 African and global research organizations engaged in the clinical trial research on novel COVID drugs for LMICs.  

On 15 March, DNDi issued a  public statement expressing its concern that “efforts to conduct urgently needed studies in low- and middle-income countries (LMICs) utilizing the novel oral antiviral, nirmatrelvir/ritonavir (Paxlovid), are being blocked by Pfizer, which developed the drug.

Paxlovid, which uses the common HIV drug ritonavir in combination with nirmatrelvir, has been found to reduce the risk of hospitalization or death by a stunning 89% in patients at high risk of severe COVID-19 disease. But the treatment needs to be taken within three to five days of patients developing symptoms.

According to DNDi, “an interim analysis done in the context of the ongoing ANTICOV clinical trial conducted in 10 African countries showed that of the 1180 patients enrolled, more than half present for care after day 5.

“To overcome this challenge, it is necessary to explore whether using Paxlovid with other drugs could widen the ‘treatment window’ to at least seven days,” DNDi said in its statement.

DNDi also wants to investigate if the drug could be “beneficial for immune-suppressed patients who are the most vulnerable to disease progression but were excluded from phase 3 trials.” 

DNDi, a Geneva-based not-for-profit research and development organisation, works to deliver new treatments on neglected diseases and serving neglected groups in low- and middle-income countries.

Still looking for ways to access nirmatrelvir

DNDi drug development.

Strub, in her comments to Health Policy Watch, suggested that DNDi, which has a good track record of building cooperation with the pharma industry, was still trying to obtain the drug somehow – or even persuade Pfizer to collaborate. 

“We would like to test nirmatrelvir/ritonavir in combination, as well, with inhaled budesonide or maybe fluoxetine (brand name Prozac),” said Strub-Wourgaft. 

“We issued a statement to say that we had asked Pfizer to get access to nirmatrelvir, to work with us on this trial. They denied. We’re continuing to try to get access to this drug.”

“We think this [combination] would extend the window of treatment to seven days of symptoms. In the study that they [Pfizer] have done, which is a great study showing really fantastic results, they looked at patients who had five days of symptoms before they were enrolled. 

“And we have seen for now, in our study in Africa, that half of the patients come after five days of symptoms,” she said. 

Such delays are typical because COVID diagnosis and treatment services are less widely available and it thus takes people longer to get diagnosed, even if they are symptomatically ill.  

“There are critically important public health research questions that must be answered quickly – particularly in low- and middle-income countries where access to vaccines remains low,” added Strub-Wourgaft, in the DNDi statement. 

“It is difficult to understand any rationale for refusing to cooperate in the midst of a global pandemic, and this sets a dangerous precedent since there are many other promising antivirals in the pipeline and these novel treatments will also require follow-on research to determine their optimal use in resource-limited settings.”

MPP deal with Pfizer – not enough 

Pfizer recently signed a deal  with another Geneva-based group, the non-profit Medicines Patent Pool, that will allow  35 new manufacturers to produce and supply generic versions of Paxlovid to some 95 low- and middle income countries – in what the company has said is a move to lower the drug’s cost and expand access in low-income countries. 

But that deal has also been criticised for failing to cover dozens of other middle-income and upper-middle income countries that will have to purchase patented versions of the drug.  

Although Pfizer had also said that it would create a tiered pricing system for Paxlovid, drug price advocates say that the price remains too high in many settings. In the United States, the government pays Pfizer about $530 for a five day course, although the pills also are in short supply in some US communities.   

In addition, most  of Pfizer’s Paxlovid supply for the first half of 2022 has already been bought up by rich countries, meaning that LMICs will only be able to get about 10 million doses of the drug in the near term.   

Pfizer’s Paxlovid Goes Generic in 95 Countries – Too Little, Too Late, say Access Advocates

 

However, even considering the MPP deal and other preferential pricing mechanisms, the fact remains that the version of Paxlovid currently being produced is not an optimal fit for many LMICs, Strub-Wourgaft said.  

“So  for now, if we were to be able to give them Paxlovid, under the current conditions, half of them would not even have access,” she told Health Policy Watch.

MPP deals with generic manufacturers may not enable supplies to ANTICOV 

DNDi is also concerned about the potential difficulty of obtaining generic versions of Paxlovid  to conduct the new ANTICOV combination studies, the company has said. 

“The terms of the Pfizer/Medicines Patent Pool (MPP) licensing agreement to the new generics manufacturers could be interpreted to mean that sub-licensees cannot provide nirmatrelvir/ritonavir for use in the sorts of combination studies that DNDi and others wish to conduct, unless they have explicit written approval from Pfizer.

“Some generic manufacturers are also encountering difficulties obtaining Paxlovid as a ‘reference drug’ so that they can conduct the necessary bioequivalence studies to show regulators that their generic version has the same effect in the body, effectively blocking availability of generics for both research and clinical use”, DNDi added in its statement. It has therefore asked Pfizer to not only provide access to nirmatrelvir/ritonavir (Paxlovid) for the DNDi-coordinated ANTICOV trial and other relevant clinical trials, but also to:

  • Remove any ambiguities or restrictions in the Pfizer-MPP licensing agreement that could prevent sub-licensees from supplying such research studies (or publicly clarify that no such restrictions exist);
  • Provide access to Pfizer’s originator product as a ‘reference drug’ so that any interested generic manufacturer can conduct the necessary bioequivalence studies for regulatory approval; and
  • Allocate sufficient quantities of Paxlovid specifically for LMICs and remove all barriers to access to generic nirmatrelvir/ritonavir to enable scale up for care and treatment in LMICs.

“Every effort should be made to ensure that clinical studies for COVID-19 treatment are conducted in low- and middle-income countries, and that any products developed reach vulnerable populations,” said Dr John Amuasi, head of the Global Health and Infectious Diseases Research Grou at Kumasi Center for Collaborative Research in Tropical Medicine in Ghana and a principal investigator for ANTICOV. 

“We must not arrive at a situation where research priorities are determined by the actions or inactions of any company.”

Pfizer response – committed to well-controlled trials

In response to a request from Health Policy Watch, a Pfizer spokesperson did not provide any clarification of the reasons behind the company’s refusal to participate in the DNDi trial – aimed a making the treatment more suitable to low-income settings.

“Pfizer appreciates the importance of gathering additional data and information for governments to help maximize the public health response to the COVID-19 pandemic,” said the spokesperson, adding that the company is committed to “well-controlled, hypothesis-driven clinical studies that can provide data that will be accepted by global regulatory agencies.

“Additional studies of PAXLOVID are underway or are being explored, and we will continue to share information as we have it,” the spokesperson added.

In addition, “Right now, we are focusing our efforts and resources in a way that maximizes availability of our overall supply, to help ensure access to patients as quickly as possible,” the spokesperson said, noting that the company remains “confident” in the clinical trial results, which showed an 88-89% efficacy rate for the drug, when it was administered to non-hospitalized, high-risk patients within 3-5 days of symptom onset.

-Updated 9 April with correction on the price of Paxlovid paid by the US government for patients in the USA and on 11 April with details of Pfizer response.

