The producers of unhealthy commodities that contribute to NCDs will attempt to dilute WHO’s recommended policies

While WHO’s recent Executive Board meeting saw a considerable amount of sound and fury over the proposed pandemic treaty, an obscurely titled but vital appendix of updated “best buys” to combat noncommunicable diseases (NCDs) was also briefly on stage. 

This new set of cost-effective recipes to combat what are now the world’s biggest killers provides crucial guidance on how to address NCDs  Were governments to adopt the recommendations as official policies, they could significantly impact the growing trajectory of NCDs. 

Yet, this potentially powerful guidance is wrapped in a wonkily titled document called Appendix 3 of the Global Action Plan for The Prevention and Control of NCDs 2013‒2030. It’s just the kind of packaging that the food, alcohol or tobacco industry would never even dream of using to launch a new product or strategy.  

Powerful but poorly displayed, this new guidance must be packaged and communicated better to protect it from untoward corporate influences. 

For all of those reasons, and more, it deserves far more attention from health policy leaders and civil society as it winds its way to approval at the World Health Assembly in May. 

Unpacking the latest formulas to fight NCDs

The updated policies and interventions address risk factors that perpetuate NCDs such as  tobacco, alcohol and ultra-processed foods. Much in the current draft is good, such as a broader definition of “unhealthy diets”  that includes not only sodium, but also transfats, saturated fats, and free sugars; strengthening countries’ capacities for strategic, multisectoral NCD prevention; and not only enacting minimum prices for harmful products but monitoring how those prices need adjustment based on inflation and other economic factors.

It also does better at reflecting the evidence from low- and middle-income countries (LMICs). The last version in 2017 had data only from 20 LMICs, while the current draft reflects the experiences of 62 countries. 

Nevertheless, the document still does not go far enough on critical aspects of prevention – such as environmental health risk factors like traffic injuries, air pollution, climate change and biodiversity loss, and related to those, unhealthy and unsustainable food systems. It must include conflict of interest policies as recommended policy interventions.

The producers of unhealthy commodities that contribute to NCDs, including the tobacco, alcohol, and ultra-processed foods industries, have a direct stake in maintaining their markets and will attempt to dilute WHO’s recommended policies.(Coca-Cola has lobbied aggressively to remove taxes on sodas and sugary drinks – a best-buy to combat unhealthy diets – in previous versions of this document.)

That is why it is imperative that trusted parties – from civil society groups to individual researchers – carefully scrutinize the proposed revisions on their merits, offer feedback ahead of the WHA, and prevent efforts by self-interested commercial entities to undercut the proposed solutions. 

And there is still room for improvement, which is why we recommend WHO includes the following updates and commitments to its current draft of Appendix 3. These should include  a more explicit articulation of recommendations against conflict of interest, corporate influence, and a more proactive stance on integrated policies related to climate and environmental health that prevent NCDs, as follows:

Preventing corporate influence 

Corporate influence has been identified as a reason for the poor implementation of NCD policies. A global study of 194 countries identified corporate influence as one of the main reasons for the poor implementation of WHO’s recommended cost-effective solutions in Appendix 3. 

The most recent Gallup poll released by WHO and Bloomberg Philanthropies on public perception of NCDs bears this out further. Many people support policies like taxes on unhealthy commodities, particularly if the money will support public programs. 

They want labels on unhealthy foods and restrictions on advertisements that entice their kids. Therefore, removing conflicts of interest from mega-corporation must be included as a specific policy intervention, at least for tobacco control, alcohol use, and unhealthy diets. 

Tobacco control may offer a good template for initial steps towards more aggressive action given that conflicts of interest had already been listed as clear and unequivocal policy interventions in WHO’s global treaty, the Framework Convention on Tobacco Control, which went into effect way back in 2005. Indices like the Global Tobacco Industry Index provide a template for monitoring the global implementation of conflict-of-interest policies.

Argentina requires warning labels on ultra-processed products.

An integrated approach to prevention and control 

The different NCD risk factors often share a common underlying relationship. Improvements in one area can foster improvements in others. For instance, best-buy solutions that improve diets, particularly by reducing the consumption of ultra-processed products, can not only address obesity but also improve malnutrition in all its forms. 

Moreover, since food production is associated with 80% of land-use conversion and biodiversity loss, as well as 20-30% of greenhouse gas emissions, reductions in consumption of ultra-processed foods – the worst of the unhealthy dietary options – can reap environmental gains. 

These “double-duty” actions and co-benefits, concepts promoted by WHO, could be better signalled in Appendix 3. We recommend that WHO commits to a better-integrated guide of best-buy solutions for policymakers.

Appendix 3 acknowledges that a broader set of NCD risk factors must be acted upon. It stresses that cost-effective solutions for air pollution, road safety and traffic injuries, and mental and oral health, are part of complementary processes. Cost-effective solutions for these are to be published but separately from Appendix 3.

There is no mention of integrating these complementary processes within a single document. Multiple parallel processes are needlessly confusing to time-strapped policymakers. We recommend that WHO commits to creating a simple and all-encompassing guide of best-buy solutions for policymakers.

