On 24 February 2021, a plane carrying the first shipment of COVID-19 vaccines distributed by the COVAX Facility landed at Kotoka International Airport in Accra.

On the eve of the first anniversary of the delivery of COVID-19 vaccines to Africa via COVAX, the continent’s leading vaccine advocates have pledged not to accept anything less vaccinating 70% of Africans against the virus by mid-year – a tall order given that only around 10% have been vaccinated.

However, to assist in reaching this target, the US on Tuesday announced new funding for the vaccination drive in Nigeria, Africa’s most populous country.

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the ‘Ports to Arms’ summit being held in Nigeria that while COVAX only has enough vaccines to cover 45% of the continent, other sources including the African Vaccine Acquisition Team (AVAT) will “provide the means for countries to reach the global target of 70% by mid-2022”.

“We must now turn our attention to addressing the crucial question of how we turn vaccines into vaccinations – or how we get vaccines from ports to arms,” said Tedros, adding that health workers, older adults, and those with underlying medical conditions, must remain the urgent and immediate focus.

Support for TRIPS waiver

Tedros reiterated WHO support for the proposal from South Africa and India for a temporary waiver of intellectual property rights under the TRIPS agreement for the duration of the pandemic in order to reach the 70% target.

“Achieving the 70% target in all countries is essential for ending the pandemic as a global health emergency and driving a truly inclusive global recovery. It will also help prevent the emergence of new variants, which could be more severe or transmissible next time around,” said Tedros.

To help achieve this target, the WHO, UNICEF and Gavi have initiated a COVID-19 Vaccine Delivery Partnership, to assist government-led vaccine strategies through political engagement, delivery funding, technical assistance and surge support, added Tedros.

“This partnership will bring the tools, training, and expertise to strengthen cold chains and logistics, deploy vaccinators, mobilize funding, strengthen data systems, engage communities, and plan and coordinate operations,” he added.

From Ports to Arms: WHO Africa Director Dr Matshidiso Moeti, ACT Accelerator envoy Dr Ayoade Alakija and CEPI CEO Richard Hatchett

COVAX anniversary

Seth Berkley, head of the global vaccine alliance, Gavi, said that Wednesday (24 February) marked the first anniversary of the first COVAX delivery on African soil. But since then, COVAX has delivered about 440 million doses now to 51 countries on the continent. Of these, 60 million had been delivered to Nigeria, the continent’s most populous country, with 30 million more allocated to the country.

“The challenge is to make sure that the absorption capacity of countries is such that those doses can be used quickly and get to the people that them,” said Berkley.

Echoing Berkley’s call, Dr Ayoade Alakija, the convenor of the “Ports to Arms” conference, stressed that Africa would not accept anything less than the 70% vaccination rate.

‘Not about vaccine hesitancy’

Atul Gawande, Assistant Administrator of USAID, announced a new partnership with the government of Nigeria under the US government’s Initiative for Global Vaccine Access known as Global Vax.

Nigeria will get an additional $33.3 million to help ensure COVID-19 vaccines reach people who need them, said Gawande, adding that the US had already donated $143 million to the country to address the pandemic.

“This additional funding to Nigeria will support activities that simply go to where our partners find they needed the most. And that can be anything from needing to build the cold chain supply and logistics, to addressing vaccine confidence or driving mobile vaccination units,” said Gawande.

He paid tribute to the country for administering six million COVID-19 vaccine doses in January, a 30% increase on the previous month.

“We clearly have a long way to go with just 30% of this population vaccinated. But what Nigeria is showing us is what we want to show the world. This isn’t about vaccine hesitancy. It’s not about an unwillingness to be vaccinated. It’s about making sure that access is closer to people. It’s nearer to people and that when we do people actually do take the vaccine,” said Gawande.

Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations’ (CEPI’s), described mRNA technology as “game-changing technology that offers the potential for African countries to leapfrog over those alleged decades that it will take to catch up and achieve self-sufficiency”.

Image Credits: UNICEF/Kokoroko.

The formula milk industry is using  ‘unethical’ marketing tactics to influence new parents and pregnant women to substitute breast milk for formula milk in breach of the international standards on infant feeding practices and is detrimental to child nutrition and health, according to a new report by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

The report was based on a survey of over 8,500 pregnant women and parents and 300 health workers in Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Vietnam. It was complemented by in-depth interviews of mothers, and marketing executives in China. 

Some 51% of new parents and pregnant women surveyed had been victims of “systematic and unethical” marketing strategies by the formula milk industry in violation of the International Code of Marketing of Breast-milk Substitutes. 

“This report shows very clearly that formula milk marketing remains unacceptably pervasive, misleading and aggressive. Regulations on exploitative marketing must be urgently adopted and enforced to protect children’s health.” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a press release.” “Let’s stop the commercialisation of our children’s health.” 

Globally, only 44% of babies less than six months old are exclusively breastfed. The breastfeeding rates around the world have increased very little in the past two decades, but the sales of formula milk have more than doubled in roughly the same time, the press release said. 

Women’s self-reported exposure to formula milk marketing in preceding year

The $55 billion-per-year formula milk industry uses an array of techniques such as unregulated and invasive online targeting of new mothers and parents, sponsored advice networks and helplines, promotions and free gifts, and practices to influence training and recommendations among health workers to influence mothers and parents into choosing formula milk over breast milk for their children, according to the report.

 Top three channels where formula milk marketing is seen or heard among mothers

Need for policy change and intervention

According to the report, called How marketing of formula milk influences our decisions on infant feeding, there is a need for more serious political intervention. Political leaders at the highest level, public health institutions, health professionals and their associations, and civil society must step up to identify and halt the risks and pervasiveness of such formula milk marketing. 

“We need robust policies, legislation and investments in breastfeeding to ensure that women are protected from unethical marketing practices – and have access to the information and support they need to raise their families.” said UNICEF Executive Director Catherine Russell. 

Formula milk marketing had reached 92% of women surveyed in Vietnam and 97% of women surveyed in China, thereby increasing their likelihood of choosing breast milk substitutes. These women were significantly more likely to see nutrition as “more comprehensive and balanced in formula’” than breast milk. 

In Bangladesh, 72% of women who exclusively formula-fed their children had received a recommendation to feed formula from a health professional.

Meanwhile, a Mexican woman interviewed confirmed that her paediatrician had suggested a brand of formula milk for her: “Yes, the paediatrician suggested one and that’s what I chose, I didn’t do much research. I trusted what the paediatrician told me, that’s why I didn’t remember the ads.”, said a woman interviewed for the survey in Guadalajara, Mexico.

The report, which was commissioned by WHO, UNICEF and funded by the Bill and Melinda Gates Foundation,  recommends banning health workers from accepting sponsorship from companies that market foods for infants and young children for scholarships, awards, grants, meetings, or events.

It also recommends countering the targeted messages of the formula industry and creating awareness through informational messaging and advertising, investing in training and building the skills of health professionals , and by tightening the current rules of marketing breast milk substitutes.

In addition, the report recommends building a secure digital ecosystem to weed out misleading adverts and protect children’s health from falling prey to commercial and unregulated marketing. Furthermore, it argues that there is a need to support mothers, breastfeeding and health systems, and also to give impetus to maternity and parental leaves. 