Image Credits: Bobbi-Jean MacKinnon, DNDI/Twitter, DNDi.

AI
Machine learning is playing an increasingly important role in computing and artificial intelligence.

TEL AVIV – Ninety percent of drug candidates fail in clinical trials because of unexpected safety issues or lack of efficacy in human subjects, according to Noga Yerushalmi, Investment Director at M Ventures, the strategic, corporate venture capital arm of Merck.

There have been dramatic improvements in omics technologies – that is the collective technologies used to explore molecular behaviour, such as genomics, proteomics, metabolomics, metagenomics and transcriptomics.  And this is enabling scientists to analyze potential drug targets more efficiently in terms of their potential impact on a pathogen or disease. 

But there is no automated solution that harnesses all preclinical data in a way that allows for a reliable assessment of the clinical trial readiness of a new drug candidate.

Now, some pharma and research initiatives are hoping to change that, among them AION Labs.  Together with its German partner BioMed X, the Israeli-based research alliance, hosted 15 teams of computational biologists, AI researchers and biomedical scientists for a ‘boot camp’ that aims to speed up the drug discovery process and lower costs – harnessing AI technologies in novel ways. 

Mission: identify critical safety issues before expensive clinical trial stage 

The latest boot camp cohort

The teams were charged with making a proposal for the development of a versatile, next-generation computational platform that can identify hidden safety liability and lack of efficacy, and close identified gaps in the drug candidate pre-clinical data package. 

“The big problem in drug discovery and development is that after a lot of experiments have been done and we have a new drug candidate, many of these candidates fail in very expensive clinical trials in humans,” Dr. Christian Tidona, founder and managing director of the

BioMed X Institute told Health Policy Watch. “That’s because humans are different from mice or a dish in the lab.”

The challenge is that pharma companies usually only discover that a drug candidate either is not safe or will not work after years of effort and hundreds of millions of dollars of investment. Companies can invest $5 billion and 12-years’ time, on average, Tidona said, to create the next  “blockbuster drug.” 

“When one thinks about these numbers, he can imagine why some of these drugs are so expensive. Could an AI platform predict if a drug is really ready for the clinic and, if not, tell us what was missed before we go to trial?” Tidona asked. “This is the question.

“If drugs can be made more efficiently, medicines can become cheaper and more people in all parts of the world could afford them,” he said. 

Solving therapeutic challenges

Kahina Lang, head of Strategic Innovation at Merck Group, addresses the candidates at the AION Labs boot camp.

Based in Rehovot, not far from the the famed Weizmann Institute, AION brings together some of the biggest names in pharma, including AstraZeneca, Merck, Pfizer, and Teva, with young biotech inventors and entrepreneurs, to crack biomedical research challenges together and in a novel way. 

“We work with each of our pharma partners separately and then together to identify the top research challenges that solving would be majorly impactful for the industry at large,” AION CEO Mati Gill told Health Policy Watch. Then, AION looks for innovators and scientists to develop solutions for them.

For last week’s boot camp, 15 applicants from around the world were selected to come to Israel and participate. 

“The winner receives a $2 million investment, mentorship and access to a wealth of data for model training from these four big pharma companies,” Tidona said. “It is more or less paradise for anyone who wants to start a company.”

The concept is based on a model Tidona first developed on the campus of the University of Heidelberg in Germany, with a world-wide network of partner locations. 

If the company succeeds, the technology belongs to it but will be made available for purchase by the pharma partners. 

‘Bringing the promise of AI to fruition’

Guy Spigelman of AWS addresses candidates at the AION Labs bootcamp.

Merck’s Yerushalmi said that there have been “all kinds of efforts to make the drug development model more efficient – to expedite it,” but until now it has not worked. When computational approaches to research were first introduced, “it brought a lot of promise, but until now it has not brought as much fruit as we hoped. Now, with AI tools and the amount of data pharma and other companies can generate, we do hope we may be able to bring this promise to fruition.”

AI is one of the most sophisticated computational tools. AI analysis has brought “ingenious” solutions to other fields, like the automotive industry, she pointed out. 

“AI tools and big data have proven themselves in so many other cases, I think it will probably work for our industry too,” Yerushalmi said. “Want to make [drug development] more affordable and shorter, so we can bring drugs to the market faster and cheaper for the benefit of humanity.”

Finding the most effective antibodies 

AION will be looking for the next therapeutic antibodies.

This most recent boot camp was AION’s second one so far. Earlier this year, it invited computational biologists and biomedical scientists to propose ideas for discovering therapeutic antibodies.

“Advances in protein structure prediction, artificial intelligence algorithms, and increased availability of experimentally determined antigen-antibody structures present a unique opportunity for AI-driven antibody discovery,” AION said in a release. 

In the coming months, it will hold a third boot camp at which computational biologists, bioinformatics and cheminformatics scientists and AI researchers will propose ideas for the development of a next-generation computational platform to optimize antibodies for targeted therapies with enhanced properties, including developability or manufacturability, stability, aggregation, immunogenicity, pharmacokinetics and tissue distribution. 

“The ultimate solution is an AI platform that receives sequences of binders and generates novel variants with optimized IgG sequences, biophysical and targeting properties,” a background briefing explained. “The goal of the AI algorithm is to make an existing antibody a better drug while reducing design iterations, optimization of cycle times and lowering attrition rates.”

CEPI launches AI-based quest for beta-coronavirus vaccine candidate 

The AION initiative, while pioneering in the use of AI for drug discovery, is not the only one. 

On Thursday, the Oslo-based Coalition for Epidemic Preparedness (CEPI) announced that it would provide seed funding of up to US $4.8 million to a consortium to support the AI-based development of betacoronavirus vaccine candidates – the new holy grail for coronavirus vaccines. 

The research consortium, led by a Norway-based subsidiary of the Japanese NEC Group, which specializes in AI technologies, also includes the European Vaccine Initiative (EVI) and Oslo University Hospital. 

It aims to establish preclinical proof of concept for an mRNA-based vaccine that protects against a broad range of beta coronaviruses – rather than SARS-CoV2 alone, said CEPI in a press release.

NEC will apply its experience in the AI design of immunogens to identify novel vaccine antigens with broad reactivity against beta-coronaviruses. The lead antigens will be selected iteratively and validated in preclinical studies against known beta coronaviruses that already pose a significant epidemic or pandemic risk, such as SARS-CoV, SARS-CoV-2 and MERS-CoV.

 If the approach is successful, it may also be applicable for developing vaccines against other pathogens in the CEPI portfolio, including ‘Disease X’ – unknown pathogens with pandemic potential that have yet to emerge.

What the future holds

What the future of AI holds.

Tidona, for his part, hopes that AION will spin off 20 new start-ups in the next four to six years. 

“We are building an innovation ecosystem,” he said, noting that it is attractive to host countries as it provides a draw for youthful talent, which in turn spurs economic development. 

He added that if the model works well, BioMed X plans to export it to other countries as well.