WHO’s updated guidance for NCDs is a great start. With under-resourced health systems struggling to keep up with cascading crises, countries need efficient solutions that will yield a big bang for their buck. Previously known as the “best buys,” “Appendix 3” offers just that. 

By helping governments determine where to place their efforts, Appendix 3 is a valuable document worthy of time and revision. But like any living document, it is open to interference. Global advocates must hold the process accountable. WHO leadership must welcome this committed activism and collaboration by producing a document with real potential for impact. 

Nandita Murukutla is Vice President of Global Policy, Research, Policy Advocacy and Communication for Vital Strategies

Image Credits: Wei Ding/ Unspash, Global Health Policy Incubator , Vital Strategies.

INB co-chair Roland Driece

The draft pandemic accord needs more emphasis on preventing pandemics at their source – where animal pathogens “spill over” to people – according to a number of organisations participating in a consultation on the document’s “zero draft” on Wednesday.

Negotiations between World Health Organization (WHO) member states on the draft are due to begin at the fourth meeting of the Intergovernmental Negotiating Body (INB), scheduled to take place from 27 February to 3 March.

However, Wednesday’s meeting gave WHO’s civil society stakeholders an opportunity to comment on the draft ahead of that meeting.

Only member states will take part in the actual treaty negotiations, which are likely to start behind closed doors on the second day of the month-end meeting (called INB 4), INB co-chair Roland Driece told the meeting.

INB 4 and the following INB5 meeting from 3 to 6 April would be approached as “one big meeting”, he added.

While the start of the meeting would be open to all stakeholders, “as soon as member states tell us that they accept the zero draft as the zero draft, we will move into negotiation mode, and that means that only member states can be present,” said Driece. “So that’s why it’s so important that you tell us and member states now what you feel and think about this zero draft.”

He added that he thought that the INB Bureau had done “a pretty decent job [of synthesizing stakeholders’ inputs]” but “this is an important moment for you all to share whether or not you share my optimism about that and tell us what you think is important”.

Prevent ‘zoonotic spillover’ – environmental and animal health groups

Across large swathes of Asia and Africa, wholesale markets often sell wild animals captured or bred for food consumption, and which may harbor dangerous viruses. Many scientists believe that SARS-CoV2 was transmitted to humans via live, wild animals, caged for slaughter in Wuhan’s wet market.

An unprecedented number of organisations spoke about how the draft needs to pay more attention to pandemic prevention at the source; this means addressing the social, environmental and food safety factors that lead to the spillover of pathogens from wild animal populations into human communities. These drivers range from deforestation which has prompted animal populations like bats, which harbor a range of deadly pathogens from SARS-COV to Marburg, to move closer to human habitats; to wild animal trafficking and trade, both legal and illicit; as well as industrial production, sale and slaugher of wild animal species.  

The Wildlife Conservation Society recommended that the accord commit governments to “identifying and prioritising actions to prevent pathogen spillover in the first place” by prioritising tougher regulations on “markets and trade chains and wildlife domestic and international trade”. 

“We have extensive experience and expertise with habitat degredation, deforestation, forest degradation, wildlife trade and wildlife markets,” said the WCS representative. “And this isn’t about illegal trade, its about any live trade, particularly for food but also for other purposes, birds and mammals.  We look forward to working with member states and the INB to ensure that first and foremost there are commitments by governments to avoid the spillover in the first place. And we do know how to do that, from a biodiversity perspective and in terms of markets.”

The World Wildlife Fund (WWF) appealed for the “list of drivers of pathogen emergence risks to be expanded to include not just deforestation, but ecosystem loss, fragmentation and degradation”. 

“Deforestation alone omits many of the potentially important pandemic frontiers and ignores the role of fragmentation and degradation in increasing proximity between humans and wildlife,” said the WWF.

Meanwhile, the World Organisation of Animal Health (WOAH) called for the inclusion of the full definition of “One Health” in the treaty.  Its delegate also questioned why preparedness and response were stressed whereas “preventive actions targeting activities and places that increase the risk of zoonotic spillover” were not.

Pointing to a lack of expertise to address zoonotic spillover, the Action for Animal Health Coalition said that member states needed to invest in increasing the animal health workforce.

Equity obligations

Oxfam’s Piotr Kolczynski, who also represented the People’s Vaccine Alliance.

Meanwhile, Oxfam, also representing the People’s Vaccine Alliance, said that “the accord’s language must oblige governments to take specific actions to ensure equity; otherwise it would be very difficult to implement this”.

The current zero draft also assumes that “critical public health interventions are based on the willingness of pharmaceutical companies to engage in voluntary mechanisms” but “these have proved to be largely insufficient during the current and previous pandemics,” said Piotr Kolczynski, of Oxfam and PVA.  

For this reason, it added, “the accord must require governments to invest in research and development and manufacturing capacities and to condition public funding on the sharing of technologies, knowledge and intellectual property with developers and manufacturers in the South”. 

In reference to the accord’s proposal that 20% of pandemic-related goods be allocated to the WHO for distribution, Oxfam stated that “equitable allocation of medical countermeasures cannot be achieved by reserving a 20% of production for 80% of the world’s population”. 