Breastmilk is best

The benefits of breastmilk are scientifically proven to outweigh those of formula milk. Breastfeeding for six months and continued breastfeeding for up to two years or beyond, offers children a powerful line of defence against all forms of malnutrition, including wasting and obesity. It also acts as a ‘first’ vaccine for children by providing protection against common childhood illnesses. 

A switch to formula milk is not scientifically recommended and leads to increased infant morbidity and mortality, and are causes of suboptimal breastfeeding that are responsible for an estimated 823,000 deaths among children each year, according to a paper published in BMJ Global Health last week. 

Proportion of women who received recommendations from health professionals to use a formula product

The paper also called for scientific journals to cut ties with breastmilk substitute makers and the formula industry if they want to protect infants and young children from being at risk of malnutrition, illness and death.

The formula industry uses health professional financing and engagement through courses, e-learning platforms, sponsorship of conferences and health professional associations and advertising in medical/health journals to influence health professionals into prescribing and promoting formula milk over breast milk.  

Unscientific claims 

The research shows ways that formula milk companies have exploited and entered markets for their products, such as  “allergies and sensitivities” to enjoy more sales and business opportunities and circumvent restrictions on formula milk company representatives visiting health facilities. 

Formula milk is positioned as close to, equivalent and sometimes superior to breast-milk, presenting incomplete scientific evidence and inferring unsupported health outcomes, the report noted. The ingredients in formula milk which are listed as ”informed” or ”derived” from breastmilk and claimed to be linked to child developmental outcomes were found to not be supported by scientific evidence. 

According to the marketing executives interviewed for the report, formula milk companies’ engagement through digital channels has been intensified by the Covid-19 pandemic. The targeted ad campaigns are based on search histories, cookies and online profiles.

Time to revamp the code? 

The survey showed that women reported being targeted by online marketing through promotions based on their search behaviour for infant feeding advice and information.

Speaking at the launch of the report, Helen Clarke, Former Prime Minister of New Zealand and Board Chair of the  Partnership for Maternal, Newborn and Child Health, questioned whether it was time for the Code to be completely overhauled since those rules are not in the digital age.

”The code needs to be brought up to date with the new media for advertising, which is so pervasive and can be very, very harmful,” said Clark.

Helen Clark, Former Prime Minister of New Zealand and Board Chair of the Partnership for Maternal, Newborn and Child Health

“Formula marketing does have a direct impact on survival health, and development, both of children and women,” said UNICEF’s Dr Nigel Rollins at the launch. “It does disrupt access to impartial truthful information and support that is so necessary for parents to make decisions and this is an essential human right.” 

WHO calls on governments, health professionals, and the baby food industry to put an end to the ‘exploitative’ formula milk market and to abide by the Code provisions. These provisions include publicly committing to full compliance with the Code and subsequent World Health Assembly resolutions globally.

A 2020 report by WHO, UNICEF and IBFAN shows that of the 194 countries that were analysed in their report, 136 had provisions for some form of legal measure related to the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions adopted by the World Health Assembly.

It noted that the legal restrictions in most countries did not fully cover marketing that occurs in health facilities as only 79 countries had banned the promotion of breast-milk substitutes in health facilities, while 51 had provisions that prohibited the distribution of free or low-cost supplies within the healthcare system.

Image Credits: WHO/C. Black, WHO, WHO/UNICEF, HOW THE MARKETING OF FORMULA MILK INFLUENCES OUR DECISIONS ON INFANT FEEDING, WHO UNICEF Report .

Bill Gates meeting with Pakistani President Arif Alvi in Islamabad during a visit to Pakistan on 17 February

ISLAMABAD – The timing couldn’t have been worse. 

On the same day that Bill Gates, completed his maiden visit to Pakistan to cheer on the country’s progress towards polio eradication, WHO and Malawi health authorities announced that a small child thousands of kilometers away in Malawi had been ill with polio – infected by a Pakistani strain of wild poliovirus (WPV type-1).   

WHO officials hastened to say that the polio case in the 3-year-old girl in Lilongwe, diagnosed after she experienced an onset of paralysis, did not threaten Africa’s hard-earned  “polio free” status – because it was an “imported case” of the deadly virus.  It was only after repeated queries by Health Policy Watch, that WHO acknowledged that neither the young girl or her family members had recently traveled to Pakistan – meaning that she became infected locally.   

But in fact, the particular genetic strain of the wild poliovirus that popped up in Lilongwe Malawi, hasn’t even been seen in Pakistan since 2019, Pakistani authorities there later stated – raising questions about if and how the virus may indeed be circulating more widely now in the African country.  

It was only in August 2020 that Africa was declared free of wild poliovirus.  Pakistan is getting closer to that goal as well. 

But the surfacing of a Pakistani wild poliovirus strain in Africa, underlines the challenges still faced to global elimination of polio – not to mention control and elimination of other diseases. And if more cases of wild poliovirus occur in Malawi, the whole continent’s wild polio-free status could be threatened – even if WHO is loath to state that publicly.   

Three month delay in WHO announcement of Malawi polio outbreak   

The other conundrum raised by the episode is one of timing – the apparent three-month long delay in identifying and reporting the wild poliovirus case.

The WHO African Regional Office announcement took place on 17 February 2022. But the child’s polio symptoms were first reported in November, 2021. 

“The three-year-old girl in Malawi experienced onset of paralysis on 19 November 2021, and stool specimens were collected for testing on 26 and 27 November,” stated a Global Polio Elimination Initiative report, also dated 17 February 2022.

“Sequencing of the virus conducted in February by the National Institute for Communicable Diseases in South Africa and the U.S. Centers for Disease Control and Prevention confirmed this case as WPV1,” the GPEI statement continued.   

So far, no one has been able to explain why there was a three-month delay in sequencing the virus and announcing the case – when new SARS-CoV2 variants were being identified by the same laboratories within days or weeks.  

But only four days later, WHO Director General Dr Tedros Adhanom Ghebreyesus commended Malawi’s President Lazarus Chakwera for  “rapid action and transparency” in responding to the outbreak.

Analogue era of reporting – in digital age

A similar pattern occurred last October, when WHO reported a Ziki outbreak in India – four months after a cluster of new cases actually occurred and were diagnosed.

It raises, once more, again thorny questions, once more, about the snail’s speed at which national governments report, laboratories examine and WHO publicly releases sensitive “disease outbreaks news” – that national governments may find embarrasing. 

Fault lines in the chain of alert and response have come under heightened scrutiny during the COVID pandemic – something The Independent Panel described it as an “analogue” system operating in a digital age.

WHO’s alert and response system “seems to come from an earlier analogue era and needs to be brought into the digital age,” observed panel co-chair Helen Clark, former Prime Minister of New Zealand, in a media briefing on 21 January 2021. 

The SARS-CoV2, the virus was probably circulating in Wuhan for weeks, if not months, before the first public report was made by Wuhan health authorities on 31 December 2019, experts now believe. After the first public reports, it took WHO another full month to declare an international health emergency, Clark noted.     

Imported case – but circulating locally  

Another issue raised is how you define an “imported” case of a disease.