“The focus now is on Israel as our first partner outside Germany,” Tidona said. “But in the future, we hope to have sites” in other places, too.

Image Credits: https://www.flickr.com/photos/mikemacmarketing/42271822770/, AION Labs, Elad Malka, Twitter: @WHO, https://www.flickr.com/photos/158301585@N08/43267970922/.

WHO argues that climate-smart initiatives are good for health. But the health sector receives  less than 1% of international climate finance, said Prof. Guéladio Cissé, Coordinating Lead Author of the Intergovernmental Panel on Climate Change (IPCC).

Global health leaders have repeatedly called for stepped up investments  to  both slow down climate change and recognize the health co-benefits of more climate action.  

But political leaders, including those in low and middle-income countries, still need to do more, Prof. Guéladio Cissé, Coordinating Lead Author of the Intergovernmental Panel on Climate Change (IPCC) told Health Policy Watch in a briefing on Thursday, World Health Day. 

Meanwhile, WHO’s Regional Director for Africa, Matshidiso Moeti, enjoined African governments to “prioritize human wellbeing in every strategy and decision,” including halting fossil fuel expansion that ultimately will boomerang on the countries concerned.  

“I’d like to take this opportunity to call on an African governments to prioritize human wellbeing in every strategy and decision to halt new fossil fuel exploration and subsidies, institute taxes for polluting firms and to implement the WHO air quality guidelines for example,” said Moeti, speaking on this year’s World Health Day theme, ‘Our Planet, Our Health.’

Added Cissé, countries that harness more of their own national and local policies, innovations and resources can make a difference. 

“Countries can go for some financial incentive policy at a national scale that includes taxes and subsidies; they can also have some innovative policies regarding insurance. They can also give some small scale financial products to low income and other households,” Cissé said.

Support to health sector less than 1% of international climate finance  

Experts are increasingly aware of the multi-faced impacts of the climate crisis on health – as well and the increased precarity of health in the face of deforestation and biodiversity loss as well as  unhealthy foods production – which are also driving climate change. 

So far, however, support to the health sector for climate action still comprises less than 1% of international climate finance investments, Cissé said, speaking at a WHO African Region World Health Day briefing. 

Health co-benefits of climate mitigation strategies – for instance fewer air pollution-related deaths from cleaner energy investments, also go uncounted in climate strategies. 

This, despite health being mentioned as a priority in 54% of countries’ Nationally Determined Contributions (NDCs), which are the main instruments now being used for global climate pledges to reduce harmful emissions, under the UN Framework Convention on Climate Change.   

Cissé who works with the Swiss Tropical and Public Health Institute at the University of Basel in Switzerland, noted that this reflects the low priority still being given to climate change in the context of health.

World Health Day at a time of heightened conflict and fragility

Joint press conference in Washington DC with US Secretary of Health and Human Services Anthony Becerra (center) and WHO Director-General Dr Tedros Adhanom Ghebreyesus (right)

This year’s World Health Day, which marks the April 7, 1948 date of WHO’s founding, comes at a time of both heightened political conflict and greater ecosystem fragility, noted WHO Director-General Dr Tedros Adhanom Ghebreyesus. He was speaking at a joint press conference in Washington DC with US Secretary of Health and Human Services Anthony Becerra.  

“The pandemic has highlighted the intimate links between the health of humans, animals and the environment. And yet, we’re rapidly making the planet on which all life depends and inhabitable… 

“The climate crisis is a health crisis,” Tedros said at the Thursday briefing, which concluded a series of face-to-face meetings this week with US Administration officials – the first since President Joe Biden’s inauguration last year.  

”Air pollution kills 7 million people every year. And 99% of the world’s population breathes unhealthy air mainly as a result of burning fossil fuels,” Tedros added. (see related story)

“Our warming world is facilitating the spread of mosquitoes and diseases they carry. Extreme weather events, biodiversity loss, land degradation, and water scarcity are displacing people and damaging their health,” Tedros said. 

“Systems that produce highly processed, unhealthy foods are driving a wave of obesity, increasing cancer and heart disease, and generating one-third of greenhouse gas emissions.

“As the world recovers from the pandemic we have a choice: we can go back to the way things were or we can change course. We can create societies, economies and products that nurture health and well being, and stop subsidizing those that destroy – because we cannot afford to pump carbon into the atmosphere at the same rate, and still breathe clean air.

“We cannot afford the same patterns of consumption and expect less diabetes, hypertension, heart disease and cancer. We must choose.  We cannot afford ever-deepening inequalities and expect continued prosperity. We must choose.” 

Half new fossil fuel exploration and subsidies, prioritize health, says WHO Regional Director

Water shortage in Ethiopia. Population exposure to heat is increasing due to climate change. Globally, extreme temperature events are observed to be increasing in their frequency, duration, and magnitude.

In Africa, one of the regions of the world that is worst affected by climate change, extreme weather events are having ever greater impacts on food security, water access, and related to that, nutrition and disease transmission. 

Of the more than 2000 public health events recorded in the African region between 2019 and 2020, more than half were climate-related, said Moeti, speaking from WHO’s Regional Office in Brazzaville. This, she said, represented a 25% increase compared with the previous decade.

“In Africa, diarrhoeal diseases are the third leading cause of death and illness in children younger than five, which could be preventable with safe drinking water, adequate sanitation and hygiene, and installation,” Moeti said. “Our analysis showed that waterborne diseases, mainly due to cholera outbreaks, accounted for 40% of climate-related health emergencies in the past 20 years.”

In urging African governments to adopt cleaner, healthier policies, she said the main motive is really self-preservation. 

“Älthough Africa contributes the least to global warming, the continent bears a disproportionate burden of the consequences,” said Moeti. “It’s up to every one of us to promote and support multi-sectoral interventions that address the threat of climate change, while helping to better prepare for future health shocks like the COVID-19 pandemic.”

Image Credits: Oxfam East Africa.

ukraine
WHO Regional Director Hans Kluge, speaking from Lviv, Ukraine

In a highly symbolic visit to Lviv, Ukraine, World Health Organization Regional Director Hans Kluge reaffirmed WHO’s commitment to rebuilding the country’s war-torn health system.  

Speaking in a press briefing staged directly from Lviv, Kluge said, “We are committed to work through a decentralized footprint [in Ukraine], both during the current humanitarian response but also to be there with local and national authorities to rebuild the war-torn health system.”

Kluge’s presence in Western Ukrainian city for the briefing demonstrates an important sign of moral and even political support from WHO, for the country which was invaded by Russia on 25 February, and has endured massive bombing of cities, health facilities, as well as the direct targeting of civilians in a range of incidents that some western politicians say amount to war crimes. 

“Health requires peace. Well-being requires hope, and healing requires time. I speak on behalf of the entire WHO family when I say that it is my deepest wish that this war comes to an end swiftly without further loss of life,” said Kluge.

The European Regional Director said hw was using the visit to the city, on the border with Poland, that has served as a comparative refuge for Ukranians fleeing areas under intense bombardment, in order to speak with frontline health workers, patients, local and national authorities in order to gather insight on both the immediate and longer-term health needs of Ukraine.  

