Latin American student members of UAEM call on their governments to reject the TRIPS waiver compromise.

The Global South has been subjugated to the world economic order for centuries. This isn’t news to us. But the COVID-19 pandemic has started one of the most acute chapters in this story as, for over two years, we have witnessed our people dying en masse.

In response to this unsustainable yet critical situation, countries from the Global South banded together in October 2020 to urge the World Trade Organization (WTO) to adopt measures that would mitigate the pandemic’s effects in their territories and save people’s lives. India and South Africa, rooted in their own historical struggle with intellectual property rights, demanded a waiver from certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for the prevention, containment and treatment of COVID-19.

In spite of this clear demand from the Global South for solidarity, more than one year later, this debate has been continuously and shamefully postponed at the WTO. Pressured by transnational corporations, a minority of the so-called ”developed countries” have been hindering the negotiations. All the deaths and suffering have been reduced to an immense theater in which powerful players have been trying their best to delay, narrow or completely block the end of this dramatic show. 

And now, the most recent move of this ”profit-over-lives” coalition has just come to light. A leaked document reveals the details of a ”compromise” that “would end this deadlock” at the WTO. Veering away from the original proposal, the scope of this leaked text would firstly, be restricted to vaccines (excluding other important health technologies, such as treatment and testing formulas) and secondly only apply to patents (excluding other important IP rights, such as trade secrets, industrial designs and copyrights).

 Antivirals remain inaccessible

Free the Vaccine activists in San Francisco held a memorial for all those who had died of COVID-19 and called for support for the TRIPS waiver.

Baricitinib, for instance, a costly WHO-recommended drug  for the treatment of people with severe or critical COVID-19, would remain scandalously inaccessible in many countries in the Global South. Most patents on it will not expire until 2029. Instead of expanding access to generic versions of this life-saving drug, the ”compromise” text would in fact endorse this unacceptable situation. It is only fair to label this as an extremely harmful deal – even worse than the one we already have, actually.

It’s quite clear to us that what has been called a ”compromise” is, in fact, just another clear example of the historical subjugation of the Global South. What has been claimed as a solution to a ”deadlock” is nothing more than a late, ineffective and disrespectful way to silence our suffering.

 However, despite being a move that is yet another traditional illusionary act, these economic powers haven’t been able to sell this ”compromise” as a credible victory for humanity or as a reasonable solution. The truth is we’ve come to a place in history where they are so comfortable that they don’t even bother to mask it anymore.   

Don’t accept this ‘compromise’

We urge our countries not to accept this “compromise”. But even if our governments, pressured by the global politics of power, decide to shut their eyes to their own populations and capitulate, we want to make it clear: we are not our governments. We know this is the same old story. It’s just ”business as usual”. And we will not buy it as a victory.

 Successive defeats are not undermining our hope. The fact that our open letters, opinion pieces and multiple claims haven’t been heard has not discouraged us. On the contrary. Things are clearer than ever and so is our mission. These setbacks are boosting the rise up of a whole new force: a growing number of young activists has engaged with and reinvigorated our movement. The post-TRIPS generation is becoming aware of what has happened. We are just understanding what has been done to our parents, what is planned for ourselves and what you’re intending to do to our children.

Rooted in our ancestors’ struggles and aware of the transformations of our era, we are ready to answer our own historical call and keep fighting for justice. The COVID-19 apartheid is a bomb that is exploding now and will be surely heard later. In spite of its apparent stability, it is not wise to take the IP system for granted. The time to honor our dead is coming and no unfair system will be able to resist us.

This is neither a threat nor a juvenile lament. This is simply a direct statement from a great number of hearts that are sick of all this suffering and injustice. This is an inevitable result of centuries of exploitation and indifference. Do not underestimate our resilience. The times they are a-changin: now is time to heed the call and completely abandon all sorts of illusory victories.

Alan Rossi Silva
Luciana MN Lopes

Alan Rossi Silva and Luciana M. N. Lopes represent Universities Allied for Essential Medicines (UAEM), a global student-driven organization in defense of universal access to medicines and a fair biomedical innovation system. Alan is a PhD candidate in Law at the State University of Rio de Janeiro (UERJ) and Luciana is a PhD student in Public Health at the Federal University of Minas Gerais (UFMG), in Brazil. She is also the Executive Director for UAEM in Latin America.

 

 

Indian children have to stay indoors in certain areas because of extreme heat.

When schools closed for the summer in March, the vibrant sound of children playing on the streets of Mumbai was conspicuously absent as they stayed indoors to avoid the scorching heat.

The early onset of heatwaves this year has affected several parts of India just as citizens were getting back to normal life after the Omicron wave subsided. The Indian Meteorological Department (IMD) noted that “heatwave to severe heatwave conditions were observed” in several parts of the country, with temperatures reaching 39 to 41 °C, which is  4 to 6 °C above normal.

The IPCC 6th assessment report (AR6) on ‘ Impacts, Adaptation and Vulnerability’, released this February, highlights heatwaves and rising surface temperatures as one of the major climate challenges faced by India. The report states that with increasing urbanization and land-use change, more people are likely to be vulnerable to heat stress.

“The frequency and intensity of heatwaves will increase exponentially as unplanned anthropocentric development has disrupted the landscape, and proper circulation of warmer air from land to oceans and vice-versa is not taking place,” Abinash Mohanty, program lead for the Council on Energy, Environment and Water (CEEW), New Delhi, told Health Policy Watch.

Last year, a CEEW analysis found that 45% of India’s landscape has been disrupted by unsustainable planning, and this is triggering microclimatic changes, such as surges in heatwaves and other extreme weather events.

Trapped heat 

“Further, heat islands are being created – imagine having a heater in your room on a warm day – where the heat is trapped and cannot go out. This is seen more in urban hamlets because urban areas also emit a lot more carbon emissions that increase the local temperature,” Mohanty added.

Chandni Singh, Senior Research Consultant at the Indian Institute of Human Settlements in Bangalore and a lead author of the AR6 report warned that India faced more heatwaves.

“The IPCC report says that the globe has already warmed by 1.1 °C above pre-industrial level.  India has warmed by 0.9 °C on average. If we continue to emit as we are doing now, we will see more heat waves – especially in cities, where we are seeing hot days, and hot nights,” Singh told Health Policy Watch.

She explained that after a hot day, cool nights were important to enable the body to recuperate from the heat. But if the night is also hot, this will have a negative impact on the health of many people, particularly those who work outdoors or in small, poorly ventilated, rooms, people with comorbidities, children, older people and pregnant women.

Exacerbating inequality

Anjal Prakash, also a lead author on the AR6 report and research director of Bharti Institute of Public Policy at Hyderabad’s Indian School of Business, said that the IPCC assessment emphasizes the fact that social and economic inequities compound vulnerability to climate change and could further exacerbate injustices, as well as constrain climate actions. 