Medecins sans Frontieres (MSF), meanwhile, asked for a legal definition of “pandemic”, and “explicit reference to governments complying with international humanitarian law obligations in the context of pandemic preparedness, prevention and response”.

It also demanded stronger language in relation to commitments to protect “humanitarian populations of concerns” and healthcare workers during pandemics.

Private sector is a ‘critical partner’

IFPMA’s Grega Kumer, Deputy Director of Government Relations.

“The private sector should be seen as a critical partner in preparedness, response and recovery, and should have a seat at the table,” stated Grega Kumer, Deputy Director of Government Relations at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

However, it warned that some of the accord’s proposals “would jeopardise our capacity to efficiently prepare for the next pandemic.” Key concerns it cited included proposals for a waiver on intellectual property rights (IP) for health products during a pandemic, as well as proposals that would “be “transactionally linking access to pathogens and sharing of benefits”. 

It also urged the INB to “avoid unnecessary overlaps and duplications including other multilateral organisations mandate and expertise such as WTO and WIPO”. 

While there were over 200 participants online, a handful of member states were also on hand to listen in person at WHO’s Geneva Headquarters to the inputs as they prepare for INB4, when the real negotiations begin for the accord that is due to be presented by May 2024 to the World Health Assembly.

Image Credits: Peter Griffin/Public Domain Pictures.

Mpox
Dr Tedros Adhanom Ghebreyesus speaking at the media briefing on Wednesday.

The World Health Organization (WHO) declared on Wednesday that Mpox will continue to remain a Public Health Emergency of International Concern (PHEIC). The decision to continue with the status quo on Mpox was based on the recommendations made by an Mpox Emergency Committee, whose findings were published on the same day.  

“The emergency committee for the global outbreak of Mpox met to assess whether, in its view, the outbreak remains a public health emergency of international concern. The committee has advised me that, in its view, Mpox remains a global health emergency, and I have accepted that advice,” Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said at a press briefing on Wednesday.  

In its report, the Mpox committee, which met on 9 February, acknowledged the progress made in reducing the virus transmission and the sharp decline of reported cases. However, it also expressed concerns that “a few countries continued to see a sustained incidence of illness” while in other countries it’s likely that more cases are occuring under the radar.   

“More than 30 countries continue to report cases, and the possible underdetection and under-reporting of confirmed cases in some regions is concerning. Particularly in countries where animal-human transmission of Mpox has been reported before,” Tedros pointed out. 

In its report, the expert committee also expressed concerns about the possible resurgence of cases due to the expected resumption of LGBTQ social events and other mass gathering events; lack of access to vaccines and testing capacities in many lower-income countries; and the recurring zoonotic transmission in Africa.

It added that “not all countries are receiving the support they need or have structures or systems to respond to mpox, including inadequate support for marginalized groups; and general fatigue among supporting agencies.”

Returning from Syrian scenes of devastation

Tedros spoke at the briefing shortly after returning to Geneva from a visit to earthquake affected areas in Syria. The 7.8 magnitude earthquake that hit Syria and Türkiye last week is now estimated to have killed over 41,000 people. 

Describing the damage caused to Aleppo and Damascus first due to the war, and now by the earthquake, Tedros said “I saw the destruction of entire communities, the unspeakable suffering of people, and the courage and determination of survivors and responders. As we drove from Aleppo to Damascus, I saw the legacy of conflict, with town after town destroyed and abandoned.  Survivors are now facing freezing conditions without adequate shelter, heating, food, clean water, or medical care.”

While two more cross-border points between Türkiye and Syria have been opened, Tedros said he had had asked Syrian president Bashar al-Assad to open still more crossings so that relief could reach people in need more rapidly.  Humanitarian aid groups charge that the Syrian president has “weaponized aid” channeling available supplies to government controlled areas – while most of western Syria where the earthquake hit, is controlled by  Kurdish and other Syrian anti-government militias. 

“WHO remains committed to supporting all people in the Syrian Arab Republic now and in the days, weeks, months, and years ahead,” Tedros added.  

The WHO has launched an appeal for $43 million to support its response in Syria and Türkiye and expects the amount to double by this weekend. Meanwhile, UN Secretary General Antonio Guterres called upon countries to fully fund a $397 million earthquake fund for Syria, in particular, which lacks resources to mount its own response. 

Marburg disease – ramping up diagnostics and clinical trial possibilities

Touching back on the Marburg Virus Disease (MVD) outbreak in Equatorial Guinea, which has claimed nine lives, Tedros said that the WHO is working with the country’s health authorities to ramp up their diagnostic capacity. 

“So far, no confirmed cases have been reported in Cameroon and or Gabon,” he added, referring to the two countries that, along with Liberia, border Equatorial Guinea. “We’re also supporting the governments of Cameroon and Gabon to prepare to rapidly detect, isolate, and provide care for any suspected cases.” 

Following up on the Marburg Virus Vaccine Consortium (MARVAC)’s meeting on Tuesday, Tedros said that WHO is trying to accelerate talks on possibile clinical trials for Marburg virus diseaes vaccine candidates. But he reiterated that any decision on the trials of vaccines and therapeutics for Marburg needs to be taken by researchers and the national authorities of Equatorial Guinea. 

