The inequitable distribution of COVID-19 vaccines is the result of the “complete collapse of global co-operation and solidarity”, Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at the World Economic Forum on Tuesday.

“The moral failures that we witnessed over the last two years cannot be repeated in 2022,” he added.

“We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%? We really have to bring all forces to bear to increase our global cooperation, partnership, solidarity and coordination to try to move from where we are to 70%, recognising that it is only through that massive coordinated efforts that we could all be safe.”

Nkengasong added that Omicron’s rapid spread had borne out predictions that global safety involved global vaccination.

“We’ve seen what Omicron has done. We all said this at the start: that if we did not protect and invest at speed, even those who have been vaccinated will be challenged. We truly don’t know what the next variant will look like and the only way to prevent other variants is to vaccinate at scale and that includes Africa.”

COVAX hit ‘barrier after barrier’

Seth Berkley CEO of Gavi, the vaccine alliance that manages COVAX, said that “the original plan was to have every high-risk person in the world vaccinated at the same time, and every health worker and then moving to low-risk people”.

“Of course, that’s not what happened,” said Berkely, noting that while COVAX had managed to deliver the first vaccine to a developing country 39 days after high-income countries, the vaccine platform then “hit barrier after barrier”.

“We had export bans, we had vaccine nationalism, we had companies not meeting their requirements to put doses forth,” said Berkley.

He also warned that delays had also fuelled vaccine hesitancy and complicated delivery.

“The good news is that, in general, developing countries actually appreciate vaccines more because they see the diseases and so the vaccine demand has always been higher, and vaccine hesitancy is actually been lower. But it’s more complicated at this point,” said Berkley.

More COVID deaths related to inequality than old age

Gabriela Bucher, Executive Director of Oxfam International

Gabriela Bucher, Executive Director of Oxfam International, told the WEF session that research showed “inequality is a higher predictor of COVID-19 deaths than age”.

“We have seen vaccine hoarding over and over again, and [governments protecting pharmaceutical monopolies”, said Bucher.

Oxfam published a report this week on COVID-related inequity, including that the wealth of the world’s 10 richest men has doubled since the pandemic began, while the incomes of 99% of humanity are worse off because of COVID-19.

Bucher said that lifting intellectual property rights from the beginning of the pandemic and allowing vaccines to be produced at scale across the world would have been “a game danger”.

“We would have avoided not only deaths directly from COVID but all the deaths that have been associated with growing inequality and crippled health systems across the world,” she added.

Breakdown of trust

Dr Michael Ryan, Executive Director of the World Health Organization (WHO) Health Emergencies Programme, said that while COVID-19 would not be eliminated this year–  and SARS-CoV2 might never be eliminated – “we can end COVID as a public health emergency”. 

But, said Ryan, the global pandemic response system was not “fit for purpose” to end this or future pandemics.

“What is very clear is that the current mechanisms that are in place for the production of vaccines do not lead to the equitable distribution of these vaccines,” said Ryan.

“One of the most scarce commodities in this whole pandemic response has been trust: trust between communities and government, trust between countries, trust between manufacturers,” he added.

Serum Institute of India appeals to African countries to ‘get in touch’

Adar Poonawalla CEO of the Serum Institute of India (SII), said that his company had 1.5 billion vaccine doses in the past year, and “actually have to stop production in December because we had 500 million in stock”.

“Vaccine supply is no longer a constraint,” said Poonawalla. “We’ve supplied vaccines to the African continent and it supported over the last many decades. We are ready to support you again. Please get in touch.”

SII was supposed to be the key supplier for COVAX of a generic version of the AstraZeneca vaccine, but stopped its supply to attend to India’s domestic vaccine needs. This generated bad blood between the company and African countries.

However, according to Poonawalla, the SII will “probably supply a billion-plus doses in the first quarter of 2022 through COVAX to the African continent.”

UN Secretary General Antonio Guterres addresses the opening day of the World Economic Forum.

International financial institutions need to extend widespread debt relief to developing countries, and private sector companies need to mend “social contracts” with societies, and in order to “beat climate, beat COVID” fight hunger – and global financial instability, said UN Secretary General António Guterres. He was speaking on the opening day of the World Economic Forum, taking place online this week for the second year in a row, rather than at the posh Alpine ski resort of Davos.  

“I’ve been calling it a new global deal – the reform of international financial institutions and the way that international finance works,” Guterres said in a keynote address Monday evening.