“People and livelihoods that are climate-sensitive will be directly affected. “Agriculture, fisheries and coastal and Himalayan ecosystems will have bearing on around 60% of people in India who are directly dependent on these primary sources of livelihood,” Prakash told Health Policy Watch.

The IPCC assessment uses the wet-bulb globe temperature – an index of the impact of heat and humidity combined, to gauge the impact of heat stress. The critical wet bulb temperature threshold above which humans are unlikely to survive is 35°C.

“in some of the densely populated regions of South Asia, the critical threshold of the wet-bulb temperature of 35 °C will be exceeded under the business-as-usual scenario of future greenhouse gas emissions. Based on this, it is most likely that India will be facing the issues of heat and humidity, the decline in glacial mass balance, sea level rise and cyclones,” said Prakash.

Meanwhile, Singh pointed out that, in many coastal areas across India, we have already reached wet-bulb temperatures of 24 to 25 °C. 

“If carbon emissions are not mitigated, we can hit 35 °C by 2050/2060- we are not adequately thinking about the impacts of this,” she added.

More heat stroke and tropical diseases

Heatwaves since the 1990s have claimed 17,000 deaths in India and impacted health. 

“Heat stress affects health, productivity and livelihoods. Exposure to heat causes heat exhaustion. If this is not treated, it will lead to heat stroke where fatality is very high,” said Rohit Mogatra, deputy director of Integrated Research and Action for Development in New Delhi.

“Unfortunately, people are not aware of how heat affects them since they are living in a tropical climate. Even doctors have trouble identifying if the patients are suffering from normal fever or heat stroke,” added Mogatra.

Training doctors, providing oral rehydration solutions in Primary Healthcare Centres (PHCs), ensuring access to drinking water, clean toilets, and proper housing design are important measures to adapt to heat stress, he said.

Increasing temperature also changes the transmission of vector-borne diseases such as dengue and malaria.  

“Places that were not seeing these diseases will start seeing incidences. Dengue could spread to the foothills of Himalayas and places where the disease is prevalent, may have increasing incidences,” said Singh.

Ministry of Climate?

However, the future is not all bleak. India has introduced some adaptation policies such as early warning colour coded alerts issued by the IMD. For coastal cities, a yellow alert is issued at 35.9°C, orange at 41.5°C, and red at 43.5°C, for cities with a dry and arid climate, orange is 43°C  and red at 45°C, and for hilly regions above 30 °C is considered a heatwave.

Other initiatives include heat action plans (HAPs) and cool roofs, which have helped to  reduce loss of lives, but there are still gaps in implementation of these policies.

But Singh opined that while heat action plans are doing well, as are other measures such as shifting neonatal wards to lower floors and asking people to stay indoors, these are short -term measures. What is lacking is the link between HAPs and city development plan, she said.

“For example, how can we harness green cover to mitigate heat? Low-income groups have very low green cover as they are densely populated. Where do you plant tress with space constraints? Can we look at other forms such as terrace gardens or balcony gardens? There is anecdotal evidence that this helps people feel the reduction of temperature in their homes.”

Meanwhile, Prakash advocated for a separate ministry for climate change staffed by climate scientists and climate change practitioners to work in the science-policy-diplomacy space “so that we have the required acumen and skills to combat climate change at the central level”.

 

Image Credits: Loren Joseph/ Unsplash.

Kenya
Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax.

The COVID-19 pandemic has pushed the scientific community to start to implement a  ‘One Health’ approach – encompassing people, animals, plants and the environment – to ensure the early identification of infectious diseases and make the world a healthier place.

The issues that “One Health” may tackle are diverse. They can range from curbing deforestation to prevent new pathogens from being released from the wild to targeted efforts to improve sanitation and food safety in slaughterhouses, to vaccination as an alternative to the overuse of antibiotics in both humans and animals.

‘One Health’ is a key theme at the upcoming Geneva Health Forum, but it is often difficult for many people to fully understand what it means.

Until the pandemic, ‘One Health’ was often consigned to the margins of health agendas. But the importance of a holistic approach to health across species became evident when it emerged that the SARS-CoV2 virus was likely to have originated in a bat and could have been transmitted to humans via infected mammals that were housed and slaughtered in unsanitary conditions at a marketplace in Wuhan, China.

Freshly slaughtered animals in a market in Wuhan, Hubei, China

Suddenly, the once-obscure ‘One Health’ approach has become a broad international movement supported by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and, most recently, the United Nations Environment Program (UNEP).

There has been some heated debate about the definition of One Health, Dr Rafael Ruiz De Castañeda, a researcher and lecturer in the Institute of Global Health at the University of Geneva, told Health Policy Watch.

Only in December 2021, did an inter-agency One Health High-Level Expert Panel (OHHLEP) roll out a formal definition. This definition states: “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.”

According to OHHLEP, One Health collaborations will contribute to protecting health and addressing the full spectrum of disease control challenges, while improving and promoting health and environmental sustainability.

“One Health is the added value of a close cooperation between human and animal health experts and those working in related disciplines,” Dr Jakob Zinsstag-Klopfenstein, deputy head of the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, told Health Policy Watch.

Ruiz de Castañeda describes the approach as “transdisciplinary”, encompassing veterinary health, human health disciplines, natural and environmental sciences, and even social sciences and the humanities. It also engages non-academic actors, including civil society and communities affected by the health problem that can become active players in the One Health approach.

“One Health has sometimes been criticized for remaining too high level and we need to make it more operational and implementable at the national and subnational levels,” Ruiz de Castañeda said.

Geneva Health Forum

At the next month’s Geneva Health Forum (GHF) from 3 to 5 May, One Health is a key point of focus, within the broader theme of the conference, which is the COVID pandemic and the environmental health emergency.

The event will kick off with a high-level discussion on why One Health is a “paradigm shift” requiring much closer cooperation between health and the environment sectors as well as between human health and animal health sectors.

Addressing the link between health and environment is critical because climate change, deforestation, biodiversity loss and unsustainable urbanization have increased the risks of human infection from pathogens once harbored mainly in the wild – from insect-borne diseases like dengue to pathogens carried by birds and mammals, including Ebola virus, coronaviruses, influenza viruses and more.

At the same time, the overuse and misuse of many drugs in both animal health, as well as human health, is increasing the threat of antimicrobial resistance – which also increases future pandemic risks.

Among the One Health sessions, Ruiz de Castañeda will take part in a panel entitled “Science and Global Health Diplomacy to Preventing and Tackling Pandemics: Opportunities and Challenges for One Health.” He and other speakers will address how diplomacy and international cooperation can further contribute to One Health research and action, and how systemic, integrated and cross-sectoral approaches in science and global health practice can support cooperation.