“In the meantime, WHO is convening the vaccine prioritization committee to identify which vaccine candidates should be evaluated first and prepare for potential trials. WHO is also discussing with the ministry of health, the possibility of providing access to experimental therapeutics as part of a clinical trial,” he said.     

COVID-19
Dr Maria Van Kerkhove, speaking at Wednesday’s media briefing.

A senior World Health Organization (WHO) official has emphatically denied that abandoned its investigation of the origins of the virus that caused the COVID-19 pandemic.

The comment by Dr Maria Van Kerkhove, COVID-19 technical lead, was in response to a report published on Tuesday by Nature which stated that the agency has “quietly shelved” its plans to continue with its investigation of SARS-CoV2’s origins. due to the barriers to plans to conduct further, crucial studies in China. A controversial report by a joint Chinese and international mission to Wuhan, covering the first phase of the investigation was published in March 2021,  But critics said glossed over China’s omission of key patient data from the early days of the outbreak in Wuhan. The report also declared that it was “extremely unlikely” that the virus could have escaped from a local research laboratory, without sufficient data or evidence to make such a determination, critics said. 

Subsequently, WHO laid plans for an extensive set of on-site, follow-up studies over the summer of 2021, including further assessment of Wuhan wild markets, the lab escape theory, and closer examination of early transmission patterns, based on blood samples from anonymized patient data. But China rejected those plans outright, and has remained unwilling to release further patient data or to let teams of researchers visit the country.

In the Nature report, Van Kerkhove was quoted saying that WHO had in fact abandoned its plans for a Phase II of the COVID origin studies: “There is no phase two,” she reportedly said. While WHO protocols had called for extensive follow-up studies in China, “that plan has changed”, she added, saying: “The politics across the world of this really hampered progress on understanding the origins.”

Speaking at Wednesday’s briefing, Van Kerkhove appeared to walk back on her comments, stating:

“I think we need to be perfectly clear that WHO has not abandoned studying the origins of Covid 19. We have not, and we will not.”

However, she also admitted that WHO’s “updated” plans for a second phase would have to take a more generalized approach to the origins question:  

“In a sense, phase two became the Scientific Advisory Group for the Origins of novel pathogens (SAGO),” she clarified. SAGO held its first meeting in November 2021 and was established as a permanent advisory group to work on drawing up a framework to understand the origins of not just COVID-19 but any future outbreaks. “So the creation of SAGO was in effect, our best effort to move this work forward.”

China has evaded WHO’s requests for cooperation

China continues to refuse WHO’s requests to release more data or to open its borders to scientific teams for further on-site investigations, Kerkhove also admitted.

“Studies that were recommended from the March 2021-WHO report, from the June 2022-SAGO report and studies that we’ve been recommending at the animal human interface and markets, on farms need to be conducted in China. We need cooperation from our colleagues there to advance our understanding,” she added. 

Over the past year, WHO repeatedly called on China to cooperate in further SARS-CoV2 origin studies. Last month, WHO Director General Dr Tedros Adhanom Gheyebresus also appealed to Beijing to share more data about death rates and SARS-CoV2 variants ciculating in the country as the country was swept by a fresh COVID wave after removing its controversial “zero COVID” policy measures. 

Dr Tedros added that it remains crucial to understand the origins of the pandemic for scientific and moral reasons. 

“Millions of people lost their lives and many suffered. The whole world was taken hostage by a virus. It’s morally very important to know how we lost our loved ones.

“Recently, seven weeks ago, I sent a letter to a top official in China, asking for cooperation because we need cooperation and transparency and the information we ask in order to know how this started,” he stated.

But apparently so far, there has been no return mail.

Image Credits: Megha Kaveri.

Image Credits: Abdulsalam Jarroud/TNH.

Marburg
Health workers in protective gear during the Marburg outbreak in Guinea in 2021.

Following a first-ever outbreak of deadly Marburg virus disease in Equatorial Guinea, the World Health Organization (WHO) on Tuesday called an emergency meeting of the Marburg virus vaccine consortium (MARVAC) to receive an urgent update on possible vaccine candidates for the filovirus that can have an 80% fatality rate.  

At the meeting, the agency received updates from five vaccine developers who have been working on candidate vaccines.  WHO experts said that they will soon convene a working group to prioritize existing vaccine candidates, with an eye to seeing if clinical trials for any of the vaccines can be launched in real time, particularly if the outbreak expands.  So far the virus has claimed nine lives, while there are 16 suspected cases in quarantine, and another 15 contacts are under observation.  All cases have occurred in the province of Kie Ntem in the country’s western region.

“The critical next steps include getting full sequence information on the virus, which is being detected in Equatorial Guinea to use that for a number of different purposes,” said Philip R. Krause, chair of the WHO Covid Vaccines Research Expert Group, who led the meeting.