Despite the virtual venue, the messages coming out of the conference were urgent, and at times  frenetic, with Guterres warning of massive economic woes and financial insecurity, as well social unrest and more climate disasters, if developing countries are unable to access sufficient debt relief to recover from the pandemic – and embark on a greener recovery. 

“If you fail to provide debt relief and financing to developing countries, we create a lopsided recovery that can send an interconnected global economy into a tailspin,” Guterres warned.

“And if you fail to match climate rhetoric with climate actions, we can then ourselves to a hotter, more volatile hers, with worsening disasters and mass displacement.”

“And at the core of these failures is a global inequities… Without immediate action to support developing countries, inequalities and poverty will be this will result in more social unrest and more violence,” Guterres said. 

Earlier in the day, a new WEF Global Risks 2022  report warned about “a world on fire” with climate change, ballooning debt in lower income countries, and linked to that social and food inecurities – while countries still battle pandemic flames.  

‘Our planet is on fire and we have to deal with it – this is a risk we know, we are not faced with a blind spot,’ said WEF president Borge Brende at a press briefing early Monday on the new Global Risks report, which tracks perceptions of risk among risk experts as well as world leaders in business, government and civil society.

‘Humans not good in the boiling frog scenario’ 

WEF president Borge Brende (left) at special address by UN Secretary General

We are faced with supply chain challenges, inflationary pressure and looming debt crises. I believe if we’re going to deal with these, with inequality and nature challenges, we need more private-public cooperation,” Brende added, of the report projections. 

Others expressed concerns that global solidarity on climate action has been far weaker than what has been seen in the fight against COVID-19 – however the fraught the latter may be with failures, including the lack of adequate vaccine coverage in Africa.

While countries continue reeling financially and socially from the COVID pandemic, “climate action failure and extreme weather events are seen as the most critical long-term risks,” said Peter Giger of the Swiss insurance giant Zurich. “And the strains of combatting the pandemic have limited even more countries’ abilities to respond. 

“Humans are not good in the boiling frog scenario, which is climate change; they’re much better in the fight or flight scenario, which has been the pandemic,” he added. 

Key Asks – Vaccine equity now; No new coal plants; Massive support & coalitions for green transition

Poverty and social inequity – Global Risks Report – 2022

Guterres, meanwhile, called upon countries to ensure that all nations reach the WHO 70% vaccination goal by mid-year – saying high income countries are “shamefully seven times higher than in African countries” in vaccine rates – and “we need vaccine equity now.”

To address the fractures seen at the Glasgow Climate Conference (COP26), he called upon the global community to support public-private “coalitions” that would muster “massive support” for investments in renewable energy, and channel those, along with technologies, to emerging economies. 

More action in Asia and Africa, along with momentum in developed economies, is critical to head off a projected 14% rise in climate emissions by 2030 under current scenarios – even if all current climate commitments are met, he asserted.

The aim should be clear, “phase out of coal… no new coal plants,” he said.

 “But let’s not go into blame and shame,” he added of countries such as India that have argued that they cannot afford a faster pace of change. “Let’s assist, help the emerging economies to accelerate the transition.

“I’m calling for the creation of coalitions – coalitions with countries, public and private financial institutions, investment funds, and companies that have the technological know-how to provide targeted financial and technical support for every country that needs the systems. 

“The governments of Vietnam and Indonesia have just announced their intention to get out of coal and to have a transition to renewable energy. But they need support.

“South Africa now has in place a ‘just energy transition’ with a partnership that involves a number of key countries and international financial institutions to support accelerating their moving out from coal. So we see a clear role for businesses and investors in supporting our net zero role.” 

India resists term “coalition” – but has accepted support for green energy transition 

Global Risks Report 2022

Not everyone has responded positively to his overtures, he admitted, saying that India had “doesn’t like” the idea of a “coalition” very much.  

At the same time, he added, “India has accepted several bilateral forms of support. And I’ve been in close contact with the US, the UK and several other countries to make sure that there is a strong project to support India, namely in their investment of 450 gigawatts of solar energy.” 

Whatever its name, the net results of such initiatives should be clear Guterres declared: “No new coal plants should be built. This must be a priority for us all.” 

“1.2C degrees of warming has already brought devastating consequences and price tags measured in dollars and despair. 

“Over the last two decades, the economic toll from climate related disasters skyrocketed by 82%.  Extreme weather in 2021 cost US$120 billion in insured losses and killed 10,000 people.  Climate shocks forced 30 million people to flee their homes in 2020 alone – three times more than those displaced by war and violence. 