Other sessions will include: a look at achieving more sustainable antibiotic access using a One Health approach, how the private sector could be a key player in the operationalization of the One Health concept and what training might be needed to move One Health forward.

Finally, Zinsstag-Klopfenstein will run a workshop on the One Health model as it pertains to the health of nomadic pastoralists, of which there are an estimated 50 million to 200 million globally. Pastoralists have frequent exposure to animal reservoirs of pathogens with emerging epidemic potential.

An integrated approach to surveillance

Kenya
Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax. Droughts in the area often push herders to seek greener pastures in areas where wild game mingle, and this can put herders’ families at risk too.

As the COVID-19 pandemic continues to surge in countries worldwide, the discussion will focus on how to implement an integrated approach to epidemiological surveillance in humans and animals.

“Studies have shown that two-thirds of emerging infectious diseases emerge from animals,” Ruiz de Castañeda said – usually wild animals, but sometimes livestock. This phenomenon is expected to grow due to anthropogenic pressure on the environment. But he said that we often fail to catch these pathogens on time, detecting them when they are already in humans, which “puts up behind an epidemic and potential pandemic.”

An integrated approach to epidemiological surveillance in humans and animals could detect these pathogens in animals before they reach humans or when only a few humans are infected, which would save time, money and improve public health outcomes.

This is already working in Italy, for example, Zinsstag-Klopfenstein explained. Since 2012, the country’s health services have managed an integrated approach to surveillance of West Nile virus. This is an arbovirus first identified in Africa that is transmitted by mosquitoes, infecting wild birds, horses and humans. With warmer temperatures it has been found in Europe and the United States, after being first discovered in New York state in 1999. That programme has shown evidence of cost-effectiveness.

“The earlier a zoonotic pathogen can be detected in the environment, in wildlife or in domestic animals – and the better human, animal and environmental surveillance communicate with each other to prevent an outbreak – the lower are the cumulative costs,” wrote Zinsstag-Klopfenstein and his colleagues in a paper titled “Why One Health?”, published by CAB International in 2021.

In contrast, a lack of integration and collaboration can have detrimental effects, according to Zinsstag-Klopfenstein. In a recent outbreak in the Netherlands of Q-fever, a disease caused by the bacteria Coxiella burnetii, public health authorities were not informed by veterinary authorities about a wave of abortions in goats. Likewise, outbreaks of Rift Valley fever in humans in Mauritania were misidentified as yellow fever until public health services contacted livestock services and learned about the occurrence of abortions in cattle.

One Health: the human and livestock nexus

Another area where One Health could have an impact is in terms of food security and nutrition, Zinsstag-Klopfenstein told Health Policy Watch. That’s because, for a large portion of the developing world, animals directly provide physical and financial sustenance.

“Animals play a very important role in most semi-arid areas, such as Mongolia or among the Bedouin community in Israel’s Negev,” Zinsstag-Klopfenstein said, adding that even in the Swiss Alps “if you do not want to survive on tourism, you need a cow. A cow can convert grass into milk. If a drought comes and there is no grass, you have nothing.”

While a farmer can grow fruits and vegetables, the harvest is usually only once or twice a year. A chicken, in contrast, can lay an egg a day and a goat can provide a litre of milk, providing a family with daily income.

Around 800 million small-scale farmers rely on livestock production to keep themselves out of extreme poverty, so maintaining the health of livestock is essential, added Zinsstag-Klopfenstein.

Ways need to be found to improve animal health while controlling the overuse of antibiotics, which also are critical to human health,and can lead to antimicrobial resistance.

Ugandan dairy farmer Tony Kidega has taken a keen interest in turning the tide of antimicrobial resistance (AMR) in his country.

Sometimes there are unexpected benefits. Zinsstag-Klopfenstein highlighted an example in Chad, where a team of doctors and veterinarians discovered that more cattle were vaccinated than children against childhood diseases.

“Recognition of this fact enabled subsequent joint human and animal vaccination campaigns, providing preventive vaccination to children who would otherwise not have had access to health services,” he wrote. “This is one of the rare and first examples of One Health in healthcare provision, where you can save money from working together to provide health services.”

He said it could work for the eradication of rabies, too. Today, humans are vaccinated against rabies if they are bitten by a dog, in what is a painful and prolonged series of shots. But if you want to eliminate the disease, you really have to vaccinate the dogs once or twice.

Case study: Snakebite envenoming

While better infectious disease surveillance and prevention is the major value of a One Health approach, improved diagnosis and treatment are important as well. This is particularly true for neglected tropical diseases (NTDs), which by their nature often lack high-quality medicines and vaccines and because many of these diseases involve animals, Ruiz de Castañeda told Health Policy Watch.

“If you look at the problem only with a human perspective, you are often missing a big part of the problem. You need a broader systemic One Health approach to understand, prevent and better control NTDs,” he said.

One example is snakebite envenoming, in which Ruiz de Castañeda has done extensive research.

Snakebites kill between 81,000 to 138,000 people every year, according to the latest research. And most victims are among the world’s poorest, living in rural Africa, Asia and South America. It was only in 2017, that WHO included snakebite envenoming on its list of neglected tropical diseases.

Because anti-venom treatments are often hard to access, snakebite is often fatal. In Nepal, for instance, snakebite impacts 252 out of 100,000 people with a 7.8% fatality rate. They injure both domestic livestock and people which cause a significant loss of livelihoods.

Ruiz de Castañeda and team assessed the effect of snakebite in the Terai region of Nepal using a One Health perspective that encompasses health and socioeconomic losses associated with snakebites of people and domestic animals. They used primary data from a large-scale household survey to produce estimates for disease burden, out-of-pocket healthcare expenditure, productivity losses for people who had been bitten and their families and losses associated with cases in domestic animals.

“Our results confirm that snakebite is an important problem in the Terai region that affects livelihood and DALYs [disability-adjusted life years], which are mostly associated with envenoming in women, high pediatric mortality and losses in domestic animals,” the report said.

Households whose domestic animals were impacted by snakebite experienced a median loss of $90.80 out of average monthly earnings of $250.36, meaning that snakebite can lead to an economic crisis and feed the vicious cycle of poverty.

What’s next?

Ruiz de Castañeda said that One Health has gained a lot of momentum due to COVID-19 and “we see a very interesting discussion among countries trying to see how One Health can be part of their national strategies and their international relations”.

“Pandemics often emerge far away from the Western world – Ebola in West Africa and COVID-19 in China, for example – but they are quickly on our doorstep,” he said. “One Health needs to become part of the international strategy for countries: Science for diplomacy and diplomacy for science.”