“The life-saving medicine Ukraine needs right now is peace,” Kluge emphasized. 

Almost 100 attacks on health care across Ukraine 

In Kharkiv, there are more than 200 pregnant women left in the underground maternity hospital.

Forty-three days into the Russian invasion, coinciding with World Health Day, the country has seen devastation across its health system, with WHO verifying 91 attacks on health. 

Kluge referred to this as a “clear breach of international humanitarian law.” 

“A health facility has to be a safe place.” 

Additionally, half of all Ukrainian pharmacies are presumed closed, and 1000 health facilities are in proximity to conflict areas or in changed areas of control. 

Routine immunization coverage for measles and polio is below the threshold for population immunity.

Frontline health workers are also impacted by the conflict, with members of the International Committee of the Red Cross (ICRC) released by Russian forces Tuesday after trying to enter the besieged coastal city of Mariupol. 

“We have to prepare for different eventualities, anticipating that health challenges will get worse before they get better,” said Kluge, reiterating WHO’s commitment to be in Ukraine for the long and short-term to address immediate health challenges and future reconstruction.

WHO working to support Ukrainians in and out of country 

Jarno Habicht, WHO Reprsentative in Ukraine

WHO is currently working to keep health services operational in the country, working closely with national and local authorities, and more than 80 partners to maintain services. 

Over 185 tons of medical supplies have already been delivered to the hardest hit areas of the country, reaching half of a million people with materials to support trauma, surgery, and primary health care. 

“From the health perspective, it is very important that we ensure access to health care in the same way we are asking for humanitarian convoys,” said Jarno Habicht, WHO Representative in Ukraine.

Essential supplies to the northeastern city of Sumy, besieged by Russian troops, have been delivered last week, with an additional 125 tons of medical supplies also on their way. 

Assistive products, including wheelchairs, mobility aids, communication aids for the blind, are also in transit and will be distributed across Ukraine soon. 

WHO is also coordinating with the European Union and national authorities of other countries to extend health services to an estimated 4.2 million people who have fled Ukraine since 24 February.

This includes offering routine childhood immunization, and equipment and supplies needed to manage COVID-19 and other communicable diseases such as measles and polio. 

Working to ‘Not Lose the Momentum’ Against TB and HIV

Prior to the invasion, Ukraine had seen excellent progress in its fight against tuberculosis and HIV, with Kluge praising Ukraine’s model TB programme.

“Ukraine was a beacon of best practice in Europe, with TB incidence falling by almost half in the past 15 years.”

The country had significantly reduced its TB cases from over 127 cases per 100 000 people in 2005 to just 42.2 cases per 100 000 people in 2020. 

Despite the war, WHO is determined to support Ukraine and not lose the momentum against TB, with WHO teams prepared to redeploy throughout the country as access and security improves. 

WHO will also be working together with the US President’s Emergency Plan for AIDS Relief (PEPFAR), and Ukrainian authorities and other partners to ensure the supply of antiretroviral drugs to cover the needs of an estimated 260 000 people in Ukraine will be met for the next 12 months. 

A delivery of 209 000, 90-day supplies of antiretroviral medicines has arrived in Lviv, Ukraine ready to be distributed, UNAIDS said on Wednesday. However, distribution within Ukraine is set to be a challenge, particularly in conflict areas.

Image Credits: UNICEF, Hanna Liubakova/Twitter.

who covid
Dr Matshidiso Moeti: Africa’s decision to prioritize testing symptomatic individuals meant that most asymptomatic individuals infected were not detected.

Nearly two-thirds of Africans have already been infected with SARS-CoV-2 — the virus responsible for COVID-19, WHO said, announcing the release of a new assessment of virus seroprevalence on the continent.  The analysis, a systematic review of some 150 studies, was published on the pre-print server, medRXiv.org.

Addressing a press briefing on Thursday, Dr Matshidiso Moeti, WHO Regional Director for Africa said the WHO study demonstrates that there had been some 800 million infections as of September 2021 – nearly 100 times greater than the 8.2 million cases reported at the time.   

To arrive at the estimate, WHO synthesized the results of 151 studies published on virus seroprevalence in Africa between January 2020 and December 2021. It found that blood samples with SARS-CoV-2 antibodies skyrocketed from about 3% in June of 2020 to 65% by September of 2021. Exposure to the virus rose sharply following the emergence of the Beta and the Delta variants, she said. And that data doesn’t even consider the big Omicron wave of infections that hit countries in southern Africa in early December and continued into early 2022. 

The study is the first systematic review of disease incidence in the region that has consistently shown the lowest COVID infection rates – but is also plagued by an overall lack of reporting of health data generally on major diseases as well as deaths. 

The study was carried out by a team of scientists from WHO’s African Regional Office, WHO Headquarters in Geneva, and a group of Canadian scholars from McGill University, University of Calgary and elsewhere. 

It’s unusually broad in scope, covering data from some 22 of the continent’s 54 WHO member states (the African Union counts the disputed Sahrawi Arab Democratic Republic in Western Sahara as its 55th member). More significantly, the studies cover countries that include some 71% of the continent’s roughly 1 billion inhabitants. And it includes data from all of Africa’s major geographical regions – all of which had very different experiences with COVID response.   

The Ghana experience

One of the West African studies considered in the report was carried out in Ghana, by a research team including Dr Irene Owusu Donkor, a postdoctoral fellow at Ghana’s Noguchi Memorial Institute for Medical Research.

Appearing at the briefing, Donkor noted that her team conducted the study between February and December 2021 to measure seroprevalence of COVID-19 among 6,000 individuals spread across Ghana’s rural and major urban areas. The results yielded a 68% rate of seropositivity, which means that 68% of the people tested had been exposed to the SARS-CoV-2 virus. 

“We also saw that males and females have the same levels of exposure. However, we saw that people aged between 15 to 19 years were the most exposed,” Donkor told journalists.

Testing policy responsible for significant underreporting

Moeti attributed the significant underreporting in Africa to the prioritization of symptomatic individuals for testing, due in part to the shortage of COVID tests and challenges in rolling out COVID tests very widely at key stages of the pandemic. She said this meant that Africa’s reported cases are not true reflection of infections considering not every infected person shows symptoms.

“In Africa, the focus was very much on testing people who were symptomatic when there were challenges in having access to testing supplies. We are under-representing the true number of people who have been exposed and infected by the virus,” she told journalists. 

She however noted that this is not peculiar to Africa as experts presume that there has been significant underreporting of COVID infections in countries.  For instance, while there have been about 495 million reported COVID infections worldwide, to date, the latest WHO estimates, are that some 45.2% of the world’s 7.9 billion people were likely infected by the virus as of September 2021, she said.

“We do know, however, that fewer studies are conducted in Africa than elsewhere. The production of accurate data in Africa is further complicated, because 67% of people with COVID-19 on the continent have no symptoms,” Moeti added. 