When WHO described the Malawi polio case as “imported” that meant that “laboratory analysis shows that the strain detected in Malawi is linked to the one that has been circulating in Sindh Province in Pakistan”, WHO African Regional Office,  Dr. Modjirom Ndoutabe, told Health Policy Watch, in an interview.

Neither the child nor her parents had been to Pakistan, he affirmed.

“When we are talking about importation, it will be an adult passive vector who traveled from an infected country to the polio-free country,” he explained. Laboratory analysis of the virus strain showed that it is genetically linked to a wild poliovirus found circulating in Pakistan in 2019, Ndoutabe added.

This was confirmed by Pakistan’s Dr. Rana Mohammad Safdar, Director General of the Ministry of National Health Services. However, the same virus strain has not been seen in Pakistan since 2020, he told Health Policy Watch. 

“Origin is, of course Pakistan, but remains to be investigated where it survived as hidden circulation,” Safdar said.

Heading off a wider outbreak 

An oral polio vaccine is administered to a child.

Meanwhile, WHO’s African Region polio coordinator, Ndoutabe, admitted that the virus “may be spreading silently”, elsewhere in the environment. 

Just one infected child can contaminate water sources, as well as other people who come into contact an infected persons stool – and the virus can also multiply and thrive in untreated sewage, he observed.

If the virus indeed spreads further, then it could compromise the recently-gained status of Africa being free of wild poliovirus Type 1.  That, in additon to the vaccine-derived polio cases that some 16 African countries continue to battle.    

In the wake of Malawi’s polio case, the Global Polio Eradication Initiative (GPEI) team based at WHO’s Brazzaville Regional Office is deploying a team to Lilongwe to support coordination, surveillance, data management, communications, and operations, WHO said.  

Ndoutabe  expressed confidence that Malawi health authorities could head off a wider outbreak, saying: “We can stop it very quickly with excellent vaccine campaigns.” 

Gates – Pakistan faces ‘hardest phase’ of eradication effort 

Meanwhile, in his first-ever visit last week to Pakistan, Gates, the billionaire philanthropist and co-chair of the Bill and Melinda Gates Foundation (BMGF), declared that not a single case of wild poliovirus has been reported in that country in the last fourteen months.

“It has been over a year since wild polio paralyzed a child in Pakistan, presenting an incredible opportunity to stop this disease for good,” Gates said in a tweet. 

Malawi’s case aside, Pakistan and Afghanistan are the only countries left in the world still struggling to eliminate wild poliovirus. 

Officials at Pakistan’s ministry of National Health Services Regulation and Coordination told Health Policy Watch that they believe Pakistan is indeed very close to eradicating the wild polio virus Type 1 that remains endemic in the country  – although the virus continues to be identified in stool samples collected by surveillance in a few sites in the country’s northwestern province.

“Two samples in the south of province Khyber Pakhtunkhwa were tested positive in December while all other sites were negative,” a senior official said, asking to remain anonymous. 

This was formally confirmed by a BMGF statement about Gates’ visit and meeting with Pakistan’s President Arif Alvi, and Prime Minister Imran Khan.  The BMGF statement noted that “wild poliovirus was detected in sewage samples in Khyber Pakhtunkhwa, a province located in the northwestern region of the country, in December 2021”.

During his visit, Gates commended Pakistan’s commitment to “the hardest phase” of the eradication effort. 

“This is the final, and hardest, phase of the eradication effort, but by keeping up the momentum and staying vigilant, Pakistan has an opportunity to make history by ending polio for good,” he said.

Vaccine hesitancy and reaching children in areas of civil unrest 

Children in Pakistan display their finger nail died purple – proof they have been vaccinated against polio.

Other challenges include vaccine hesitancy and reaching children in insecure areas, said the BMGF and Pakistani government statements.

Dr Shahzad Baig, the coordinator of the health ministry’s National Emergency Operations Center (NEOC) – highlighted the need to halt virus circulation in border areas shared by Pakistan and Afghanistan – in the throes of crisis and with refugees crossing the border daily. 

Against that landscape, Pakistan’s Polio Eradication Programme continues to work closely with Afghanistan’s new Taliban government in efforts to halt poliovirus transmission across shared corridors and amongst highly mobile population groups, Baig underlined. Reversing years of vaccine hesitancy, the new Afghan leaders have committed to continue polio vaccination efforts on their side of the border. See related Health Policy Watch story. 

Baig also commended the growing synergies between the activities of WHO-supported Expanded Programme on Immunization (EPI) and Polio Eradication Programme (PEI) – to carry out routine vaccination campaigns that offer multiple health services at the same time.

In 2022, for instance, targeted polio vaccination campaigns across all four provinces in Pakistan will be followed by health camps that offer communities free routine vaccinations, nutrition services, and referrals to health facilities.  

https://healthpolicy-watch.news/93812-2/

Image Credits: UNICEF Pakistan, Pakistan, President's Media Team , WHO.

At the National TB Centre in Abovian, Armenia, Dr Shahidul Islam examines a patient with drug-resistant TB

There is finally “cause for optimism” in the quest for a tuberculosis vaccine, Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAD), told the opening of the sixth Global Forum on TB Vaccines on Tuesday.

Before the COVID-19 pandemic, TB was the most deadly global infectious disease yet there has been little progress on vaccine development for TB for decades as it is seen as a disease of the poor.

Acknowledging that there were still “basic knowledge gaps” about TB, Fauci said that “there have been significant research advances and there is cause for optimism in the context of our research advances”. 

The only licensed TB vaccine, BCG, was discovered 100 years ago and only provides moderate protection against severe forms of TB in babies and young children but does not stop TB transmission in teens and adults.

There are currently 15 TB vaccine candidates, including three in phase 3 trials and two others preparing for Phase 3 trials.

But Fauci cautioned that “incremental changes alone are not sufficient and not acceptable” – particularly in light of how COVID-19 had set back advances in TB. 

He also expressed his concern about the rise of “vaccine hesitancy” – even for vaccines as efficacious as those for COVID-19 – and warned that more attention needed to be paid to “effective messaging” about vaccines.

Multi-platform portfolio for vaccines

Dr Tedros

“Public funding for TB vaccine research remains inadequate and industry engagement is low owing to the lack of market incentives, but there are solutions,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the meeting, which is being hosted by France.

“The pandemic has demonstrated the value of a multi-platform portfolio of vaccine candidates, including mRNA and viral vector technologies. This approach could transform vaccine development efforts for other diseases including TB,” said Tedros.

He identified three essential ingredients to find a TB vaccine: public-private partnerships to bring together expertise and funding; strong political leadership, backed by substantial financial resources and thirdly, “equitable access must be considered early with need prioritised above the ability to pay”. 

Mark Feinberg, Co-Chair of the Global Forum, said that the CVID-19 pandemic had shown that “how quickly and creatively we act is what counts”.

“In particular, the speed with which mRNA vaccines can be produced offers real hope that, through application of cutting-edge science, we can harness a more nimble and responsive approach to vaccine design and testing.,” Science is our way out of the tuberculosis epidemic,” stressed Feinberg.

Drug-resistant TB

 Antimicrobial resistance (AMR) is now killing more people each year than HIV or malaria and is tipped to be the world’s most lethal health challenge by 2050. TB drug resistance accounts for nearly a third of the 3,500 daily deaths from AMR.