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

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

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society, Arend Kuester/Flickr, Tony Kidega, Geneva Health Forum.

virtual healthcare
Digital healthcare services are growing and can play crucial roles in crises, including pandemics and violent conflicts that disrupt traditional healthcare facilities.

The World Health Organization (WHO) has confirmed 82 attacks on healthcare in Ukraine since 24 February. The country’s virtual healthcare services, already strong from the pandemic, have stepped-up in response.

Why it matters

Online healthcare has provided a crucial lifeline to thousands of Ukrainians as the war imposes physical and psychological trauma on those caught up in its fury and medical facilities restrict access, shut, or are reduced to rubble.

Attacks on healthcare facilities have killed at least 72 people and injured at least 43, the WHO’s director general said on Wednesday. In a recent attack on 9 March, the Russian military targeted and destroyed a maternity hospital in Mariupol. 

Approximately half of Ukraine’s pharmacies are thought to be closed, according to the UN, while many health workers are displaced themselves or unable to work.

Empty hospital beds line the hallways of the Kyiv Regional Perinatal Centre, Ukraine, on 7 March 2022. As hospitals are disrupted or destroyed, online healthcare services can mitigate gaps.

Ukraine’s pandemic telehealth

Ukraine’s digital healthcare infrastructure, bulked up during the pandemic, has aided the country’s resilience under the latest phase of the war. 

Ukraine’s ministry of digital transformation, established in 2019, has been expanding the country’s digital infrastructure with the goal of providing 100 per cent of public services digitally by 2024. 

As part of this transformation, the ministry of health is digitising all medical records, Oleksii Sukhovii, head of the Center for the Organization of Psychiatric Care of Ukraine’s ministry of health, tells Geneva Solutions.

The digitisation has improved ease of reference for healthcare providers and it will provide greater transparency within Ukraine’s National Healthcare System.

Many non-governmental initiatives have also sprung up. In 2021, UNICEF and Giva Care Group, a Ukrainian medical technology company, launched 50 digital healthcare platforms in the country’s east where the conflict has been ongoing since 2014. 

Among the digital healthcare tools UNICEF and GIVA Care Group have distributed are Tyto Care kits for remote medical examination. A kit includes an otoscope for examining ears, a stethoscope for the heart, lungs, and abdomen, a basal thermometer, and a digital camera for taking pictures of skin and the throat. The devices transmit the data to a doctor who can advise patients in real-time. 

Virtual mental healthcare

Online services for mental healthcare have grown significantly since February in response to the heightened trauma and distress people are suffering. 

UNICEF, together with Ukraine’s ministry of education and science, the Ukrainian Institute of Cognitive Behavioral Therapy, and the All-Ukrainian Public Center “Volunteer”, launched a mental health lifeline for children, teenagers, and parents in late March. Known as the PORUCH project, the initiative offers online consultations with psychologists. 

Nezabutni, which translates as “Never-to-be forgotten”, is a local charity supporting those living with dementia and their caretakers and offers a similar service. Mental healthcare services for relatives have been central to Nezabutni’s work from the start. These services have gone entirely online since the COVID-19 pandemic and are increasingly in demand since the war’s February escalation, Irina Shevchenko, the foundation’s director tells Geneva Solutions. 

Nezabutni’s online services include individual consultations with psychiatrists and psychologists as well as group therapy sessions. Relatives of people with dementia can also connect via a group chat.

Over 90 percent of Ukrainians have Viber, the calling and messaging app, which is increasingly being used for remote medical consultations, Sukhovii says.

Family members of people with dementia were initially reluctant to continue with online group therapy early in the escalation, says Shevchenko. For two weeks, the groups stopped. “They were afraid to resume; to talk about this painful experience,” she adds. Some were on the move while others sought refuge in bomb shelters. 

Two of its three online therapy groups are now back up and running. The other is on hold as one of Nezabutni’s three psychologists is herself in the process of escaping the violence. 

Nezabutni’s forty volunteers have been getting medicines to patients as many pharmacies have closed. Early in the escalation, and still in areas of intense conflict, volunteers delivered medicines personally. “Sometimes it was by bicycle, sometimes it was by foot, sometimes by car,” Shevchenko says.

Online deliveries have resumed in some regions over the past couple of weeks and Nezabutni helps with ordering the medicines online.

In one of its last in-person social gatherings, Nezabutni organized the first Alzheimer / Memory Cafe in Ukraine in September 2021. Its mental health consultations and group therapies have gone entirely online.

Nezabutni has fewer members from the eastern Donbas region which has borne the brunt of the war over the past eight years. 

Tell Me is another free Ukrainian online mental health service, which was launched in response to the war. It specialises in cognitive-behavioural therapy and receives support from the Ukrainian Red Cross and Ukraine’s ministry of health. 

In addition to online consultations, online healthcare information services have grown since February. One is Viyna, which offers continuously updated information on a broad range of issues, including advice for those who are pregnant or have just given birth, what to do if you find an unaccompanied child, and a list of open pharmacies, shops, and gas stations. It has several pages on psychological support with contact information for psychologists in and beyond Ukraine and a page on how to manage insomnia. 

Nezabutni expects to launch a prototype website in the coming week that will provide up-to-date information and resources for those living with dementia and other mental and physical disabilities, both in Ukraine and abroad. 

Health information is currently not available through the Ukrainian Red Cross website, which the organisation has shutdown until it resolves a cyberattack. Information remains accessible through its Facebook page, Instagram, Telegram, and Twitter as well as by email and telephone at 0 800 332 656.

Digital challenges

Innovation and growth in telehealth has been able to fill some of the gaps left by bombarded hospitals, clinics and other medical facilities. But it comes with its own set of challenges. 

Elderly patients and medical professionals are often not adept at digital technologies and can struggle to connect with online services, Shevchenko and Sukhovii say. If they live in rural areas, they may lack internet access in the first place, Shevchenko adds.

Digital security is also a concern. Ukraine’s National Healthcare Service has removed all geographic data and doctor’s contact information from the system in case of a cyberattack, says Sukhovii. This means that doctors cannot look up other doctors, which impedes medical referral and getting in touch for online consultations. 

On top of this, digitisation of patient records has been slow. Psychiatry’s digitisation has especially lagged, says Sukhovii. This makes it difficult for doctors to assess new patients when conflict or other crises disrupt the transfer of paper files. This disruption has been amplified with both doctors and patients on the move. 

On the move

Displacement is a source of trauma and can worsen existing trauma. The WHO, International Organization for Migration (IOM), and Red Cross in collaboration with other members of the UN’s health cluster for emergency response are running mental health and psychosocial support technical working groups to assist those in Ukraine and those migrating to neighbouring countries. 