Donkor called for more seroprevalence studies and to continue with routine surveillance to ensure that cases are quickly detected while also using the waves that have been seen so far with the various variants to put the pandemic in check.

Moeti told Health Policy Watch that the implication of this finding is the need for the expansion of surveillance for COVID-19 on an ongoing basis in African countries.

“It’s very important for governments and partners and even populations to know the actual situation — to know something that is closer to the true situation because it is this that’s going to guide the preparedness and the adjustment of prevention measures as the situation continues to evolve,” she told Health Policy Watch.

WHO publication of global estimate of COVID cases, still pending 

WHO is supposed to be preparing for the publication of a formal global estimate of actual COVID cases, which highlights the worldwide problems with COVID under-reporting at the end of this month, sources told Health Policy Watch.  Originally that publication was to have been issued at the end of March, but it has been delayed, the sources said.  

As with the publication of any WHO data, political issues involving member state agreement can lead to the delay, and even censorship, of what are supposed to be professional WHO assessments. 

 

COVID-19 testing in Shanghai

China’s COVID-19 situation is getting worse, and strategies to control the spread of the Omicron variant are getting stricter as the country registered 20,472 daily cases on Wednesday – the highest-ever infection rate.

The epicentre of the outbreak is Shanghai, which recorded 17,007 cases on Wednesday and municipal authorities are conducting mass testing in the city populated by 26 million in an attempt to identify infected people and place them under quarantine.

Shanghai authorities have also been separating SARS-COV2 positive young children under the age of seven from their parents. According to reports, and videos on the Chinese microblogging application Weibo, children have been separated from their COVID-19 positive parents in Shanghai’s Jinshan district. 

The incidents of separation of young children from their parents were reported to be from the Shanghai Public Health Clinical Centre. This separation is a part of China’s strict zero-COVID strategy, a policy that has now been questioned for being overly regimented. 

Even as Shanghai health authorities continue to defend the policy of separating COVID-19 positive children from their parents, they clarified on Monday that if parents of COVID-19 positive children also test positive, they can isolate together and will not be separated. 

Wu Qianyu, an official from the Shanghai Municipal Health Commission said that according to the Law on the Prevention and Control of Infectious Diseases and the requirements for prevention and control work, infected people should be isolated from non-infected persons.

“In accordance with the principle of classified treatment, we have made it clear that if the parent of the child is also a positive infected person, they can live in the children’s area to accompany and care for them and receive observation and treatment together.” 

Zero-COVID policy under scrutiny

China is under scrutiny for sticking to its zero-COVID policy which includes strict isolation for those with COVID-19, contact tracing, and long lockdowns with very little movement allowed in cities with perceived outbreaks. If your area has been identified for mass-testing, you  cannot leave the home for any reason. 

Professor Antoine Flahault, Director of the Institute of Global Health at the Univerity of Geneva’s Faculty of Medicine, said that China’s “zero-COVID approach seems to continue to be effective up to date, at least in terms of reported numbers of contaminations and deaths which remain very low in comparison to other countries”.

According to Flahault, China fears a “Hong Kong scenario” since they share the same weakness in their vaccine coverage, with low uptake among the elderly population. Currently, only 50% of the population over the age of 80 is vaccinated in Hong Kong. 

Hong Kong has experienced a huge Omicron wave with one of the highest death tolls in the world that has overwhelmed health care system after the region gave up its zero-COVID strategy. 

“Continental China’s authorities believe they have no other choice today than maintaining their zero COVID strategy to avoid similar health disaster,” said Flahault.

China is one of the few countries where the zero-COVID strategy is still in action. Australia, Singapore, New Zealand also tried this approach but have abandoned it, Dr Flahault said. 

Weaker vaccines

“Hong Kong followed them in the midst of their crisis, but China and to a lesser extent Taiwan decided to keep it [zero-COVID strategy]. China probably hesitated and was expected to switch to suppression strategy after the Olympic Games,” he said. “Even as the strategy to suppress was less stringent than an elimination strategy, the Omicron variant changed the rules of the game.”

One of the disadvantages China faces is that immunity gained from two doses of its vaccines, Sinopharm and Coronavac, is only about 56% on average, while the mRNA vaccines, Pfizer and Moderna, have over 95% protection, said Sayantan Bose, Principal Scientist of Virology at Autonomous Therapeutics in the US.

Bose added that China is extremely capable of carrying out mass vaccinations and the regime could very effectively vaccinate the whole population with a third dose which would boost the immunity to a “large extent.”

“Ultimately, the virus has infiltrated the human population to such an extent that it will not completely disappear ever. We just have to figure out the best way to deal with it.”

According to the state media CCTV, China’s zero-COVID approach has “proved effective and necessary” in curbing the spread of the virus despite the recent flare-ups of the epidemic in multiple places across the country. 

Isolated in Shanghai

Shanghai is turning an exhibition centre into a COVID-19 hospital

Currently in Shanghai, all those who test positive for the disease – irrespective of whether they are symptomatic or asymptomatic – have to be isolated at a facility. This has brought fresh fears to people who will be separated from their young dependent children. Isolation is not limited to adults but also to children who test positive but whose family members do not. 

In its crackdown over the dominant omicron variant of SARS-COV-2 that has taken over the major financial hub, Shanghai has converted multiple hospitals, gymnasiums, apartment blocks and other venues into central quarantine sites. Further, according to media reports, Individuals who refuse to be tested for COVID for no justifiable reason will face administrative or criminal punishment. 

Shanghai’s lockdown was supposed to end this week, but it has been extended and military personnel have been deployed to Shanghai to assist in the mandatory screening. 

The images from the Shanghai health centre showed several young children crammed together in rooms with cribs and beds. The health centre, according to media reports, verified the images and said they were real and did not deny the separation of parents from their children. However, after gaining traction and attention of many shocked citizens, the post showing the reality of the children’s separation in Shanghai was deleted. 

According to a report in Reuters, children as young as three months old are being separated from their breastfeeding mothers. In a video shared by a popular Chinese science writer, children can be seen separated and crying in the health centre:

Booster doses are ‘a must’

Last week, China’s National Health Commission published new guidelines that narrowed down the geographic scope of mass testing and said that local governments must aim to complete testing of each designated area within 24 hours.

Such changes in protocols come after Chinese President Xi Jinping has pledged to achieve “maximum prevention and control” while minimising damage to China’s economic and social development earlier last month. 

According to Flahault, China seems determined to continue its zero-COVID strategy and make it a success, whatever social and economic costs.  

“It was a policy which was waiting for the vaccines, but vaccines never allowed for substantially contributing to elimination. By stubbornly continuing with the elimination strategy, Chinese authorities have no other choices now but to implement very tough measures which may become highly unpopular, and even strongly rejected by the population,” said Flahault.

However, Bose says that “it does seem like the zero-Covid policy is outdated as it is impossible to completely stop the virus from spreading in the population, even if you manage to vaccinate every single person in China”.

He said that, according to recent reports, immunity from these vaccines is waning quickly in China and a third dose is a must. 