Virologist Philippe Sansonetti,  Emeritus Professor at the Institut Pasteur and College de France, said that the development of a TB vaccine was essential to reduce drug-resistance.

“We need vaccines because they protect against antibiotic resistance by reducing the burden of disease,” said Sansonetti. Drug-resistant TB is a significant problem worldwide, caused by incorrect use of TB medication.

“It’s been calculated that more than 300,000 tonnes of antibiotics are released every year on the planet, essentially un-degraded,” said Sansonetti. This was causing a significant reduction in microbial diversity and accelerating antibiotic resistance.

The European Commission’s Jean-Eric Paquet, Director-General of Research and Innovation, assured the forum that multidrug-resistant TB was a “key focus” of its Innovative Medicines Initiative, a partnership with European pharmaceutical companies.

What it will take to end TB by 2030

Carol Nawina

Carol Nawina, who is living with HIV in Zambia, said she had struggled with TB for years.

“According to current modelling, we will be able to end TB by 2030 if a vaccine becomes available by 2025. And for that to happen, we need to fast-track the trials, particularly Phase 2 trials,” said Nawina, who works for the Community Initiative for Tuberculosis, HIV/AIDS and Malaria plus related diseases (CITAMPlus).

She added that TB vaccines received just $118 million in research funding in 2020, only  9 million more than 2018 levels., and that funding for TB vaccine development is “completely lacking”.

“The COVID pandemic has shown us that the world has the money. The question is does it care about people who died from TB the same way it cares about people who died from COVID?” asked Nawina, urging the European Union and host country France to “commit to champion this effort to ensure an operational TB vaccine by 2025”.

Image Credits: End TB.

Residents in the European Union will soon have access to a single electronic database with information about all medicine available in the region, following the European Medicines Regulatory Network’s adoption of a common standard for electronic product information (ePI). 

“This will enable any EU resident to get up-to-date information on all medicines available to patients in the EU through an ever-expanding range of electronic channels,” according to the European Medicines Agency on Tuesday.

This information will include the package insert for patients on how the product should be used and the summary of product characteristics (SmPC) for healthcare professionals, explaining how it should be prescribed. 

“The EU ePI Common Standard will support the provision of harmonised electronic information on medicines within the EU and is a step towards improved delivery of information for patients, consumers and healthcare professionals to aid their informed decision-making,” according to the EMU.

It added that developing the common standard was one of the key deliverables of an ePI project run by the European Medicines Agency (EMA), National Competent Authorities (NCAs) and the European Commission (EC) in 2021.

A follow-on pilot project supported by the EU’s funding programme EU4Health will develop tools and guidance to pilot the use of ePI prior to implementation. 

 

Image Credits: Shutterstock.

United States cancer patients protesting the price of a prostate cancer drug that costs up to five times more in the US than in other high-income countries have recently revived a petition to lower it’s price – a battle that was lost during the administration of US President Barack Obama but seems to be gaining more political momentum now.

The petition, submitted to the Department of Health and Human Services, is callling upon the administation of another Democratic President, Joe Biden, to exercise its so-called “march-in” rights that would enable generic competition to lower the drug’s price – as provided for in legislation covering drugs that received government R&D funding. 

Xtandi (enzalutamide), which is co-licenced by Japan’s Astellas Pharma and Pfizer, costs US patients about $156,000 a year on average – five times more than it costs in Japan and Canada, according to Knowledge Ecology International, which is champining the new appeal.  In Denmark, the drug costs about $45 per capsule, as compared to $113-130, in the US, while in some countries generic vesions are available for as little as $1.72. 

The differential is particularly striking insofar as Xtandi was developed at the University of California Los Angeles (UCLA) with the support of grants from the US National Institutes of Health (NIH) and the Department of Defense (Army).

Charitable foundations, including the Prostate Cancer Foundation, the National Cancer Institute, the Howard Hughes Medical Institute and Doris Duke Charitable Foundation, also assisted with research and development costs.

Back in 2016, the Union for Affordable Cancer Treatment (UACT) and Knowledge Ecology International (KEI) failed in their quest to get the National Institutes of Health (NIH) and Department of Defense (DoD) to use their “march in” authority under the Bayh-Dole Act to authorize the generic production of the expensive prostate cancer drug.

Under the Act, the federal government is able to award third-party licenses if the patent holder does not make the product “available to the public on reasonable terms.”

Support growing in United States for reducing drug prices?

However, since then, the high cost of many drugs in the US – as compared to Europe and other high-income countries –  has received more public attention recently, and there are some signs that the petition could be picking up political steam – at least among Democrats.

Last week, Senators Elizabeth Warren and Angus King and Representative Lloyd Doggett wrote to HHS Secretary Xavier Becerra, urging him to move forward with the “march-in” petition and consider authorising generic production for government programmes.

“Xtandi is not the only case where Americans are paying exorbitantly high prices for prescription drugs – there are legions of examples. But the Xtandi costs are particularly galling because the drug’s research and development were underwritten by American taxpayers,” according to their letter.

The high cost of the drug means that insurers often require its pre-approval, at repeated intervals, which can delay treatment, the petition’s supporters say.  That is without reference to the high insurance co-payment charges that may be required, even if the drug is covered, which can be a big financial burden to many patients.  

A statement by Astellas, dated 9 February, claimed stated that, “while the U.S. government contributed approximately $500,000 to the initial discovery of the molecule that eventually became XTANDI, Astellas has invested more than $1.4 billion to date in research and development efforts for XTANDI.”

A response by KEI said “that is a lot to unpack,” noting that  “Charles Sawyers, the lead inventor on the Xtandi patents, is listed as the principal investigator for $27.7 million in NIH-funded projects and $8.3 million in subprojects, beginning in 1985.  Michael Jung, another of the Xtandi inventors, was the principal investigator for 42 NIH grants involving $5.99 million….

“Once Xtandi was approved by the FDA on August 31, 2012, it became a commercial and profitable product that has generated more than $20 billion in global sales,” added the KEI statement – calling for a more transparent accountancy of the R&D costs of the drug pre-approval, and how those costs were covered.

GUWAHATI – Amid sharply falling COVID-19 cases, the streets in the largest city in north eastern India have started to resemble pre-pandemic days, crowded with pedestrians, vehicles, roadside vendors and hawkers jostling for space with scarcely anyone wearing masks.

This follows the decision by Assam state to lift all restrictions from 15 February, removing curfews and  restrictions on public gathering of people, and even mandatory testing for passengers at airports and railway stations, according to the chief minister of the state, Himanta Biswa Sarma. 

Across the rest of the country other states have followed Assam’s lead, by easing restrictions. The Delhi Disaster Management Authority (DDMA) has allowed schools and gyms to reopen in the national capital. In Andhra Pradesh, Meghalaya, Rajasthan, the night curfews imposed to check the spread of coronavirus, have been lifted. 

India’s surge in coronavirus surge began on 27 December, and peaked in mid-January with more than 340,000 daily cases. But by 13 February, that number had dipped to 44,877 cases, according to India’s health ministry. Across south Asia, cases are also falling including in Nepal and Bangladesh. 