And one billion children are at an extremely high risk of the impacts of climate change.” 

Environmental risks—in particular, “extreme weather” and “climate action failure”—appear as top risks in both the short-, medium-and long-term outlooks, according to the report. 

Social and environmental risks have worsened since the start of the COVID pandemic 

Among the other top findings of the Global Risks report were perceptions that along with health, climate and environment and the debt crisis, a broad range of other social risks have worsened since the start of the pandemic, with “social cohesion erosion”, “livelihood crises” and mental health also taking top spots. Other risks identified included, as having worsened significantly were migration, “cybersecurity failures”, “digital inequality” and an overall “backlash against science”.

Only 11% of respondents thought the world would be characterized by an accelerating global recovery towards 2024, while 89% perceived the short-term outlook to be volatile, fractured, or increasingly catastrophic.

Alongside those, are worries about a looming debt crises and “geoeconomic confrontations” between global and regional powers.  

Guterres – calling for expanded business partnerships in health, stronger WHO, more preparedness 

Gutteres also called for expading partnerships between the pharmaceutical industry and lower-income countries to transfer valuable medical know-how needed not only to fight this pandemic – but to prepare better for the future.  But he suggested that should be done voluntarily, through pharma’s voluntary expansion of licenses for vaccines and medical technologies. 

“We need pharmaceutical companies to stand in solidarity with developing countries by sharing licenses and new technology. So we can all find a way out of this pandemic,” he added. 

He also said that countries need to invest in primary health care, a stronger World Health Organization – and through those systems, “to prepare for the next pandemic.”

“We need to confront the pandemic with equity and fairness,” he stressed. “The last two years have demonstrated a simple but brutal truth if we leave anyone behind. In the end, we leave everyone behind. We fail to vaccinate every person, we give rise to new variants that spread across borders, and bring daily life and economies to a grinding halt. 

Global Risks Report 2022

World Economic Forum – taking place under a shadow 

“This year’s World Economic Forum takes place in the shadow of an enormously difficult period for economies for people and for the planet,” Guterres added in his address. “According to the UN’s economic report released last week, the world is emerging from the depths of a paralyzing economic crisis, but recovery remains fragile,” Guterres said. “

And then even the lingering pandemic, persistent labor market challenges, ongoing supply chain disruptions, rising inflation, and looming debt traps, not to mention the geopolitical divide. 

“And as a result, we see recovery slowing down quite substantially. And all of this threatens our own progress in advancing the 2030 agenda, and the Sustainable Development Goals, our key projects.” 

Image Credits: Global Risks Report 2022 – World Economic Forum , World Economic Forum .

An Israeli woman gets a COVID-19 vaccine.

A fourth COVID-19 booster mRNA vaccine has proven ineffective against Omicron infection, according to preliminary research from Israel released on Monday.

“Despite a significant increase in antibodies after the fourth vaccine, this protection is only partially effective against the Omicron strain, which is relatively resistant to the vaccine,” lead researcher Prof Gili Regev-Yochay, told a media briefing on Monday.

Some 154 health workers at Sheba Medical Center received their fourth Pfizer shot two weeks ago. A week ago, 120 healthworkers received a shot of Moderna following three doses of Pfizer one week ago.

They were matched with a control group of around 6,000 health workers who have been being followed by the hospital since the start of Israel’s vaccination campaign in December 2020. 

According to Regev-Yochay, the third dose resulted in “much higher antibodies, neutralization and the antibodies were not just higher in quantity but also in quality” than the second dose – but the fourth vaccine did not show  significant antibody increase.

”Maybe there are a few more antibodies but not much more compared to the third dose,” said Regev-Yochay.

Last week, she told Israeli Prime Minister Naftali Bennett that there had been a five-fold increase in antibodies in people who took the fourth dose, but she later told a radio station that “the amount of antibodies returns to the level it was after the third vaccine, not more. It’s nice, but it’s not what we expect from a booster.”

In addition, around the same percentage of hospital workers who received the fourth dose caught the virus as those who didn’t get the fourth booster. 

Booster demand may affect global supply

Meanwhile, the European Medicines Agency (EMA) cautioned last week that there was no evidence to back a fourth booster, warning that repeat boosters every four months might actually weaken people’s immune systems.