The working groups employ psychologists, counsellors, psychotherapists, and social workers to run mental health hotlines. IOM has set up separate hotlines for those displaced in Ukraine and those migrating to Poland, Romania, Lithuania, Slovakia, and Moldova. The Ukrainian Red Cross offers a mental health hotline at 0 800 331 800. Psychosocial support also can be sought from Red Cross and UNICEF staff at shelters on the ground in Ukraine and neighbouring countries. 

For further support, contact:  

PORUCH: https://poruch.me/ 

Nezabutni: https://www.nezabutni.org/

Tell Me: https://tellme.com.ua/ 

Viyna: https://viyna.net/

Ukrainian Red Cross: national@redcross.org.ua 

IOM hotlines: https://www.iom.int/ukraine-iom-hotlines-garyachi-linii-mom-persons-affected-war

This article was first published by Geneva Solutions.

Image Credits: Pexels/Tima Miroshnichenko, UNICEF/Oleksandr Ratushniak, Nezabutni.

Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases.

WHO on Thursday launched a new global initiative that aims to tackle a group of fast-growing and poorly understood viral diseases that are carried by insects – and which have future pandemic potential.  

The Global Arbovirus Initiative aims to tackle diseases such as Dengue, Yellow fever, Chikungunya and Zika – which have few effective treatments, with the exception of yellow fever vaccines. 

Due to warmer climates, international travel and urbanization, one or more of the leading arboviruses are now present in most countries of the world.

Their span and impact is also rapidly expanding – borne by air and ocean transport to far-flung lands, leap-frogging from forests to cities, and moving into Europe and North America as global warming creates more favorable climate conditions in which mosquitoes can thrive.   

The name ‘arbovirus’ is little known. But it is an acronym for “arthropod-borne” virusës, referring to viruses transmitted by mosquitoes and ticks. Although malaria is a mosquito-borne virus, it is in fact a parasitic disease, not a virus.

And unlike malaria, or many other parasitic diseases, there is also a dearth of ready treatments.  Notably, dengue fever, which infects 390 million people in 130 million countries where it is endemic, and Zika virus, which came to center stage during a 2016 epidemic in Latin America, have no readily available treatments. Zika causes birth defects, such as microencephaly, while dengue fever infections and subsequent attacks can recur, in worsening forms that cause dengue hemorrhagic fever and death.  Since the 2016 epidemic, outbreaks have occurred regularly in countries as far-flung as India. 

Sir Jeremy Farrar, director of Wellcome Trust

“These diseases are the diseases of our time,” said Jeremy Farrar, head of the Wellcome Trust, who appeared with a long line-up of WHO officials and virology experts from virtually all corners of the world in a launch event on Thursday. 

“These are things of the 21st century because the drivers of these diseases are drivers that are going to be with us in the 21st century,” he added. “And those drivers we all know are about: climate change. land use change, ecology change, urbanization… increasing trade and travel, for instance, between Asia and Africa, wholly welcomed but [this] will lead to changes in the dynamics of infections,” he added, noting that “the links between Central and South America, Southern United States, Southern Europe and all other parts of the world means that the mosquitoes, which are some of the most remarkable things on Earth, are adapting to different communities, in the context of 21st century, which is why this is just so important.”

Particularly in light of heightened awareness about pandemic risks from new or re-emerging viruses, post-COVID, this initiative that tackles a family of single strand RNA viruses is important, said Farrar. 

”In the context of the last two years, the world has changed, and we need to change with it, and provide the leadership that change requires,” Farrar concluded.  

Integrated approaches 

Six pillars of the global arbovirus initiative

The new six-point WHO initiative aims to better link the various research, surveillance and vector control efforts happening around the world in a more formal network of collaboration – building around six pillars, including: 

  • improved real-time monitoring of outbreak risks in countries; 
  • early detection, investigation and response;  
  • strengthened vector control initiatives, particularly in cities where viruses like dengue are now flourishing in waste and water containers; 

Along with that stronger global collaboration and surveillance; research innovation and partnerships are key to the new strategy, said WHO’s Sylvie Briand, Director of  Pandemic and Epidemic Diseases and WHO Assistant Director General, Minghui Ren. 

“As urban populations continue to expand, the threat of these diseases grows more alarming, as close living arrangements amplify the spread of these viruses,” said Ren.  “We must address these challenges now to prevent catastrophic impacts on health systems in the future.”  

Sylvie Briand, WHO Director of Pandemic and Epidemic Diseases

“We have been through two years of COVID-19 pandemic and we have learned the hard way what it costs not to be prepared enough for high impact events,” Briand added. 

“The next pandemic could very likely be due to a new arbovirus. And we already have some signals that the risk is increasing. Since 2016, more than 89 countries have faced epidemics due to the Zika virus,” she said, citing just one example among many. 

“In addition, many other viruses circulate in the wildlife,” Briand added. “As the interface between humans and animals expands, the opportunity for new zoonosis increases. 

“And given human mobility and urbanization, the risk of amplification of localized arbovirus  outbreaks is real. So what can we do to better manage this? What did we learn from the COVID-19 experience and from years of combating arboviral diseases to help us to get better prepared for the next high impact event? 

“I would like three cite three key aspects:  collaboration, trust and community engagement as essential.”

Building on a series of regional consultations 

who
Dr Mike Ryan, Executive Director of WHO Health Emergencies

The new initiative represents the culmination of a series of global and  regional consultations that was undertaken by WHO to ensure a “more integrated approach” to this family of viruses,  which have often been ignored, said WHO Health Emergencies Executive Director Mike Ryan, also appearing at the session. 

The buy-in gained from the consultations was evident in the launch session, which was attended by dozens of researchers from far flung countries in Latin America, Africa and Asia, as well as Europe and North America.  

The initiative “brings together a network of partners which has enabled an efficient and successful collaboration across a range of pathogens and disciplines,” said Ryan, referring to the consultations leading up to the launch. “The COVID 19 pandemic and the public health emergencies that preceded it continue to humble us. As a society we remain susceptible to many recognized and some unrecognized infectious disease threats. However, these events have also highlighted the possibilities for effective collaboration.”

Despite their relative neglect, recent “virus-specific” advances in the field of arboviruses can be leveraged by such a coalition, Ryan said. 

‘Integration’ key to progress

Leading arbovirus diseases today

Indeed, a more integrated approach to the prevention, detection and treatment, is key to success, stressed Farrar.  

“In fact, the progress in some of the areas around arboviruses in the last 10 to 15 years has also been staggering – and may have been forgotten a little bit in the last few years as everybody’s focused on COVID,” Farrar said. 

“But because there is no single bullet that is going to give an answer to every arbovirus, it is all about integration.” 

Along with that, he stressed that biomedical research needs to be linked up better with social science in terms of ensuring that communities and policymakers take up solutions and really use them. 