In parallel, WHO will “rapidly” convene a vaccine prioritization committee, Krause said, to “consider updated information from vaccine developers and to simplify, which really means extract relevant sections from the vaccine clinical protocol for potentially use in Equatorial Guinea,” Krause said. He was referring to an already-approved WHO clinical trial protocol for Marburg vaccines, which would likely need adaptation to the context of the current outbreak. 

“Assuming we’ll proceed with clinical studies, and of course this is pending agreement and support from local authorities in Equatorial Guinea, assuming that such a study were to be done, it would be important to convene the prioritization committee to look at these in the context of most up-to-date information – to make decisions about which of these  should be included in in such a study,” Krause said.

Marburg
Phil Krause at the WHO-led MARVAC meeting on Tuesday.

The meeting came only a day after WHO officially confirmed the first-ever outbreak of Marburg haemorrhagic fever in Equatorial Guinea. That confirmation came a week after the country’s Health Ministry notified WHO of a suspected case that had first been reported on 7 January in the country’s Kie Ntem province.

Vaccines in the pipeline

At the meeting, the WHO experts reviewed the status of five active vaccine candidates against the virus. Two of the candidates, one developed by the Sabin Vaccine Institute and one by Janssen are in the Phase 1 clinical trials. The other three vaccine candidates being developed by International AIDS Vaccine Initiative (IAVI), Public Health Vaccines (PHV) and Auro Vaccines, are still in the pre-clinical stage of development.

Marburg
The five active vaccine candidates that are in development for Marburg disease.

Babajide Keshinro of Janssen said that the company could mobilise 3500 doses of its Marburg vaccine candidate for WHO-led trials immediately in Equatorial Guinea. However, he stressed that the trials would have to begin within the next two months. Beyond that, the company does not yet have a firm estimate on the length of time the Janssen vaccine candidate remains stable.  

Matthew Duchars, speaking on behalf of the Sabin Vaccine Institute, told the committee that the Institute has up to 20,000 doses of active vaccine ingredient, which it was already planning to use for its own Phase2/3 trials later this year. “We have quite a reasonable amount of drug substance, which has been manufactured and is awaiting to be filled, and is probably up to about 20,000 doses from the bulk that’s currently made.”

The Institute also had reserved “slots” with a number of vaccine manufacturers which could be “repurposed” to rapidly produce several hundred finished vials of the vaccine candidate for deployment in Equatorial Guinea. he added.  

Joan Fusco, of PHV, said that their vaccine candidate had just recently secured FDA approval for clinical testing and that they have around 350 vials ready for use. But they do not have further active manufacturing of the product planned at present. 

As for IAVI, Andi Kilansk said that the organization does not have “any available bulk drug, substance or field drug product.” Similarly, Auro Vaccines said it had no Clinical Trial Material (CTM) available at present, and that its own clinical trials had been planned only for later in the year.

In relation to therapeutics, Dr Simon GP Funnell from the United Kingdom’s Health Security Agency, referred to a recent study that found a combination treatment of monoclonal antibodies and remdesivir performed better against the virus than individual drug agents. “A combination of monoclonal antibodies and remdesivir was better than either alone at Day 6. And that’s going to be a theme that’s carried forward,” he said.

Index case on 7 January

The index case of Marburg virus disease occurred on 7 January 2023, Dr George Ameh, country representative of WHO to Equatorial Guinea, told the meeting. However, the Country’s Health Ministry only notified WHO of the case on 7 February, with a definitive lab confirmation of the disease from a Senegalese laboratory on 13 February.

“In total, there have been nine deaths associated with this outbreak, with established epidemiological links. Close family members, those who attended burials of these close family members…nine confirmed deaths as of today. We also have 16 suspected cases in quarantine and 15 asymptomatic contacts being closely followed up from their homes,” he said. 

Marburg
Equatorial Guinea is located in west central Africa.

Despite the month-long lag between the report of the suspected first case and notification to WHO, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised the “rapid and decisive” action by Equatorial Guinean health authorities.

“Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” said Moeti.

Marburg virus disease, also known as MVD, is a highly infectious disease that has a fatality ratio that can range between 24% and 88%. The virus, named after a town in Germany where the virus was first identified in 1967 after causing 29 infections and 7 deaths, belongs to the same family of filoviruses as Ebola. The virus is typically transmitted to humans by fruit bats, and then spread between humans through direct contact with bodily fluids of infected people, surfaces and materials.  In Africa, outbreaks have been reported peridically in the Democratic Republic of Congo, Angola, Uganda – but never before in Equatorial Guinea.

Common symptoms of Marburg disease include fever, fatigue, blood-stained vomit and diarrhoea, according to WHO.

“Efforts are also underway to rapidly mount emergency response, with WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory and risk communication to support the national response efforts and secure community collaboration in the outbreak control,” stated a WHO press release, published on Monday.

“WHO is also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.”

Image Credits: WHO, Megha Kaveri, Alvaro1984 18, Public domain, via Wikimedia Commons.

The fourth Intergovernmental Negotiating Body (INB) meeting takes place 27 February; portrayed here, WHO member states at the second meeting 18-22 July 2022.

On 27 February, World Health Organization member states will meet to commence formal negotiations on a global pandemic preparedness agreement – unofficially turning the page from responding to COVID-19 to readying ourselves for future health emergencies.