Boosters “can be done once, or maybe twice, but it’s not something that we can think should be repeated constantly,” said Marco Cavaleri, the EMA head of biological health threats and vaccines strategy, said at a press briefing last week, as reported by Bloomberg.

Instead, the agency recommended that boosters should be tied to the cold season with longer intervals.

The World Health Organization (WHO) has also warned repeatedly against boosters while a high percentage of people in low and middle-income countries – estimated to be over 40% of the world’s population – are unvaccinated, fearing boosters will lower the number of vaccine doses available to these countries.

“With near- and medium-term supply of the available vaccines, the need for equity in access to vaccines across countries to achieve global public health goals, programmatic considerations including vaccine demand, and evolution of the virus, a vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable,” the WHO said on 11 January.

Vast majority of Omicron patients in hospitals are unvaccinated

Meanwhile, the latest research from South Africa, New York City and California show that the vast majority of people hospitalised by the COVID-19 Omicron variant are unvaccinated – but that they still experienced less severe disease than those infected with Delta.

South Africa reported that around 82% of those hospitalised during its Omicron-fueled fourth wave were unvaccinated.

Hospital statistics of over 128,000 patients with Delta and almost 35,000 patients with Omicron, showed those with Omicron fared significantly better than those with Delta. 

In the Delta group, 26.4% of patients, 14.6% were admitted to ICU and 63% had severe disease.

South Africa Omicron vs Delta, NICD January 2022

In comparison, only 9.7% of those with Omicron died, while 5.8% were admitted to ICU and 31.7% had severe illness, according to a presentation by the National Institute of Communicable Diseases delivered at a media briefing hosted by South African Department of Health last Friday.

A similar trend was reported by the New York City (NYC) Health Department, which reported that about 2% of Omicron cases were hospitalised in comparison to around 5% of Delta cases.

About half the proportion of NYC hospitalized patients required intensive care during the Omicron wave compared to the peak of the winter 2020-2021 wave – about 11% versus about 20%, according to a NYC health department report released late last week. 

“In NYC, those most likely to be hospitalized are people who are not vaccinated, and a higher proportion of Black New Yorkers and people age 75 and older were hospitalized,” according to the report.

“New Yorkers who were not vaccinated were more than eight times more likely to be hospitalized compared to New Yorkers who were fully vaccinated, early in the Omicron wave. Differences in health outcomes among racial and ethnic groups are due to long-term structural racism, not biological or personal traits,” it added.

In addition, a pre-print study of COVID-19 cases in southern California compiled by Kaiser Permanente of over 52,000 Omicron infections and almost 17,000 Delta infections, found 0.5% of hospital admissions for Omicron patients and  1.3% for those infected with the Delta variant.

Rates of ICU admission from Omicron patients were 0.26 fold those of Delta, while mortality for Omicron patients was 0.09 fold that of Delta patients.

No Omicron patients received mechanical ventilation in comparison to 11 Delta patients, and Omicron patients stayed in hospital on average 3.4 days less than Delta patients.

 

Image Credits: Maccabi Health Services, Clalit Health Fund .

protest fine
Tens of thousands of people protested against COVID-19 vaccine passes across France

France’s newest measure to tackle COVID-19 – requiring a certificate of vaccination at public places such as restaurants, cafes, cinemas, and long-distance trains – was approved by its parliament on Sunday. 

With lawmakers in the lower house of parliament voting 215 to 58 in favour, the law is set to be enforced in coming days.

President Emmanuel Macron told Le Parisien paper in an interview this month that he wanted to “piss off” unvaccinated people by making their lives so complicated they would end up getting the COVID vaccine. 

“The unvaccinated, I really want to piss them off. And so we’re going to continue doing so until the end. That’s the strategy,” said Macron.

Currently, unvaccinated people can enter these places with recent proof of a negative COVID-19 test. 

The new law is part of a string of mandates that have been implemented across the European Union (EU) in an effort to quell the rise in cases. Greece, Italy, and Austria have begun to implement fines or mandatory vaccinations for adults. 

France is experiencing its fifth COVID-19 wave, with daily cases hitting record highs of over 300,000. However, the number of serious hospitalizations is much lower than compared to the first wave in March and April 2020. 

Unvaccinated Greeks to pay monthly fines

Individuals 60 and over will be fined if they do not receive their COVID vaccination in Greece.

Greeks over the age of 60 who have not yet scheduled an appointment to get their first jab against COVID-19 will be fined every month, starting on Monday, o boost lagging vaccination rates and reduce pressure on healthcare in Greece.  