“It is about social sciences. It’s about anthropology. It’s about behavioral science. And if we don’t embrace that after the last few years, what have we learned?”

Image Credits: Sanofi Pasteur/Flickr.

plastics
Microplastics found from the US Chesapeake Bay.

Microplastics have been discovered in human blood for the first time, with scientists warning that these mostly invisible pieces of plastic could also make their way into organs, in a new study examining blood samples of 22 anonymous, healthy adult volunteers.

The study, published in the Environment International journal Thursday, found that 17 of 22 blood samples drawn from a group of volunteers in the Netherlands, or 80%, had some concentration of microplastics.

Additionally, half of the blood samples showed traces of PET plastic, which is widely used to make drink bottles, while more than a third had polystyrene, which is used for disposable food containers, electronics, automobile parts, and other products. Almost a quarter had polyethylene, the most commonly used plastic today. 

“This is the first time we have actually been able to detect and quantify” such microplastics in human blood, said Dick Vethaak, an ecotoxicologist at Vrije University in Amsterdam, and one of the authors of the study.

“This is proof that we have plastics in our body, and we shouldn’t,” he told AFP, calling for further research to investigate how it could be impacting health.

“Where is it going in your body? Can it be eliminated? Excreted? Or is it retained in certain organs, accumulating maybe, or is it even able to pass the blood-brain barrier?” 

The study noted that “it is scientifically plausible that plastic particles may be transported to organs via the bloodstream.”

‘Unequivocal’ proof that plastics pervade both environment and people 

Plastics at a local municipal recycling center.

While the fate of plastic particles in the bloodstream needs “further study”, scientist Alice Horton, of Britain’s National Oceanography, said that this “unequivocally” proved there was microplastics in blood. 

“The study contributes to the evidence that plastic particles have not just pervaded throughout the environment, but are pervading our bodies too,” Horton told the Science Media Center.

Uptake of plastic particulates is likely either through ingestion or inhalation, the study suggests.

These ubiquitous pollutants already make their home in our soil and food systems, as well as in the ocean, air, and our health systems. As a result, some 175 UN member states had agreed to negotiate a landmark treaty by 2024 to curb plastics pollution earlier this month.

Other studies have shown the human placenta able to absorb 50, 80, and 240 nanometer polystyrene beads, and possibly also microsized polypropylene, a plastic used for packaging in cleaning products, bleaches, and first-aid products. 

Despite the small sample size and lack of data on exposure level of the participants, Fay Couceiro, reader in biogeochemistry and environmental pollution at the University of Portsmouth, says that the study was “robust and will stand up to scrutiny.”

“Blood links all the organs of our body, it could be anywhere in us,” Couceiro told AFP.

Image Credits: Will Parson/Chesapeake Bay Program, JoLynne Martinez/Flickr.

Delegates at the CBD Geneva talk.

Two weeks of negotiations in Geneva over a critical new agreement to protect and conserve some 30% of the planet’s land and oceans spaces by 2030 have yielded only halting progress – with the parties to the UN Convention on Biodiversity (CBD) agreeing to meet again in Nairobi in late June. 

The Nairobi meeting, 21-26 June, will be the last, critical session before the Convention on Biological Diversity’s (CBD) 15th Conference of the Parties (COP15) in Kunming, China – where a new, landmark agreement on is supposed to be finalized, following a two year delay due to the pandemic. The new framework has been billed as the biodiversity equivalent of the 2015 Paris Climate deal, but the delay in talks and negotiations have not helped its profile.  

Some 91 countries and the European Union, have publicly supported incorporating a “30×30” agreement into the CBD – as part of the “High Ambition Coalition for Nature and People”. Observers said a number of new countries from the Caribbean, the Middle East, Asia and Latin America also had expressed support for the target at the Geneva meeting, which ended on Wednesday.  

But with the exception of India, the influential BRICS bloc, including Brazil, Russia, China, and South Africa, have refrained from supporting the goal.  Nor are the BRICS among the 72 members of the Global Ocean Alliance (GOA), which has publicly supported a 30×30 target for the world’s oceans. 

The proposed 30×30 framework has been portrayed by biodiversity advocates as equivalent to the 2015 Paris Climate deal in terms of its significance. 

The Convention on Biodiversity, however, lacks the high political profile of its sister climate agreement, the UN Framework Convention on Climate Change (UNFCCC).  A two-year delay in convening the recent negotiations, due to the pandemic, have not helped.  

“There is an emerging consensus in support of the science-based proposal to protect at least 30% of the planet’s land and ocean by 2030, which is encouraging,” said Brian O’Donnell, Director of Campaign for Nature, one of the groups that has been lobbying for the 30x 30 proposal. 

However, he said that the progress with the negotiations had been “painfully slow”, and the level of ambition with financing is “woefully inadequate”.

“Unfortunately, the negotiations in Geneva have not reflected the urgency that is needed to successfully confront the crisis facing our natural world,” O’Donnell said.  

One million species at risk of extinction 

Delegates at the negotiations meeting, UN CBD, Geneva.

Scientists warn that without more assertive action by the nations of the world, rapid overdevelopment will lead to the extinction of another one million species within decades.

Rapid deforestation and consequent losses of natural habitat, coupled with climate change, have already pushed major species like giraffes and koalas into the ‘endangered’ category. Currently, there are 17 critically endangered animal species while over two-dozen species are considered “endangered”, according to the World Wide Fund for Nature (WWF). That has made it imperative that the 30% target be achieved as the absolute minimum amount of conservation needed to curb global biodiversity loss, according to a recent paper in Science Advances. 

In January 2021, a group of scientists from around the world issued a stark warning that “humanity is causing a rapid loss of biodiversity, and, with it, Earth’s ability to support complex life.”

This year, an Intergovernmental Panel on Climate Change report further underlined the urgency of addressing the biodiversity crisis which is deeply interrelated with climate change. The number of endemic species subject to “very high extinction risks” in biodiversity hotspots is projected to at least double from 2% between 1.5°C and 2°C global warming levels and to increase at least tenfold if warming rises from 1.5°C to 3°C. 

For instance, according to another recent study of satellite imagery of the Amazon forest, deforestation and climate change, via increasing dry-season length and drought frequency, may already have pushed the Amazon close to a critical threshold of rainforest regeneration. When forests dies, so do the animal and insect species living in them – or else they relocate to areas inhabited by humans, bringing new pathogens with them. 

Increased risk of disease outbreaks

In terms of health, environmental health experts have also pointed to the increased risks of disease outbreaks, such as the recent COVID-19 pandemic, as the loss of biodiversity also means the loss of the natural system of checks and balances that keep many diseases under control. 