Cases subsiding rapidly

Dr Abhijit Sarma, superintendent at the Gauhati Medical College Hospital (GMCH), the largest government hospital in Assam state, said there has been a sharp decline in daily cases and the positivity rate shows that the wave is “subsiding and retreating”. “It is coming down,” he said. 

This surge, fueled by the highly transmissible Omicron variant, was termed the third wave of the pandemic in India by experts. It was predicted that the wave will be short-lived and its impact will not be as severe as that of the first and the second waves. 

“The symptoms for Omicron stay for three days and by the fifth day, it usually goes down. So, the severity is less compared to Delta,” Dr Sarma said, but added that it had been more serious for those who were unvaccinated or partially, and senior citizens with comorbidities.  

The country has so far given more than 1.7 billion doses of vaccines and about 76% of eligible adults have been fully vaccinated. In reaction to the third wave, the country began administering a precautionary booster dose of vaccine to healthcare workers, frontline workers including personnel deployed for election duty and those aged 60 and above with comorbidities from 10 January onwards. It also started vaccinating 15-18-year-olds from January.

Professor K Srinath Reddy, president of the Public Health Foundation of India (PHFI), said that the vaccination drive in India is going “fairly well in terms of intended coverage from whatever has been reported in the media.” 

India’s battle with the Omicron variant was surely aided by the large scale vaccination programme, which reduced the severity of the disease, along with apparently milder Omicron symptoms. “Two doses of the vaccine is highly effective,” Chennai-based virologist Dr Jacob T John said.

“We must recognise another fact that vaccines are meant only to protect against severe illness and death, not against infections, per se,” Reddy explained. “The Omicron wave has resulted in not as much severe infection and illness, partly because the virus itself appears to be milder and partly because a lot of our population has acquired immunity through natural infection, vaccines or both.” 

Most restrictions have been lifted in India, but experts urge people to still wear masks.

For its vaccination drive, although India has approved seven vaccines it is currently using only three – Covishield (AstraZeneca), Covaxin (Bharat Biotech) and Sputnik V (Russia), with  Covishield accounting for more than 85% of the doses administered so far.

When asked which of these vaccines was functioning well, Reddy explained that there are two ways of assessing whether the vaccines performed well or not. One is through lab tests by studying T cell immunity and the other way of assessing is by identifying how many breakthrough infections are occurring. 

“We do not have adequate data to analyze what the amount of breakthrough infections or the amount of hospitalization in vaccinated people are,” said Reddy, but added that the National Institute of Virology in Pune had demonstrated that both Covishield and Covaxin had continued protection against even the Omicron variant. 

Lack of testing and underreporting confound diagnoses 

Dr Angkita Barman, a Guwahati-based doctor who specialises in anesthesiology, and works at a private hospital in the city, said that in smaller cities such as Guwahati it had been difficult to determine whether a person is infected by Omicron or Delta . “An assumption is made based on the symptoms of a patient as we don’t have a proper lab here which will suggest what variant it is,” she said. 

To confirm whether a suspected case is Omicron requires a full genetic analysis, which can take between four and five days. 

“We have come across severe cases in this third wave as well and that could be due to Delta as well but we do not know. We are not investigating on that front due to lack of a proper lab,” Barman explained. 

Virologist John said most current cases are Omicron and that although official case figures for the Delta wave appeared higher than the Omicron wave, this was contrary to international trends and due to an “undercount”.

“Everybody knew that this disease did not cause pneumonia and hypoxemia, therefore a lot of people did not bother to get themselves tested,” said John, adding that the government was also not enthusiastic about following up on cases due to the state elections in five Indian states. 

Death toll may be six or seven times higher

India also reported a surge in the use of home testing kits with 200,000 home tests used in the first 20 days of January in comparison to 3,000 in all of 2021, the director general of the Indian Council of Medical Research, Balram Bhargava said on 20 January.

In Mumbai, the sale of self-testing kits also rose but the municipality made it compulsory for purchasers to provide their individual identification number when buying kits in an attempt to keep track of cases.

 Six to seven times more people could have died of COVID-19 in the first and second waves of the pandemic than officially reported in India, according to a study published in Science last month. 

The study estimates that as many as 3.2 million people could have died from the disease, whereas the government-recorded number is 419,000 deaths between June 2020 and July 2021. 

“India’s reported COVID death totals are widely believed to be under-reports,” the authors wrote in the study, “because of incomplete certification of COVID deaths and misattribution to chronic diseases and because most deaths occur in rural areas, often without medical attention”.

Reddy urged people not to abandon masks, noting that the virus “could still mutate to a more virulent form particularly if it mixes up with other viruses in what’s called an antigenic shift”.

 

Image Credits: Deepak Choudhary/ Unsplash, Govind Krishnan/ Unsplash.

TDR-supported postgraduate fellows during a conference on implementation research in Dhaka, Bangladesh, in June 2019

In a village in eastern Ghana where Comfort Tetteh grew up, many people thought it was normal for a child to urinate blood. But after studying public health, Tetteh recognized this as a sign of schistosomiasis, one of the many neglected tropical diseases that affect her community.

“In the districts that I’ve worked in, everything is about tropical diseases,” said Tetteh, who became a disease control officer after graduating with a Bachelor of Science degree. “I saw Buruli ulcers, I saw leprosy, I saw schistosomiasis, I saw yaws and many other diseases. My job was to implement disease control measures, and my interest grew to go beyond treatment and help people to apply community-level measures to prevent the appearance of these diseases,” Tetteh said.

Comfort Tetteh

Tetteh, now a senior public health officer in Greater Accra, recently had the opportunity to learn how to do exactly that through postgraduate training in implementation research at the University of Witwatersrand in South Africa, with a scholarship from TDR, the Special Programme for Research and Training in Tropical Diseases. The University of Witwatersrand is one of seven universities in low- and middle-income countries partnering with TDR on the Postgraduate Training Scheme.

TDR is a global programme aimed at combating infectious diseases of poverty and is based at the World Health Organization (WHO) headquarters in Geneva. TDR is co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO.

Focusing on infectious diseases of poverty

 Infectious diseases of poverty include tuberculosis (TB), neglected tropical diseases (NTDs), malaria and other vector-borne diseases. These diseases are prevalent in low- and middle-income countries (LMICs), where they mostly affect poor communities and disproportionately affect women and children. The pandemic has also prompted research on how COVID-19 is affecting control efforts for these diseases.

While HIV, TB and malaria have been the priority for two decades of global efforts and billions of dollars in investments, NTDs have often received less attention. And this is despite the fact that these diseases impose a devastating human, social and economic burden on more than 1 billion people worldwide. WHO recently launched a new road map to end this neglect.

Implementation research: the research-to-community link

TDR was established almost 50 years ago, and in the early years, it led the development of critical new NTD treatments – from the first modern treatments for sleeping sickness and river blindness to bednets for malaria.

But with many other agencies now involved in the laboratory development of actual treatments for NTDs, TDR has shifted its focus to implementation research to understand and address barriers to effective implementation of health interventions, strategies and policies.

“The focus of our work is to teach the researchers and scientists in low- and middle-income countries to better address the implementation bottlenecks that prevent the uptake of products and strategies,” said Dr Mahnaz Vahedi, who has been managing TDR’s flagship postgraduate training programme since 2017.