The monthly fine will be 50 euros ($57) in January, but will rise to 100 euros ($115) in subsequent months.

Speaking on Greece-based Skai Television, Health Ministry General Secretary Marios Themistocleous said there would be no extension to the rule for those over 60: “Whoever does not get vaccinated will pay the fine every month,” he said.

This decision follows a rise in cases as Omicron sweeps through Greece, with 20,409 new cases reported in the last 24 hours. 

Authorities have also decided to extend other COVID-19 measures, including midnight curfew for bars, restaurants and cafes; no music at venus; and mandatory high-protection masks at supermarkets and on public transport until 23 January. 

Prime Minister Kyriakos Mitsotakis told seniors that the simplest way to avoid the fine is to get vaccinated. Greek authorities say the non-vaccinated remain at high risk for hospitalization from coronavirus.

Some 90% of COVID-19 related deaths have been among people 60 and above, while 70% of those hospitalized from the virus are over 60, and of those 80% are unvaccinated. 

Over 50 fined in Italy without booster shot 

Italy is implementing a similar fine with its population – people 50 and over could be fined 100 euros ($115) if they fail to get their booster shot, according to the country’s latest COVID restrictions.

The government’s 5 January decree now requires people over 50 to have a ‘super green pass’ health certificate showing that they are either vaccinated or recently recovered from COVID, in order to enter the workplace. Anyone in this age group, employed or not, is also at risk of being fined 100 euros if they do not get vaccinated by 1 February. 

In addition, those who do not get their booster shot also could face a 100 euro fine.  

“We are working in particular on the age groups that are most at risk of being hospitalized,” said Italian Prime Minister Mario Draghi. 

This new mandate applies to anyone currently 50 or over living in Italy, or anyone due to turn 50 by 15 June. 

The fines will be collected by Italy’s Agenzie delle Entrate (Inland Revenue-Recovery Agency). 

People notified they are in violation will have ten days to communicate to their local health office, the reason for their vaccination status. 

COVID-19 vaccinations to become mandatory for 18 and over in Austria 

Protests in Vienna, Austria over compulsory vaccination.

Austria plans to make COVID-19 vaccinations mandatory from February for Austrian residents 18 and older, the government confirmed on Sunday. 

Presenting the final version of a draft law at a press conference on Sunday, Chancellor Karl Nehammer sought to reassure Austrians that the vaccine works.

“It’s not about fighting the vaccinated against the unvaccinated,” but rather to underscore that “vaccination is the best guarantee that we can live together in freedom.” 

The mandate will apply to Austrian residents 18 and older, with exemptions for pregnant women and people who cannot receive the vaccine due to medical reasons. 

While the law will take effect 1 February, police checks won’t be carried out until 15 March. Unvaccinated people then face a penalty of around 600 euros (US $684) and up to 3600 euros (US $4105). 

Those noncompliant with the mandate will be fined up to four times a year; however, the fine will be dropped if the recipient is vaccinated within two weeks of receiving the penalty notice.

Though the Austrian parliament still has to vote on Thursday on the vaccination mandate, the law is expected to pass. Around 74% of Austria’s population is vaccinated against COVID. 

Image Credits: akilligundem/Twitter, John Perivolaris/Flickr, Ama Bushman/Twitter.

On 24 February 2021, a plane carrying the first shipment of COVID-19 vaccines distributed by COVAX landed in Ghana.

Rwanda became the recipient of the one-billionth COVID-19 vaccine delivered by COVAX, the global platform set up to ensure equitable access to the vaccines,announced last Friday.

After numerous supply problems – most seriously when its key supplier, the Serum Insitute of India, was banned from exporting its vaccines by the Indian government – COVAX was forced to slash its 2021 delivery target from two billion to 930 million doses.

However, since mid-December, COVAX delivery has escalated substantially, and 100 million vaccine doses were delivered in the last week of December alone.

“COVAX is leading the largest vaccine procurement and supply operation in history, with deliveries to 144 countries to date,” said the World Health Organization (WHO) over the weekend.

“But the work that has gone into this milestone is only a reminder of the work that remains. As of 13 January 2022, out of 194 Member States, 36 WHO Member States have vaccinated less than 10% of their population, and 88 less than 40%,” said the WHO.

“COVAX’s ambition was compromised by hoarding or stockpiling in rich countries, catastrophic outbreaks leading to borders and supply being locked. And a lack of sharing of licenses, technology and know-how by pharmaceutical companies meant manufacturing capacity went unused.”