“So overall, it appears that at this point in the pandemic, the Zero-Covid policy seems like more of a burden to the suffering population. It is unlikely to yield further success and in the end could just add to the suffering of the people and their lives could be further pushed into poverty,” said Bose.

Complex and difficult path out

Jeremy Farrar, Director of the  Wellcome Trust

Meanwhile, Jeremy Farrar, director of the Wellcome Trust, gave credit to China for having succeeded in controlling its COVID-19 pandemic with “minimal loss to life and impact on their broader health systems”.

“China have managed to control the pandemic to the point that there is no natural immunity.  Effectively they’ve had no real waves of this epidemic,” Farrar told a media briefing called by the International Monetary Fund on Tuesday.

However, he added that the vaccines China was using were “not quite as effective as some of the vaccines available in other parts of the world” and it had struggled to vaccinate “their most vulnerable populations, particularly people over the ages of 70”. 

“China has a very complex and difficult path out of this pandemic. What I hope that they do is to use the current programme of trying to reduce transmission whilst having a very active and inclusive ability to get vaccines out to everybody, particularly those who are most vulnerable. If they can buy time, like New Zealand did like Australia did, to get their vaccine programme out to as many people as possible including booster doses, I think that gives them the best strategy of trying to exit from the pandemic,” said Farrar.

Image Credits: CGTN, Wellcome Trust.

ICRC members prepare to deliver emergency supplies in Ukraine

Just as members of the International Committee of the Red Cross (ICRC) in the besieged Ukrainian city of Mariupol were released on Tuesday  by Russian forces, the humanitarian organisation warned that its resources are going to be strained in the coming months as it deals with the crisis in that country.

Dr Micaela Serafini, ICRC’s head of health, told Health Policy Watch that “until now we had reserves, but these are expected to be stretched too thin in the coming months. I think we will start to see the impact Ukraine will have on other emergencies we are trying to deal with, such as in Afghanistan or Myanmar.”

Meanwhile, the ICRC is juggling a range of other related new and old challenges, from the impact of climate change and planetary health on humanitarian crises to the challenge of assisting populations experiencing food insecurity as a result of war. 

These are all topics that ICRC will be addressing at the Geneva Health Forum, which takes place 3-5 May. This year’s forum will host six ICRC speakers, including a keynote address by ICRC president, Peter Maurer, and sessions ranging from Planetary Health, to Innovation in the humanitarian context.  

Serafini, an Argentinian-trained medical doctor, has been working in the humanitarian sector for 15 years. Before joining the Red Cross in January 2021, she served as medical director for Médecins Sans Frontieres (MSF). Her aim has been to influence international health policies to the benefit the most vulnerable patients and communities. 

In conflict zones, everyone suffers, but the weakest populations tend to suffer the most, she explained.

The main challenge is access

The ICRC health division was formed under the terms of the four treaties of the Geneva Conventions, and particuarly the Fourth Geneva Convention of 1949, as well as related protocols, which set out international legal standards for humanitarian treatment of combatants and civilians in war zones, Serafini explained. Aside from providing care, the organization strives for open dialogue with all parties in conflicts to ensure the protection of civilians and healthcare personnel, including their safe passage through conflict zones. It also strives to ensure that prisoners of war are given access to healthcare and are treated with dignity.

The organization has been active in Ukraine since 2014, but has scaled up its activities since the 24 February invasion. 

“I am worried about our employees in Ukraine,” Serafini admitted during a recent call, saying that the main challenge in Ukraine has been “access.”

“The security aspects make us go slowly, and it is sometimes impossible to get to that specific last line where most of the needs are,” Serafini said. “While we managed to get close to the frontline, we are not really close enough to those who are trapped in Mariupol, for example, or sometimes even parts of Kyiv.”

The ICRC is operating a hotline in Ukraine where people can call and get virtual help. 

Part of the challenge is that humanitarian space has reduced with time and health structures and health staff have become more of a target than they were before, she explained, noting that even if healthcare workers are given access to vulnerable people, they are not necessarily accepted or protected. 

“There are incidents in places that should be protected by international law and they are not protected anymore… Respect for international law is not as present as it was before. Of course, this makes the need for ICRC more important and present.”

Three-phase emergency response

An emergency has three phases, she said. The first is coming up with “bulk support” when the needs are still unclear, so you are just trying to help with whatever you can. The second phase is where you “fine tune the need” because you understand better, and the third phase is when you consolidate those needs.

“We are still in the first phase,” Serafini said. “Today, it is difficult to say if we had an impact or not.”

See the full GHF 2022 programme. Register here: Rates are tiered and early-bird fees range from CHF 300-100 for the in-person event, and CHF 200-70 for digital participation. Daily rates are also available.

This is part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum.

 

Image Credits: ICRC.

Rwanda, Africa
A volunteer helps a woman fill out paperwork before her COVID-19 vaccine in Rwanda.

Although the world is facing multiple simultaneous challenges including the war in Ukraine, the COVID-19 pandemic is not over and it is essential for countries to invest in systems to address this pandemic as well as future pandemic threats.

This is a key message of a new International Monetary Fund (IMF) paper, which is calling for an investment of $15-billion this year and $10-billion per year in future to fight COVID and other pandemics, as well as strengthening health systems. 

Gita Gopinath, the IMF’s First Deputy Managing Director, said that these figures pale in comparison to the cost of COVID-19 the world economies, estimated to have reached $13.8 trillion by January. 

Gopinath was speaking at the launch of an IMF paper published on Tuesday in partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Fund, and Wellcome Trust, which calls for a more comprehensive and integrated pandemic response from the international community.

“It is now clear that COVID-19 is likely to be with us for the long-term. Given the many possible scenarios for the evolution of COVID-19, from benign to severe scenarios, and given the limited resources countries have, we need a new strategy,” said Gopinath, adding that the focus could no longer be only COVID-19 alone – or vaccines alone.

“Countries need a more comprehensive COVID-19 toolkit for fighting the pandemic that includes vaccines, tests, treatments – and bolstering the resilience of health systems so they are in a better position to tackle both COVID-19 and other deadly diseases in a sustainable, effective way.”

Vaccination plateauing, Africa lacks absorption capacity

Gopinath conceded that over 100 countries are not on track to get to 70% vaccine coverage by the middle of this year, including the United States, which is plateauing at 65%.

“Many other countries, including African nations, are plateauing at much, much lower numbers. And we know that the Africa Centre for Disease Control has also called for a halt to sending vaccines because they are facing absorption capacity and vaccine hesitancy,” said Gopinath.

Peter Sands, Executive Director of the Global Fund, said that while vaccines have been, and remain, our most powerful weapon in the fight against COVID 19, the world needs a more comprehensive response. 

“The inequities in vaccine distribution have actually been exceeded by the inequities in, say testing, or the provision of oxygen. And we now have the prospect of novel antivirals that could also have a very significant impact on mortality,” said Sands.

“The advantage of moving from vaccine-only or very heavily vaccine approach to one which is kind of vaccine-plus, with a great with more emphasis on these other aspects of the response, is that it’s more resilient. It gives you better ability to detect variants, and also more resistant to different types of variants that might evolve,” said Sands.