Barriers to uptake include social, political and cultural issues, she points out. These barriers are often grossly underestimated by the innovators of new tests, treatments and vaccines. Thus, there is growing recognition among public health and global health stakeholders that these barriers need to be addressed systematically in order for health programmes to be successful.

Iconic component of TDR’s mission

 Support for postgraduate training in LMICs has been an iconic component of TDR’s mission since the beginning – fostering cadres of skilled professionals in infectious diseases of poverty across Africa, Asia and Latin America, who have become influential in research, public health and policy positions. 

WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus, has spoken out about the importance of such support in building cadres of health professionals and policy leaders from Africa and other developing regions, noting that he himself is “living proof” of the value of such programmes – as the recipient of a WHO scholarship that financed his studies towards his Master’s degree in immunology and infectious diseases, earned in 1992.  

Originally, TDR offered individual scholarships for students to study NTDs – usually in wealthy developed countries. This was expensive and time-consuming – and it also had some unintended consequences.

“The one big lesson we learned is that we weren’t strengthening the capacity of the institutions in the South,” said Dr Pascal Launois, head of TDR’s Research Capacity Strengthening unit.

“This kind of training actually led to a lot of brain drain because people went to do postgraduate training in the UK, Europe or the US and then they didn’t go back to their own countries, and if they did, in many countries there was no institutional commitment for many of them to continue with their work,” he added.

Repositioning to strengthen institutional capacity in the Global South

To correct this, in 2015, TDR issued a call inviting institutions in the Global South to host students for PhD and Masters programmes in implementation research, with TDR providing the course material and full scholarships for the students.

 A flood of institutions applied, and after a careful vetting process, including site visits with independent experts, seven universities were selected: BRAC University (Bangladesh), Universidad de Antioquia (Colombia), the University of Ghana, Universitas Gadjah Mada (Indonesia), American University of Beirut (Lebanon), the University of the Witwatersrand (South Africa) and the University of Zambia. In 2020, Cheikh Anta Diop University in Senegal was added to cater to French-speaking students in Africa.

Cheikh Anta Diop University students conducting fieldwork in Fatick, Senegal

 “The institutions like it a lot because they get visibility, they are able to host international students and it provides the opportunity for South-South networking, which means we are strengthening the capacity of institutions in the south,” Vahedi said.

The aim is to ensure that the research is done by the researchers based in the disease-endemic countries and for the institutions and students to network.

“The old-fashioned style where research was done by a lead researcher in the North with data collected in the South doesn’t work anymore,” stressed Vahedi.

Students are selected both from health ministries and academia, as the aim is to bolster the country’s capacity in government and its research capacity in institutions.

More than 400 students – with an equal number of men and women – have been trained in Southern institutions since 2015 in programmes lasting from one to two years, and the second phase of the programme is due to start this year after a new call was issued in 2021 for new partners.

There are a few changes in the second phase. The India Institute of Health Management in Jaiphur has joined the group. If funds allow, the University of Technology of Science in Bamako in Mali will also be included to provide back-up for Senegal given the high demand from French-speaking African countries. And BRAC University in Bangladesh will now also train students from the Eastern Mediterranean Region.

Close-up on Wits School of Public Health

 Professor Tobias Chirwa, Dean of the School of Public Health at the University of Witwatersrand (Wits) in South Africa, said that hosting the postgraduate training programme has been a boost for both his institution and sub-Saharan Africa.

“The Wits School of Public Health has benefited from the long-term investments from TDR, including the recent funding on implementation research capacity building to support sub-Saharan African postgraduate students,” Chirwa said.

Prof Tobias Chirwa

“Through its extensive network and rich postgraduate programmes, the School will continue to provide regional training on implementation research and collaborate with research and academic institutions in Africa and beyond to develop and implement interventions that are relevant and contextual.”

Professor Latifat Ibisomi, the academic coordinator of the training programme at Wits University, said that TDR has enabled the school to “host outstanding students from multi-disciplinary backgrounds across 12 sub-Saharan Africa countries.”

“These students have conducted country-specific implementation research, thereby transferring their skills to several countries across the continent,” Ibisomi said. “We are thus contributing to the building of a critical mass of implementation researchers who are working to unblock implementation barriers that abound in the region.”

Lymphatic filariasis – why so high despite years of interventions?

Alfred Manyeh recently graduated with a TDR-sponsored PhD focused on lymphatic filariasis, a parasitic disease transmitted by mosquitoes that he became fascinated with back in 2015 when he was first exposed to it.

“I conducted my study in the northern part of Ghana in a district called Bole, where the transmission of lymphatic filariasis is highest in the country, although a lot of interventions happen there,” said Manyeh, who is currently a research fellow at the University of Health and Allied Sciences at Ho in Ghana.

Alfred Manyeh

Through his research, Manyeh wanted to uncover why the transmission of the disease was still so high despite years of interventions in the area.

“Based on the findings of my initial assessment, I put an intervention in place with strong stakeholder engagement. Then I went in there to evaluate the process and the impact of the intervention on the people’s knowledge about the disease and then their willingness to participate in the mass drug administration,” Manyeh said.

He found that the programme implementers – drug distributors and health workers – were not following protocols and that local people had various misconceptions about both the disease and its treatment.

Driving real change from implementation research findings

“We dealt with this by organising videos, community meetings and social mobilisation programmes in the community to educate the people about the disease and also about the medication, as well as training for the implementers,” Manyeh said, adding that people were more willing to take the drug after the intervention.

While the impact of his PhD research has only been felt in one area of Ghana, Manyeh is teaching a new generation of young scientists how to do implementation research and is confident that this will improve the uptake of health products in his country.

Meanwhile, Charity Hungu, a Masters graduate from Wits, has taken her new skills back to Kenya’s Kenyatta University Teaching Referral and Research Hospital, where she is a research officer.

Charity Hungu

 “The main focus of the hospital is on cancer. My work entails coordinating research projects within the hospital as well as with partner institutions from our region and internationally,” Hungu said.

“Sub-Saharan Africa has a great need for implementation scientists to address the daunting health issues that have set us back over the decades,” added Hungu. “We need to effect a turnaround, making our health systems work better and change the reality and narrative of our continent to one of healthier and more vibrant communities.”

 Adapting for COVID times

During the pandemic, more than  400 TDR-trained researchers and programme officers have adapted the research skills they have learnt to help their countries to combat COVID-19, according to a recent survey of graduates.

The activities they have been involved in include pandemic preparedness and response, situation analysis, surveillance, infection control and clinical management.

 As the senior public health officer in Greater Accra, Tetteh has been involved in the COVID-19 case management and vaccination rollout activities in her district.

Although the Kenyan hospital where Hungu is based focused on cancer, it also served as one of the main COVID-19 isolation centres in the country in the earlier part of the pandemic, and she has been drawn into some of the COVID-19 studies.

TDR has also developed several online implementation research tools to assist students who can’t travel to their universities to study during the pandemic.

“The pandemic created an opportunity for us to adapt our programme by providing hybrid and virtual training,” Vahedi said. “We are also looking forward to embarking on the development of a Masters degree in implementation research as well as a postdoctoral programme,” Vahedi said.

Developed in collaboration with TDR, as the first in a series of stories on strengthening implementation research capacity in low- and middle-income countries to tackle infectious diseases of poverty. For more information on TDR’s Postgraduate Training Scheme, please contact Dr Mahnaz Vahedi.