Notably, continued ecosystem destruction along with unsafe and unsustainable patterns of food production are bringing more and more people into closer contact with viruses and pathogens harboured by animals in the wild – from SARS-CoV2 that may have spread to humans via the sale and slaughter of wild animals in Chinese wet markets, to Ebola virus in Africa, which infects humans via bushmeat slaughter and consumption, among other factors. 

Square brackets, late nights and talks in circles

In the two-weeks of Geneva meetings, talks sometimes went up to 3 a.m with inconclusive endings, followed by new suggestions for the text. Some paragraphs had up to 30 square brackets, which implies that governments were yet to agree on the language. 

The final draft text showed a large portion of the framework’s 21 targets still in square brackets which pimples a lack of formal agreement, said those who saw the agreement. Continued areas of disagreement also included specific goals for reducing pesticide use and goals for removing billions of dollars in national government agricultural subsidies that incentivise farmers to destroy habitats. 

The COP 15 in Kunming is seen as an important stage for finalising new targets, more ambitious than the previous CBDs.

In 2002, the CBD convention in Montreal committed to achieve a significant reduction of the current rate of biodiversity loss by 2010, but failed to meet the targets. Targets that were set for 2020 in the 2010 Aichi Convention– which included protecting 17% of the planet’s land surfaces and 10% of the ocean– were also missed. This makes the Kunming summit even more important in drawing a line in the sand over the rapid loss of habitat and species loss, by setting new targets for 2030. 

Among the 2030 targets, the proposal to protect or conserve at least 30% of the planet’s land and oceans is a flagship initiative. Even so, it would not be binding on any single nation;  countries would determine their contributions in accordance with their national circumstances.

However, another note of progress at the meeting in Geneva was an agreement by countries to add the term ‘equitably governed’ to the text, in response to requests from indigenous leaders, as well as adding the phrase ‘giving effect to the rights of indigenous peoples and local communities’ to underscore the that implementation of the 30×30 dovetail with human rights protections. 

“There is growing recognition of the need to better safeguard the rights of Indigenous Peoples and Local Communities, who must be central to achieving the world’s biodiversity goals,” said O’Donnell.

Image Credits: UN CBD Twitter .

WHO Director General Dr Tedros Adhanom Ghebreyesus at press conference on 30 March 2022

In some of his most forceful remarks to date, WHO Director General Dr Tedros Adhanom Ghebreyesus and other senior WHO officials slammed both Russia’s invasion of Ukraine and Ethiopia’s blockade of Tigray for both withholding vital health and humanitarian aid – as well as deliberately targeting civilians or putting them in harms way.

Speaking from Doha, Tedros called Russia’s war in Ukraine and invasion and slammed its continuing attacks on health facilities, saying, “We are outraged that attacks on health care are continuing. Since the beginning of the Russian Federation invasion there have been 82 attacks on health care facilities, leading to at least 72 deaths and 43 injuries, including patiens and health workers.  Attacks on health care are a violation of international humanitarian law and must stop immediately.”

As for Ethiopia’s warn in Tigray, he added that while WHO had welcomed last week’s declaration of a humanitarian truce in Tigray, between Tigrayan rebel forces and the Ethiopan government, “a week has passed and no food has been allowed into Tigray.

“Every hour makes a difference when people are starving to death. No food has reached Tigray since mid-December and almost nothing has been delivered since August. of last year. “The siege of 6 million people in Tigray by Eritrean and Ethiopian forces for more than 500 days is one of the longest in modern history,” Tedros said.  

WHO Executive Director of Health Emergencies, Dr Mike Ryan

“What’s so unusual about situations like we see in Ukraine like we see in Tigray, is that this is not is this is not people caught up in the fog of war. It is people being directly targeted, directly used as strategic implements, as chess pieces in horrific murders,” added Dr Mike Ryan, WHO Executive Director of Health Emergencies, Dr .  The world needs to look at why we end up with so many groups of people being used as pawns of war.”

Ryan added that the situation in Ukraine and Tigray, are both “a world of difference between that and a conflict situation where we struggle to get aid and assistance and because of conflict and all sides are trying to help in a way – and we struggle just because of conflict.

“That’s a very big difference between that situation, and the situation of access is being actively denied for the population – where actually cutting off of people is part of part of the tactics. It’s part of the military strategy.”

Tedros also called out the Taliban leadership in Afghanistan for the sudden turnabout last week that led to the banning of girls from secondary school classrooms – just hours after they had arrived to resume their studies for the first time since the fundamentalist Islamic group seized control of the government last August.

“Women and girls are especially at risk from lack of access to health services and lack of access to education,” Tedros said. “Last week’s decision by the Taliban leadership to ban girls from school is very troubling.”

Beseiged Mariupol remains blocked to WHO relief workers

Ian Clarke, WHO Incident Manager for Ukraine

In terms of recent relief efforts, WHO’s Incident Manager for Ukraine, Ian Clarke, said that over the past few days WHO had been able to dispatch more than 21 metric tons of medicines and other health supplies to eight locations in disputed parts of Ukraine, adding “We tried to get into Mariupol.  We have been unsuccessful today, together with our interagency partners, but we have been able to access places like Kherson”. Mariupol has been under a prolonged Russian seige that has also prevented aid groups from bringing in food and medical supplies, while Kherson already fell to Russian control several weeks ago.

Clarke added that a $57 million fund-raising drive to support short-term healthcare needs of Ukranians in the country as well as those who have abroad had nearly reached its goal.

“We’re now in the process of working with our health partners, both in Ukraine and the hosting countries to come up with a comprehensive strategic response plan that will cover the healthcare needs for Ukrainians regardless of where they are located, both in Ukraine or in hosting countries. And that will provide a longer term outlook,” Clarke said.

Remains committed to 70% COVID vaccination target – as virus continues to evolve

In other remarks, the WHO Director General said that he remains committed to a 70% goal for vaccinating people low- and middle-income countries against COVID-19, despite current trends that reflect a sharp decline in infections and less lethal variants. This, despite an undercurrent of criticism from both countries and some donors that a strategy of vaccinating the most high-risk groups like older people and health care workers might be preferable to such a broad goal.

“Even as high income countries roll out fourth doses, one third of the world’s population has yet to receive a single dose, including 83% of the population in Africa,” said Tedros.””This is not acceptable to me, and it should not be acceptable to anyone.” 

WHO is launching it’s third COVID response strategy since the pandemic began, he added, in which COVID vaccination of under-covered groups would remain a key priority along with better access to treatments, and continued testing and surveilance.

“This is our third plan and it could, or should be our last plan,” Tedros said, explaining that the plan etches out three scenarios for how the pandemic will evolve – from best to worst cases. As part of that, he said WHO is also launching a new strategy to scale up genomic surveillance globally for pathogens with epidemic and pandemic potential.