However, vaccination of the most vulnerable people was of “utmost importance” – but there are “no silver bullets”, and a multi-pronged approach, Gopinath stressed.

The IMF has indicated that it is considering establishing a Resilience and Sustainability Trust (RST) to provide affordable long-term financing to support countries as they tackle structural challenges, including pandemic preparedness.

One in 12 Londoners have COVID

Wellcome Trust director Jeremy Farrar said that one in 12 people in London were infected with COVID-19, and the pandemic was clearly far from over.

“We have many parts of the world without access to vaccines, and we have many parts of the world where transmission remains very, very high. That throws up the possibility of new variants that will escape our current vaccination and current immunity,” said Farrar.

“The actions that we take now, the reforms that we put in place, the financial support we give, will enable a pandemic and its acute phase to come to an end quicker and allow all our societies, all of our economies to get back on track faster,” he added, warning that without an adequate response, COVID-19 would “continue to reverberate and disrupt the whole of societies for many, many years to come”.

Farrar said that the “last thing” that should happen is for vaccine manufacturing capacity to be scaled down.

Image Credits: WHO.

A Somali boy struggles to get water amid the country’s climate-related drought.

Global greenhouse emissions need to peak before 2025, at the latest, and decline by 43% by 2030 if the goal of limiting global warming to 1.5°C is to be achieved, warned the Intergovernmental Panel on Climate Change’s (IPCC) Sixth Assessment  report on Climate Change Mitigation (AR 6) launched on Monday.

More aggressive investments to replace fossil fuels with renewable energy, along with zero emissions buildings; more compact, walkable cities; and massive reforestation projects are key to achieving the needed changes, the report states.  This along with a stronger emphasis on sector-based emission targets and carbon taxes, the experts stated, etching a way forward for how such changes could actually be accomplished.

But without immediate and deep reductions, limiting global warming will be beyond reach, states the report, authored by some 278 scientists from 65 countries.  

Although the IPCC experts were upbeat about dramatic reductions in the cost of solar energy and electric batteries of up to 85% in the past decade, along with a 55% decline in the costs of wind-driven energy, there was not much other good news.

While the rate of increase in climate-warming emissions was 1.3% between 2010 and 2019, in comparison to 2.1% in the previous decade, progress is far two slow, the lead authors of the report said at a press briefing. 

Jim Skea, co-chair of Working Group 3 which produced the report, said that without “immediate and deep [global greenhouse] emissions reductions across all sectors”, it would be “impossible” to limit warming to the 1.5°C (2.7F) target that was set forward at the 2015 Paris Climate Agreement.

Global warming 2022

Sector-by-sector policy commitments more effective than national government pledges

On the brighter side, the report documents that sufficient options exist to slash emissions by one-half or more by 2030 based on existing, affordable technologies.

“Specific sector-by-sector policies to reduce emissions” might, however, prove more effective as a global mitigation strategy than the voluntary pledges made by countries in the form of nationally-determined commitments (NDCs), said Diana Urge-Vorsatz, vice-chair of the IPCC’s Working Group 3, which produced the report.

Singling out the energy and transport sectors and cities as major emitters, the report underlines that a shift away from fossil fuels needs to be a cornerstone of climate policies.

By 2050, coal consumption needs to fall 95%, oil use by 60% and natural gas consumption by 45% over 2019 consumption levels the report underlines. Those are targets far higher than the commitments countries made at the 2021 Glasgow Climate Conference, where India insisted that the final statement refer to the “phase down” of unabated coal use and related subsidies, rather than the “phase-out”.  Although Prime Minister Narendra Modi grabbed the headlines in Glasgow when he announced that India would achieve net-zero emissions by 2070, NITI Aayog, India’s government think tank has meanwhile projected that coal-based electricity generation would continue to rise until 2040. 

Other energy-related IPCC proposals include widespread electrification, improved energy efficiency, and the use of alternative fuels such as hydrogen. 

Cities produce two-thirds of emissions

In terms of energy efficiencies, cities, which produce two-thirds of global emissions, could become a nexus for change by promoting more compact, walkable neigborhoods, electrifying public transport and requiring “green buildings” that can resist both extremes of heat and cold through better insulation; ventilation for cooling; and more strategic use of greenery on roofs and walls for both heating and cooling. 

In cities, networks of parks and open spaces, wetlands and urban agriculture can reduce flood risks as well as urban “heat-island” effects, the report notes. Heat waves often leave cities several degrees centigrade warmer than the surrounding countryside due to vast expanses of concrete and heat-trapping buildings – and climate change is making this worse.

“We see examples of zero energy or zero-carbon buildings in almost all climates,” said Skea. “Action in this decade is critical to capture the mitigation potential of buildings.”

Industry, which produces around a quarter of global emissions, needs to use materials more efficiently, including “reusing and recycling products and minimising waste”. 

Achieving net-zero emissions will require new production processes, low and zero emissions electricity or hydrogen powered processes, and, where feasible, carbon capture and storage.

Rural areas – restore and protect natural ecosystems

The mitigation potential of rural areas, however, is also enormous – due to the fact that forests, peatlands and other biodiverse, open spaces act as natural carbon sinks.

“Agriculture, forestry, and other land use can provide large-scale emissions reductions and also remove and store carbon dioxide at scale,” according to the IPCC.

Triple financial investments in climate-friendly strategies

The report also warns that financial investment in mitigation is woefully inadequate – a factor of three to six times below levels that would be needed by 2030 just to limit warming to below 2°C (3.6°F). But again, given political will and investor buy-in, there exists  “sufficient global capital and liquidity to close investment gaps”.

“Climate change is the result of more than a century of unsustainable energy and land use, lifestyles and patterns of consumption and production,” said Skea. “This report shows how taking action now can move us towards a fairer, more sustainable world.”

At the briefing, World Meteorological Organisation General Secretary Petteri Taalas also called for investment in climate early warning service abilities, especially in least developed countries, saying that the United Nations committed to creating such systems by 2028.

‘File of shame’

Antonio Guterres, the United Nations Secretary-General, described the report as “a file of shame, cataloguing the empty pledges that put us firmly on track towards an unlivable world”, warning that the world was currently on track for a 3ºC increase.

“Some governments and business leaders are saying one thing but doing another. Simply put, they’re lying and the results will be catastrophic,” said Guterres in a recorded message.

“Climate scientists warn that we are already perilously close to tipping points that could lead to cascading and irreversible climate impacts. But high-emitting governments and corporations are not just turning a blind eye. They are adding fuel to the flames. They are choking the planet based on their vested interests and historic investments in fossil fuels when cheaper renewable solutions provide green jobs, energy security and greater price stability.” 

Admitting that it was “not a pretty picture”, UN Environmental Programme Executive Director Inger Andersen said that the past two decades had seen the biggest net increases in climate-warming emissions in human history, “even though we know how much trouble we are in”. 

“Half-measures won’t halve greenhouse gas emissions by 2030, which is what we need to do. We need to go all-in,” urged Andersen.