Image Credits: Cheikh Anta Diop University.

COVID patient in hospital
COVID patient in hospital

Immunosuppressed individuals living in the United States and Israel have been among the first to receive a novel new “vaccine” that preventively boosts their defenses against COVID-19 infection with a cocktail of long-acting antibodies.

The vaccine by AstraZeneca, branded as Evusheld, works on the principle of “passive immunization”, and contains two long-acting monoclonal antibodies (tixagevimab and cilgavimab) that bind to the SARS-CoV-2 spike protein preventing the virus from interacting with the human ACE2 receptor, thus reducing the risk of developing symptomatic disease.

The US Food and Drug Administration issued an Emergency Use Authorization for the vaccine in December 2021, for use in individuals who do not develop an adequate immune response after receiving other conventional COVID vaccines.  The US government reserved 700,000 doses at the time, but last week increased the purchase of the antibody combo to 1.7 million doses – at a cost of $855 million. Such treatments could be particularly important in the US, which has had comparatively higher death rates from COVID, per capita, than most other high income countries – something experts link to its comparatively lower vaccination rates.

Israel also has approved the drug and is deploying it through its local health funds, while Bahrain is reportedly about to do so. The European Medicines Agency is evaluating the treatment, which is unlikely to be available quickly in most low- and middle-income countries because of its high price tag of around $500 a dose – in comparison to about $28 for an mRNA vaccine dose.

Evusheld: Targeted at people who do not respond well to vaccines

Evusheld is intended for immunosuppressed people, to directly increase the amount of antibodies in their bodies. The treatment, given in two consecutive intramuscular injections, was reported in clinical trials reviewed by the FDA to have reduced severe morbidity and mortality from COVID by 83%. The trials were before the Omicron variant.

The shots are given prior to exposure to COVID, unlike other monoclonal antibody treatments for COVID, including those produced by Regeneron, GlaxoSmithKline and Eli Lilly.

Eli Lilly researchers developing a COVID-19 antibody treatment.

“Vaccines have proven to be the best defense available against COVID-19. However, there are certain immune-compromised individuals who may not mount an adequate immune response to COVID-19 vaccination, or those who have a history of severe adverse reactions to a COVID-19 vaccine and therefore cannot receive one and need an alternative prevention option,” said Dr. Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, in the December announcement of Evusheld’s approval.

“Today’s action authorizes the use of the combination of two monoclonal antibodies to reduce the risk of developing COVID-19 in these individuals.”

She stressed the treatment is not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended.

‘Passive immunization’

The jabs operate on the principles of what experts describe as “passive immunization.”

“When we give a regular vaccine, we expect to train the immune system,” Prof. Cyrille Cohen, head of the Immunology Lab at Israel’s Bar-Ilan University, told Health Policy Watch. “We are showing the immune system a pathogen and asking the body to generate antibodies or T-cells against that pathogenic-like substance.”

“In other words, ‘active immunization’ means we are giving the body the opportunity to generate its own antibodies. In contrast, passive immunization is when we take laboratory-made antibodies or those from recovered patients and inject them into the highest risk population to give them an extra layer of protection.

“We are giving them an artificial way to fight the virus because we don’t expect them to generate antibodies on their own,” Cohen explained.

Treatment aimed at stopping hospitalizations of the most vulnerable

The treatment arrived on the market at a time when many fully-vaccinated individuals with underlying medical conditions are being hospitalized with Omicron at the same or even higher rates than the unvaccinated.

“People have to understand that people with deficient immune systems are at mercy of germs that healthy people are not worried about,” Cohen said.

Evusheld is available for people over the age of 12 who weigh at least 40 kg, are not infected with the virus or who have not been recently exposed to the virus, and who suffer from a pre-existing medical condition, including having undergone a bone marrow or organ transplant, as well as undergoing CAR-T or B-cell depletion therapy for cancer or other conditions.  It can be administered regardless of whether an individual was vaccinated previously or not with a conventional jab.

Not all antibody treatments are the same

The first monoclonal antibody treatments entered the public arena with a splash in October 2020, after then-US President Donald Trump, who had been infected with COVID-19, took Regeneron’s polyclonal antibody cocktail, REGEN-COV, a combination of two monoclonal antibodies (casirivimab and imdevimab) designed specifically to block the progress of a COVID-19 infection. At about the same time, the drug was approved by the FDA for compassionate use, and soon after, the treatment received an Emergency Use Authorization.

However, Regeneron and other similar treatments have since failed to perform against Omicron. As a result, in January, the FDA revised its authorization of REGEN-COV and another antibody treatment (bamlanivimab and etesevimab administered together), limiting their use to only when an individuals has already been infected with or exposed to another variant – one that is susceptible to these treatments.

“Because data show these treatments are highly unlikely to be active against the Omicron variant, which is circulating at a very high frequency throughout the United States, these treatments are not authorized for use in any US states, territories and jurisdictions at this time,” Cavazzoni said in a statement.

“In the future, if patients in certain geographic regions are likely to be infected or exposed to a variant that is susceptible to these treatments, then use of these treatments may be authorized in these regions.”

Despite its FDA approval, some researchers have also questioned the use of Evusheld against Omicron:  “Most antibody-based treatments are not effective against Omicron,” said Dr. Erez Garty, head of science communications at Israel’s Davidson Institute of Science Education, located in the Weizmann Institute of Science, saying he is not yet convinced.

“There is lab evidence that Evusheld has a better neutralizing effect against Omicron than some [other] antibody based treatments,” Garty explained. “But this type of treatment is very sensitive to change in variants. With the Omicron subvariant BA2.  now rising we don’t know how effective [the vaccine] will be.”

WHO Recommended treatments

WHO timetable for reviewing new COVID treatments. While monulpiravir was recently approved, three other treatments, including monulpiravir and Paxlovid, are still under review, as of 20 February, while Evusheld is not on the calendar at all,

WHO recommended treatments also don’t yet include the so-called passive vaccine of Evusheld – although the Organization has recently approved another monoclonal antibody treatment for already infected patients.

That was Sotrovimab, which received a WHO approval in mid-January, for patients with non-severe COVID-19, but who are at risk for developing severe disease.

François Lamontagne, Professor of Medicine at the Université de Sherbrooke, who sits on WHO’s Guideline Development Group, told Health Policy Watch that Sotrovimab consists of antibodies directed against a specific part of the virus that prevents entry of the virus into cells. This drug is given intravenously, requiring one infusion.

Lamontagne noted, however, that the panel only provided a “weak” recommendation of the treatment because the effectiveness of sotrovimab against Omicron is still uncertain.

WHO also has yet to make a recommendation on two other COVID treatments, Merck’s monulpiravir and Pfizer’s Paxlovid – which operate on different principles.  This despite the fact the drugs are already being widely sold in high income countries.  The pharma companies also have made commitments to sell the drugs at cost to many low- and middle-income countries either bilaterally or via the UN-supported Medicines Patents Pool (MPP), which negotiates licenses with pharma for the use of drugs in resource-constrained settings.

Image Credits: Wikimedia Commons, Eli Lilly.

disability
Wheelchair users are often left to grapple with inaccessible services.