While the Intergovernmental Negotiating Body (INB) of member states have already held a series of meetings, as well as stakeholder briefings, the negotiations at the end of the month hold special significance as they follow on from the publication of the “zero draft” of the envisioned international legal instrument.

And with the aim of concluding a draft instrument by May 2024, the clock is already counting down. This is a huge undertaking, and millions of lives depend on learning the right lessons from our collective response to the COVID-19 pandemic.

The pharmaceutical industry, which played an indispensable role in defeating COVID-19, recommends focusing on five priorities.

Sustaining a thriving innovation ecosystem

R&D of COVID-19 vaccines took place in record time.

The first must be to maintain and reinforce the policies and systems that worked well these past three years – the innovation ecosystem undergirding our industry and the immediate unhindered access to pathogens and their genetic sequences.

It was no accident that we had tests and potential vaccines and treatments in development within days of the sequence of the novel coronavirus published online – a record-breaking pace that saved an estimated 20 million lives in year one of the pandemic. Everything from the viral vector or mRNA technology behind the vaccines to the global supply chains that enabled unprecedented manufacturing scale-up wouldn’t have been possible without decades of large, risky investments in the international pharmaceutical sector.

Yet today, the very system that allowed collaboration and innovation to thrive and deliver the solutions for the COVID-19 pandemic, is under attack. The World Trade Organization’s (WTO) June 2022 decision to waive international patent protections on the COVID-19 vaccines, and the ongoing discussions on extending this waiver to COVID-19 therapeutics and diagnostics, risk undermining the system, which was critical for the success in the fight against COVID-19.

Attacks on IP at the WTO or in the zero draft of the accord fail to recognize the critical role that intellectual property frameworks play to incentivize research and facilitate voluntary partnerships, business-to-business agreements, and technology transfers. Proponents of these proposals oversimplify what the notion of “tech transfer” entails, and risk undermining, rather than facilitating our collective ability to rapidly develop and scale-up countermeasures.

Furthermore, some countries seek to twist the UN’s Nagoya Protocol – a roughly decade-old pact that gives countries more rights and incentives over their native flora and fauna with the intention of protecting biodiversity – to restrict the flow of information about pathogens. The deliberate twisting of the protocol giving value to pathogens instead of protecting global health security is a bizarre and unprecedented threat to global health.

Lest we forget, the system we had in place when COVID-19 arrived created multiple safe, effective vaccines against a novel, deadly contagion in a matter of months, produced billions of doses within a year, and has now delivered at least one dose to over 69% of the world’s 8 billion people. This is a record to build on, not to attack. Innovation and immediate access to pathogens should be at the center of all pandemic preparedness and response plan.

Shaping a new ‘social contract’

Second, the world’s wealthiest nations must adopt a new framework for more equitable global distribution of vaccines and therapies. National leaders, morally accountable to their own citizens, can now nonetheless appreciate the value of global preparedness. As wave after wave of COVID-19 variants have taught wealthy nations, viruses do not respect economic advantage any more than they do geographic borders. Amidst a global contagion, none of us are safe until we all are.

The framework that best reconciles different regions’ interests is one familiar to all democracies: the social contract under which citizens balance rights with responsibilities, independence with interdependence. Under a global pandemic preparedness “social contract”, pharmaceutical companies set aside stores of vaccines, treatments, and tests, based on real time production, for priority populations in lower-income countries.

But for this to work, manufacturing countries need to allow part of what is produced in their territories to be exported to low-income countries in real-time. And of course, we need adequate funding upfront for organizations such as Gavi, the Vaccine Alliance, to sign contracts early on.

Fostering sustainable manufacturing globally

Third, Covid-19 showed how broad a global vaccine production program must be – and how much such a program depends on a stable legal and policy framework, which gives the confidence to parties to join forces, and share technology and know-how.

The record is clear. By the end of 2022, pharmaceutical companies signed 381 vaccine manufacturing and production partnerships, and 150 more to produce COVID treatments – the vast majority of both involving technology transfer. To facilitate access and equity for the developing world, those partnerships included facilities based in India, Bangladesh, Egypt, and South Africa.

The right enabling environment to attract sustainable investments and predictable demand will be critical to maintain existing capacity and introduce new capacity in other regions.

Removing trade restrictions

Fourth, the COVID-19 experience showed that when it comes to the development, manufacturing, and distribution of goods around the world, there is no substitute for free trade. Whatever arguments might exist for protectionist trade barriers in other sectors of the global economy, it is now obvious that those arguments do not apply to public health necessities in the middle of pandemics. Open trade saves lives.

Ensuring greater country readiness

And fifth, when it comes to global equity, the ability of less developed nations to absorb supplies is also paramount. These countries need help in strengthening their healthcare systems and making huge investments in health infrastructure to prevent, detect and respond to future threats while maintaining access to routine and essential services during a crisis.

Later this month, WHO negotiators will be looking at all of the above – efficacy and equity, supply and demand, economic incentives and moral responsibilities – as members work to revise the current zero draft of a global pandemic Accord.