Image Credits: UNICEF.

Pro-abortion demonstrators in Kenya

Amid huge global contestation over abortion, the Kenyan High Court recently affirmed that women’s “access to safe abortion services is a human right” as enshrined in the country’s Constitution, and directed parliament to enact laws in this regard.

Malindi High Court Judge Reuben Nyakundi made the ruling late last month in a case involving a 16-year-old girl who had been miscarrying, and the health worker who had treated her. The two, arrested in 2019 and charged with “procuring an abortion”, had petitioned the court to have their charges dropped.

The ruling comes amid intense contestation over sexual and reproductive health (SRH) in Kenya, currently focused on the health ministry’s reproductive health policy 2022-2032 that fails to make any provision for abortion.

It also came shortly before the United Nations Population Fund (UNFPA) released its 2022 State of the World Population Report, which indicated that almost half of global pregnancies were unintended and failure to address this was a “public health emergency”.

Contradiction between Kenya’s constitution and penal law

According to Article 26.4 of Kenya’s 2010 constitution, abortion is prohibited “unless, in the opinion of a trained health professional, there is a need for emergency treatment or the life or health of the mother is in danger, or if permitted by any other written law”.

The Sexual Offences Act also allows women and girls who have fallen pregnant as a result of rape to have abortions. However, an outdated 1963 penal code outlaws all forms of abortion in contradiction of the constitution.

Over the past few years, conservatives have mobilised against any legalisation of abortion for any reason in Kenya, and the issue is increasingly becoming a populist rallying point ahead of the national elections in August.

It has thus become more difficult for women and girls to terminate pregnancies – even within the narrow confines allowed.

In the Malindi case, the girl identified only as PAK and clinical officer Salim Mohammed were arrested two days after PAK had presented with a spontaneous abortion and Mohammed had given her a manual vacuum evacuation. 

Police had removed PAK from her hospital bed, confiscated her medical records and forced her to have a medical examination. PAK was then detained in a juvenile facility for over a month while trying to raise bail. Kenyan authorities also notified her school of the criminal proceedings against her and had even sought to have her taken away from her parents and put into a children’s home.

Meanwhile, Mohammed was imprisoned for a week and two cleaners at the health facility were also arrested.

‘Violation of bodily autonomy’

As Kenya’s Constitution also affirms “the right to life”, conservatives have brandished this right against that of legal abortion.

However, Nyakundi ruled that “forcing someone to carry an unwanted pregnancy to term, or forcing them to seek out an unsafe abortion, is a violation of their human rights, including the rights to privacy and bodily autonomy”. 

“Inaccessibility of quality abortion care risks violating a range of human rights of women and girls, including the right to life; the right to the highest attainable standard of physical and mental health; the right to benefit from scientific progress and its realization; the right to decide freely and responsibly on the number, spacing and timing of children; and the right to be free from torture, cruel, inhuman and degrading treatment and punishment,” Nyakundi ruled.

“Restrictive abortion laws coupled with lack of effective laws giving effect to Article 26(4) of the Constitution, exposes women and girls to mental and physical health risks that are often associated with unsafe abortion and stigmatizes women and girls who seek abortion thereby violating their right to life and the right to highest attainable standards of health,” he added.

Parliament directed to ‘fast-track’ abortion laws

Nyakundi directed parliament to “fast track legislation that provides for access to safe abortion for women in Kenya and to actualize the provisions of Article 26(4) of the Constitution”.

Evelyne Opondo, Africa Regional Director at Center for Reproductive Rights, which assisted with PAK and Mohammed’s legal representation, described the court ruling as a “victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care”. 

“The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.”

Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), a network of reproductive health providers including Mohammed, said her members were still being arrested.

“Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care,” according to Munyasia.

“The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that the health professional in question was unqualified to conduct the procedure, the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” she added. 

Right-wing misinformation campaign

Kenyan MPs Susan Kihika and Esther Passaris have faced significant opposition to the Reproductive Health Bill that they introduced in the Kenyan parliament in late 2019, which sought to clarify grounds for abortion.

In mid-2020, the Kenyan Health Ministry withdrew the Bill, describing it as “fundamentally defective” because it made provision for abortion.

At a Senate hearing on the Bill in August 2020, Mercy Mwangangi, the health ministry’s Chief Administrative Secretary (CAS) told Kenya’s Senate committee on Health, that the Bill “normalises abortion on demand contrary to the Constitution and the values of the country”.

The Bill has since been withdrawn – apparently to allow for more public comment.

However, a recent expose by Modzilla Academy Fellow Odanga Madung found that CitizenGo, the right-wing campaigning organisation started  in Spain, had paid a number of anonymous “influencers” to spread misinformation about abortion, and attack Kihika and Passaris, on Twitter during crucial hearings on with the Bill.

“The research reveals how a right-wing European organization used Twitter to insert disinformation and inflammatory rhetoric into an important and nuanced regional conversation,” said Odanga. “It also reveals how Twitter lacks the cultural context, the staff, and the will to confront this problem.”

Meanwhile, CitizenGo has since indicated it will appeal the Malindi ruling.

However, Irungu Houghton, Amnesty International’s Kenya Director, has appealed to Kenyan polcymakers to “consider how to provide comprehensive sex education, safe abortion and post-abortion care services for those that require them.”

“For two solid years, COVID-19 subjected women and girls to a double-barrelled threat. Sexual and gender-based violence increased five-fold alongside rising living costs, joblessness and economic distress,” Houghton wrote in The Standard.

“If there is one lesson from the spiking numbers of unwanted pregnancies, it must be that turning a blind eye to the high levels of sexual violence or criminalising teenage sex doesn’t work.

Half the world’s pregnancies are ‘unintended’

Pro-abortion demonstrators in the US

Last week, the United Nations Population Fund (UNFPA) released its 2022 State of the World Population Report which indicated that almost half of pregnancies were unintended – and that 60% of these ended in abortion, often in unsafe circumstances.

“We know the steep costs associated with unintended pregnancy — costs to an individual’s health, education and future, costs to whole health systems, workforces and societies. The question is: why has this not inspired more action to secure bodily autonomy for all?” asked UNFPA Executive Director  Dr Natalia Kanem in the report’s introduction.

Kanem added that the toll of unintended pregnancies included lower human development scores, billions of dollars in health-care costs, and persistently high rates of unsafe abortion and related maternal deaths. 

“Unsafe abortion is one of the leading causes of the more than 800 maternal deaths occurring each day. This is a price tag the world simply cannot afford,” she added.

The UNFPA report estimated that there are around 121 million unintended pregnancies every year, or 331,000 per day.

“Over 60% of unintended pregnancies end in abortion, safe or unsafe, legal or illegal . Given that an estimated 45% of all abortions remain unsafe, this is a public health emergency.”

According to UNFPA research, unsafe abortion hospitalizes about seven million women a year in developing countries, costing an estimated $553 million per year in post-abortion treatment costs alone.

Image Credits: Center for Reproductive Rights, Gayatri Malhotra/ Unsplash.