From barriers to treatment for people with hearing disabilities to preconceptions about albinism and inaccessible COVID testing for wheelchair users, participants in the Global Disability Summit took a fresh look at the wide range of discriminatory practices that an estimated 1 billion people – 15% of the world’s population – living with disabilities have to face.

This summit, the second of its kind, was sponsored by the International Disability Alliance, the governments of Norway and Ghana, and the World Health Organization, drew some 5500 participants during two days of online proceedings, 16-17 February. The conference covered issues associated with a wide range of physical and mental health disabilities.

Speakers talked about the massive challenges of tackling physical and emotional barriers, as well as the legal policies and stigmatization they face in their day-to-day lives.

Olive Namutebi, Executive Director of Albinism Umbrella, Uganda

“Somebody looks at someone with albinism and thinks that their only problem is skin,” said Olive Namutebi, Executive Director of the Albinism Umbrella, Uganda.

“There is a temperature, malaria, fever, they put me to the skin doctor. I have other issues, I’m a human being. Can I be allowed to express myself instead of you having the precognition, thinking that the only problem I have is skin because I am different?”

Across the summit, speakers and world leaders cried out for more “disability-inclusive” healthcare, education, employment, and livelihoods.

“Social and economic development must be right based and disability inclusive. We must leave no one behind,” said Norway Prime Minister Jonas Gahr Støre at the opening ceremony of the summit. 

Commiting to inclusivity

The summit called for all – governments, world leaders, health organizations, people with disabilities – to collaborate and commit towards this goal of inclusivity.

“All stakeholders, including governments, civil society, multilateral organisations, the private sector, and other partners, must collaborate on taking a disability inclusive approach. We must design equitable programmes, including health services, to ensure persons with disabilities achieve the highest attainable standard of health, as demanded by the World Health Assembly in 2021,” said the WHO Director-General, President of Ghana, Prime Minister of Norway and President of the the International Disability Alliance in an op-ed in the BMJ. 

People with disabilities are three times more likely to be denied access to healthcare, four times more likely to be treated inadequately in the healthcare system, and twice as likely to suffer catastrophic health expenditure, the op-ed authors stated. Some 80% of people with disabilities live in low- and middle-income countries, where access to basic social and economic services may be especially limited for persons with disabilities.

Accessible healthcare and increased disability training

Ashura Michael, IDA-UNICEF Youth Fellow

Speakers called for more accessible, quality healthcare that combats against ignorance mindsets and lack of information.

“Information is power. So many women die because of the wrong prescription. Some go through with operations when they’re not supposed to [do so],” said Ashura Michael, IDA-UNICEF Youth Fellow, speaking about how sight and hearing disabilities can be a barrier to appropriate diagnosis and treatment.

Michael called for doctors and health practitioners to be trained in sign language, so that they can communicate with deaf people and prescribe the correct treatment and medication.

She also advocated for more funds for resources for people with disabilities in schools, and to make disability training more mainstream.

“We have diversity in our disabilities. Let us come together for betterment of persons with disabilities.”

Namutebi called it ‘everyone’s business’ to get involved, especially for people with disabilities to speak up.

“This is not an isolated case of exclusivity. When you exclude me, you are excluding yourself from advancement or enjoying better services… We need to unlearn some of the thing that we’ve grown up knowing.”

Pandemic disruption 

Antonio Guterres, Secretary-General, United Nations

The COVID-19 pandemic has brought to light “significant inequalities” in the way persons with disabilities and other marginalized groups in many countries have been underserved in the provision of COVID-19 related health, social protection and financial services, said Nana Akufo-Addo, President of the Republic of Ghana, speaking in a keynote address.

The way in which the COVID-19 pandemic exacerbated the day-to-day obstacles that may be encountered by disabled individuals was echoed by António Guterres, Secretary-General, United Nations.

“Persons with disabilities are losing their lives at vastly higher rates into persistent barriers in our system,” he said.

For instance, when the pandemic led to widespread school closures, many students with disabilities in low- and middle-income countries were left without access to technology and assisted devices for effective remote learning, Guterres pointed out. 

Workers with disabilities faced added worries since they are typically the first to lose their jobs and the last to be rehired, he pointed out.

Disabled women’s health 

Students with disabilities perform dance in rural Bangladesh. Women and girls with disabilities face higher risk of violence and abuse.

One crosscutting theme of this year’s conference was gender – as women with disabilities are even more acutely impacted by discriminatory practices.  The GDS 2022 emphasized the need for gender equality as a key to empowerment of all women and girls with disabilities.  

“Women and girls with disabilities who were already experiencing double discrimination are facing even higher risk of violence and abuse,” said Guterres.

Dr Natalia Kanem, Executive Director, United Nations Population Fund, said that women with disabilities were up to 10 times more likely to experience sexual violence. “Shouldn’t a young woman with disabilities decide what she wants for her own body? Shouldn’t she live free from the harm caused by violence, coercion and abuse?” she said. 

Young women and girls with disabilities are among those groups with the least access to reproductive health information and education, Kanen said, noting that women with disabilities are up to 10-times more likely to experience gender-based violence. 

Said Guterres, “We need to act decisively to realize and promote the rights of persons with disabilities in every corner of the world and in every facet of life. Global inequalities reverberate at the local level when developing countries have struggled financially.” 

The Nairobi-based Bridge Academy helps people with a range of disabilities to build and launch IT careers – paving a way to better livelihoods.

US’ ‘historic’ commitment 

The summit also saw the U.S making a commitment of $25 million over the next five years to the Global Partnership for Assistive Technology, founded by a consortium of partners, including the International Disability Alliance, Norway, Kenya, USAID, WHO and others in 2018.

“We’re committing to disability inclusion as a requirement in all of our humanitarian assistance. This means partnering with persons with disability organisations who all already have the expertise and relationships to make our aid more accessible,” said Samantha Power, of USAID, announcing the commitment. 

The United States made 23 new commitments on disability rights – a vast improvement from the 2018 inaugural summit, when the US made zero commitments. 

Altogether the summit saw over 1250 commitments from national governments, donors, NGOs and the private sector to take concrete steps improving disability rights in areas including: health, education, livelihoods social protection, and capacity building, summit organizers said.

Susceptibility to poverty

People with disabilities are more susceptible to poverty.

Individuals with disabilities are more susceptible to poverty than those without any disabilities.

“Without a disability inclusive approach to recovery and building resilience, persons with disabilities are at an increased risk of being left behind and falling further into poverty,” said Mari Pangestu, Managing Director of Development Policy and Partnerships at the World Bank. 

The theme of poverty and disability was also echoed by Jordan’s King Abdullah II, another featured speaker at the summit. “The political engagement of persons with disabilities is by no means less important than their economic engagement,” he said.

“They are part of societies everywhere, and that must be reflected in education, healthcare, business, sports tourism, in all facets of life. None can be dismissed as a luxury.” 

Examples of other commitments made by countries at the summit included and announcement by the Maldives to increase social protection of people with disabilities, and Angola to strengthen  processes supporting people with disabilities to vote in this year’s election.

Image Credits: Sightsavers.org, Rasmus Gerdin/ Unsplash, GDS, ILO Asia-Pacific, Adam Howarth/Flickr.