Taking the time, here in this middle hour between crises, to get the policies and incentives right will yield the public health community the coordination, collaboration, and innovation we will need to overcome the inevitable next pandemic.

____________________

Thomas B Cueni, is the director general director general of the International Federation of Pharmaceutical Manufacturers and Associations.

Image Credits: Pfizer, IFPMA .

Dr Muhammad Ali Pate, incoming Gavi CEO

The global vaccine alliance, Gavi, has appointed former Nigerian health minister, Dr Muhammad Ali Pate, as its new CEO.

Pate was Minister of State for Health in Nigeria between 2011 and 2013, where he led a national campaign to “revive routine immunisation and primary health care, chaired a presidential taskforce to eradicate polio and introduced new vaccines into the country”, according to Gavi.

“It will be my privilege to lead Gavi and continue to support countries to scale up critical routine immunisation programmes, reach more zero-dose children, expand access to new vaccines, transform primary health care systems, and help fight outbreaks and future pandemics,” said Pate in a media release on Monday.

He will join Gavi in August, replacing Dr Seth Berkley who has led the alliance for the past 12 years.

Pate is a medical doctor trained in both internal medicine and infectious diseases who also has an MBA from Duke University in US.

Between 2019 and 2021, he was the World Bank’s Global Director for Health, Nutrition and Population and headed the Global Financing Facility at the World Bank where he led the Bank’s $ 18 billion COVID-19 global health response.

He is currently the Julio Frenk Professor of Public Health Leadership at Harvard Chan School of Public Health and has served on several health-focused boards and expert panels in the public, private and not-for-profit sectors during his career.

Gavi undertook a year-long search for Berley’s replacement which was led by its board chair, Professor José  Manuel Barroso.

“Dr Pate stood out in a field of world-class candidates. With his knowledge and experience of both national immunization programming and international emergency response and global finance, I am confident that Gavi will continue to build on its vision and mission, as well as navigate the many challenges and opportunities we will face,” said Barroso.

Meanwhile, Berkley described “leading Gavi and helping the alliance to continually surpass itself in terms of saving lives, protecting children and supporting countries during global health emergencies” as “the greatest honour of my career”. 

“I am confident in its future under Muhammad’s leadership. Having worked with him during his time as Minister and at the World Bank, I know he understands intimately the landscape we work in and will be uncompromising in his drive for public health equity,” added Berkley.

Berkley has led Gavi since 2011, and during his tenure the alliance estimates that it has averted 11.8 million future deaths (compared to 4.5 million between 2000 and 2010); and has helped immunise more than 676 million children – more than double the 305 million children reached between 2000 and 2010.

During his tenure, the alliance has added a number of new vaccines to its portfolio, including to prevent HPV, polio, cholera and malaria, and in its current strategy cycle is focusing on reaching zero-dose children across marginalised communities. 

“The economic result of Gavi’s expansion of activities during [Berkley’s] tenure has been profound, unlocking over $160 billion of economic benefits compared to $24 billion in its first 10 years.”

 

The world’s biggest multinational companies are failing to meet the bold climate change pledges they have made – and are obfuscating their failures through “ambiguous commitments, offsetting plans that lack credibility and emission scope exclusions”.

This is according to the Corporate Climate Responsibility Monitor 2023, which was released on Monday by Carbon Market Watch and NewClimate Institute.

The report focuses on 24 multinational companies that have endorsed the Paris Agreement to ensure global warming does not exceed 1.5 degrees Celsius. 

Greenhouse gas and carbon emissions need to be cut by 43% and 48% respectively between 2019 and 2030 to limit the global temperature increase to 1.5°C, according to the Intergovernmental Panel on Climate Change (IPCC, 2022). 

But the companies’ targets only amount to a 15% reduction in “full value chain emissions between 2019 and 2030”.

‘Low integrity’ companies

The climate strategies of American Airlines, Samsung Electronics, meat company JBS and retail and grocery multinational Carrefour were described as “very low integrity”.

One rung up were the “low integrity” companies, including Amazon, DHL, Foxconn, Mercedes Benz, Pepsico, Volkswagen and Walmart.

Their poor ratings were the result of “inadequacy or complete lack of explicit emission reduction commitments alongside ambiguous net-zero pledges”, according to the report.

Apple, Arcelor Mittal, Google, H&M and Microsoft were some of the companies described as having “moderate integrity”, while shipping company Maersk was rated “reasonable” – the top rating of the companies. Together the 24 companies account for about 4% of all global greenhouse emissions.

Substantial ‘greenwashing’

Warning of substantial “greenwashing”, the report called on “regulatory oversight at international, national and sectoral levels”.

Speaking at the launch, Carbon Market Watch’s Lindsay Otis said that it had taken a team of accomplished researchers “a number of months” to understand the companies’ pledges and strategies.

“Companies’ climate change commitments do not add up to what their pledges might suggest,” according to the report. 

Their 2030 targets can “rarely be taken at face value”, mainly because they focus on direct emissions or emissions from procured energy but exclude indirect emission categories that account for “over 90% of the greenhouse gas emission footprints for most of the companies we have assessed”.

For others, 2030 targets are misleading due to reliance on offsetting.