“Based on what we know now, the most likely scenario is that the virus continues to evolve. But the severity of disease it causes is reduced over time as immunity increases due to vaccination and infection. Periodic spikes in cases may occur as immunity wanes, which may require very early boosting for vulnerable populations,” he said.

“In the best case scenario, we may see less severe variants emerge, and boosters or new formulations of vaccines won’t be necessary. In the worst case scenario, a more violent and highly transmissible variant emerges. Against this new threat, peoples’ protection against disease and death either from prior vaccination or infection will wane rapidly. Addressing this situation would require significantly altered vaccines, and making sure that they get to the people who are most vulnerable.”

Tedros was speaking from Doha where he was meeting with Qatari officials, shortly after delivering an address to the World Government Summit, taking place in Dubai. 

 

A man at a protest in Geneva to demand the TRIPS waiver.

A compromise proposal on a World Trade Organisation’s (WTO) waiver on intellectual property for the production of COVID-19 vaccines is ‘problematic’, ‘largely insufficient’, and WTO members should not be politically pressured into adopting the  text, several dozen civil society organisations said in an open letter published today. 

The letter, addressed to European Commissioners, European members of Parliament, and WTO Ambassadors, and signed by 42 European and International civil society organisations, called on the European Union and WTO Director General Dr Ngozi Okonjo-Iweala to “refrain from rushing WTO members” to rapidly adopt what the civil society groups termed as an “unsound proposal”.  

The draft compromise text, was brokered in mid-March with United States support between the European Union, which had until then opposed any IP waiver at all for COVID health products, and the initiative’s sponsors, India and South Africa – referred to in some quarters as “the Quad”.  However, the draft agreement still needs to be put to all 164 WTO members, which typically decide by consensus. 

To make the compromise possible, South Africa and India had to make major concessions in narrowing the waiver to only vaccines, as well as narrowing the list of countries that would be eligible to take advantage of the waiver on patents and other IP.

In their letter, the civil society critics charged that “The text under consideration by some WTO members contains problematic and contradictory elements (see Annex) and remains largely
insufficient as an effective pandemic response.

Exclusion of therapeutics and burdensome requirements among the complaints

The main innovation of the proposed waiver is that most low- and middle-income countries that decide to produce their own generic versions of vaccines would be also allowed to export their products to other low- and middle-income countries in deed – providing that the country historically produces less than 10% of the global COVID vaccine supply – effectively excluding China from the waiver provisions.  Bulky and complex requirements around export of generic products are a key complaint of the current WTO Agreement on Trade Related Intellectual Property (TRIPS).

Among the main civil soceity complaints about the new agreement, detailed further in an annex, are the exclusion of COVID diagnostics and treatments from the IP waiver.  Those products, proponents say, are even more critical now in the battle by low- and middle-income countries against the pandemic in light of the comparatively higher costs of such drugs and lower vaccination rates.

Critics also say that the compromise would require new “burdensome, unecessary, TRIPS-plus requirements for countries seeking to issue a compulsory license” for the generic production of a vaccine – in terms of notification procedures.

While patents are part of the waiver, “the draft text also does not address barriers arising from confidential information/trade secrets held by corporations or contained in documentation submitted to regulatory authorities,” the critics say.

“And eligibility requirements still exclude too many low- and middle-income countries from either “producing, supplying, export and importing” even vaccines, they add.

Ultimately, the measures create “more legal uncertainty compared to the existing TRIPS flexibilities due to textual ambiguity and a confusing structure,” the critics further charge.

Final decision set for June

A final decision on the IP waiver is expected is to be taken at the 12th WTO Ministerial Conference, now set to take place during the week of 13 June in Geneva. 

But until then, the civil society groups said that there is a need for “further negotiations are needed to ensure an effective outcome in a multilateral manner.

“Throughout the COVID-19 pandemic, the EU has repeatedly ignored evidence of the effects of restrictive licensing practices on access to COVID-19 medical tools and resisted meaningful negotiations on a proposal for a temporary TRIPS waiver at the WTO to address limited production and shortage of supply,” the letter said. 

The critics charge that the terms of the waiver, as stated now, would also cast legal doubts around the work of the mRNA tech-transfer up recently set up by WHO in South Africa, and which the European Commission has suported.  The mRNA hub recently announced that scientists there had duplicated the Moderna version of a COVID vaccine.

“We find it hard to comprehend how the EU would endorse a so-called compromise that could hamper the functioning of the mRNA tech-transfer hub that the European Commission and some Member States strongly support. It’s hard to see countries in the Global South believing in the promise of equity that the European Council assures guides its push for a pandemic preparedness treaty,” Health Action International Senior Policy Advisor Jaume Vidal said in a press release.

The current compromise reached, however, now has good chances of being approved by consensus insofar as EU countries have been the major opponents to the proposal by South Africa and India, submitted in October 2020.  The original proposal called for a blanket waiver on all IP related to COVID-19 vaccines and other pandemic-related health products for the duration of the pandemic. 

According to organisations, including Amnesty International, Human Rights Watch, Oxfam, the People’s Vaccine Alliance and others that signed the letter today, the compromise text is a “reiteration of existing TRIPS flexibilities with a narrow export waiver and additional cumbersome requirements” and that a large number of WTO members whom these proposals affect were not a part of the negotiations. 

Image Credits: Aishwarya Tendolkar.

A mother and her newborn baby at Karenga Health Center, Uganda.

Between childbirth and six weeks is the most dangerous time for mothers and babies and when most deaths occur, and the World Health Organization (WHO) issued a new guideline called ‘Recommendations on maternal and newborn care for a positive postnatal experience‘ on Wednesday aimed at guiding all role-players during this period.

One of the key recommendations is that women and their babies remain at health facilities for at least 24 hours after the birth, and have check-ups at least three times over the next six weeks. At present, around 30% of mothers and newborns don’t get health care during this crucial period, according to the WHO.

“A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers, and where a resourced and flexible health system recognizes the needs of women and babies and respects their cultural context,” says the WHO.

In total, the new guidelines bring together over 60 recommendations that help shape a positive postnatal experience for women, babies and families. Some of the key proposals include:

  • Identifying and responding to danger signs needing urgent medical attention in the woman or the baby
  • Treatment, support and advice to aid recovery and manage common problems that women can experience after childbirth, such as perineal pain and breast engorgement  
  • Screening of all newborns for eye abnormalities and hearing impairment, as well as vaccination at birth
  • Support to help families interact and respond to babies’ signals, providing them with close contact, warmth and comfort 
  • Exclusive breastfeeding counselling, access to postnatal contraception and health promotion, including for physical activity
  • Encouraging partner involvement, for example by being part of checkups and attending to the newborn
  • Screening for postnatal maternal depression and anxiety, with referral and management services where needed.

Image Credits: UNICEF/Zahara Abdul 2019.