“The findings in our report suggest that many companies only plan to reduce a small share of their full emission footprint, relying instead on offsetting their remaining emissions with contentious carbon credits,” according to the report.

“We find that at least three-quarters of the 24 sampled companies rely on forestry and land-use-related offsets. The demand for such carbon dioxide removals would exceed the potential of the world’s natural resource base by around two to four times if these practices would be replicated by other companies,” the report notes.

“Moreover, these plans demonstrate the widespread lack of awareness that the biological storage of carbon is fundamentally unsuitable for offsetting claims due to the non-permanence of the climate impact.”

Regulation

“Companies must play a central role in finding and scaling up solutions for deep decarbonisation, but their efforts need urgent acceleration and appropriate regulatory frameworks,” according to the report.

It cites the European Union’s Corporate Sustainability Reporting Directive, which enters into force this year  2023 and will introduce “tighter requirements for corporate climate strategies”.

However, it calls for close monitored “to ensure a high standard of compliance”.

Alcohol is linked to seven cancers, but public awareness of the links is low.

Alcohol is the second biggest cause of cancer after tobacco, and Movendi is mobilizing communities worldwide to publicize the link

At the WHO’s 152th Executive Board, an updated list of policy “best buys” to prevent and control non-communicable diseases (NCDs) was presented. The EB decided unanimously to adopt the updated list of cost-effective interventions in response to the lack of progress to prevent and reduce NCDs, as Health Policy Watch reported.

Higher taxes and warning labels on unhealthy food, cigarettes and alcohol, and better screening for cancers, are some of the new “best buys” to accelerate action on NCDs, such as cancer, heart disease, diabetes, lung disease, and mental health conditions.

No country is currently on track to achieve the 2030 global targets set by the World Health Assembly back in 2013, and the declaration by the UN General Assembly High-Level Meeting on NCDs in 2018 – including the 10% reduction of population-level alcohol use.

One major public health problem that is worsening due to the lack of implementation of the NCDs best buys is cancer. Cancer kills nearly 10 million people a year, but the risk of dying from cancer varies greatly across the world.

About 70% of these deaths are in low- and middle-income countries – and the disparity is worsening. For example, in Africa, cancer deaths are expected to more than double, reaching roughly 1.4 million deaths annually by 2040.

Make a noise

On World Cancer Day on 4 February, Movendi International launched an ambitious new campaign, “Be Loud For Change”. We are mobilizing communities around the world to make a noise about the direct link between alcohol and cancer, the low public recognition of the fact that alcohol causes seven types of cancer, and the unique opportunity for our governments to bring change through proven solutions.

Since 1988, alcohol – like tobacco and asbestos – has been scientifically proven to be a group one carcinogen. When humans consume ethanol in beer, wine, and liquor, the byproduct attacks the DNA. But the media found it difficult to report properly on the real effects of alcohol and instead helped the alcohol industry to keep people in the dark.

After tobacco, alcohol is the second biggest cause of cancer – before other risk factors such as infections, physical inactivity, or sunlight. Globally, 740,000 people get cancer due to alcohol, each year.

The alcohol industry wants to keep people in the dark about the fact that their products are as carcinogenic as cigarettes and asbestos. Research has shown that awareness of the link between alcohol and cancer is very low internationally.

Alcohol companies are afraid of people becoming aware of the fact that ethanol in beer, wine, and liquor causes at least seven types of cancer. And so they fight tooth and nail against scientific studies, warning labels on alcohol products, and other alcohol policy solutions contained in the recently updated list of NCD best buys.

 The wide support of the WHO Executive Board and growing momentum for addressing cancer risk factors, such as alcohol, mean something significant: The world is experiencing a shift in awareness about alcohol harm, driven by growing awareness that alcohol causes cancer.

And the world is experiencing a shift in perception of alcohol policy solutions. The alcohol policy best buys – raising alcohol taxes, banning alcohol advertising, limiting alcohol availability – help prevent diseases such as cancer and heart disease; they help strengthen health systems; and they boost economic growth.

Alcohol taxes and warning labels

This means, our governments can do a lot to bring about change. They can develop alcohol taxation systems that effectively protect people from alcohol harm, including cancer. For example, reducing total alcohol consumption by 10% would lead to a 9% reduction in alcohol-related cancer deaths. That means ca. 57.000 fewer deaths.

Our governments can also put warning labels on alcoholic products informing about cancer, heart disease, and other alcohol harms. They can fund mass media campaigns to increase public recognition of the real harm due to alcohol. They can ban alcohol advertising, sponsorship, and promotion. And our governments can put in place common sense limits on the presence of alcohol in our communities.

Our governments have proven solutions at their disposal. There has never been a better time for an ambitious approach to protect our societies from cancer caused by alcohol. Such an initiative will protect and improve the health and well-being of people and communities, it will strengthen our health systems as alcohol harms, such as cancer cases and deaths, decline, and will unlock fresh resources for investment in health promotion and disease prevention.

 

Kristina Sperkova is International President of Movendi International

Pubudu Sumanasekara is International Vice President of Movendi International

Image Credits: Taylor Brandon/ Unsplash.