Dr Seth Berkley, CEO of Gavi – the vaccine alliance that manages COVAX – said he was “proud that nearly 90% of the first billion doses COVAX has delivered have been fully-funded doses sent to the low and lower-middle countries supported by the Gavi COVAX Advance Market Commitment (AMC)”.

 

This had been made possible thanks to donations of over $10 billion to COVAX, added Berkley.

“Inequality in vaccination is enormous with 41% of the world not yet vaccinated with even one dose,” added Berkley. “In 2022, Gavi will be fundraising to make sure lower-income countries are able to access variant-adapted vaccines, boosters or additional doses as needed. COVAX will be focusing on supporting lower-income countries’ vaccination objectives – that means also raising money to ensure tailored support for preparedness and delivery, particularly for the highest-risk countries, to increase their ability to absorb the doses delivered as rapidly as possible.”   

Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI), which is a COVAX partner, also welcomed the milestone, but warned that while supply constraints had eased, “booster programs and the potential production of Omicron-specific vaccines may yet create pressure on supply”.  

Meanwhile, Eva Kadilli, director of UNICEF’s supply division, which carries out the COVAX deliveries, also welcomed the billionth delivery and thanked her teams throughout the world.

 

 

 

 

 

Image Credits: WHO, UNICEF.

“Swabbing” a sewage bore near the beach in Israel for SARS-CoV2 – could sewage be the best indicator yet of the spread of Omicron and other viruses?

Two years into the COVID-19 pandemic, monitoring sewage for evidence of disease – in this case COVID-19 – may be on the verge of becoming mainstream. 

At least that is what some trend-setting researchers are hoping to detect rising SARS-CoV2 infections early and set policies based on data even before swab testing can provide it. 

The virus spreads from person-to-person via droplets expelled from the mouth and nose. But it is also shed by infected people every time they go to the bathroom – though there is no evidence to date that anyone has become sick with COVID-19 because of direct exposure to treated or untreated wastewater, according to the United States Centers for Disease Control and Prevention (CDC). 

Wastewater epidemiology – turns human waste into a ‘data asset’

In fact, tracking the evolution of new pathogens through sewage is not a new tactic. It’s been used by researchers to probe the expansion of antibiotic resistant bacteria in  Africa and South-east Asia as well as by some national health ministries for more routine surveillance of relatively rare but deadly diseases like polio.

But the overwhelming pace of Omicron’s spread- which has made it impossible for health experts to keep up the traditional, individually-based testing and surveillance tactics – could help transform such approaches into more of a trend.

Along with high income countries like the United States, Canada and Israel, South Africa is on the cutting edge of such surveillance, while pilot projects are underway in several Latin America countries.  And now, a loose network of researchers and universities, called the COVID-19 WBE Collaborative have taken the idea to the next level – creating a global map of wastewater-based COVID monitoring sites in some 58 countries worldwide.  The is funded by the University of California at Berkeley’s CITRIS and Banatao Institute’s tech innovation hubs.

“Wastewater epidemiology turns human waste into a data asset that can improve the health and safety of populations,” explained Casey McGinley, chief of staff of Massachusetts-based Biobot Analytics, which also is conducting tests in Mexico, and piloting new surveillance projects with the World Bank in Uruguay and Ecuador.

“Wastewater analysis data is a great complementary tool to traditional public health surveillance methods that rely on clinical testing. Results can be used for different purposes and have a unique role to play at each stage of the pandemic, from early detection to detection of resurgence.”

Undercounting of Omicron cases makes wastewater-based surveillance more relevant

Ari Goldfarb, founder and director general of Kando

McGinley told Health Policy Watch that wastewater-based disease surveillance has become increasingly relevant since the start of the Omicron wave, partially because “due to incredibly high demand, availability of testing is very limited and there are long delays in reporting clinical testing results” and because “many individuals are expecting mild symptoms and resorting to at home tests which are not reported in official statistics.

“Against this backdrop of undercounting cases, wastewater data is a very important data set that gives a comprehensive overview of the magnitude of infections,” she said.

In Israel, Kando, a company that uses AI and Big Data to sample and analyze wastewater to improve management in sites around the world, just launched a partnership with the Health Ministry and several leading universities to apply its technology in hundreds of communities across the country to monitor for Omicron and any future SARS-CoV2 variants. 

According to the plan, towns of more than 20,000 people will be monitored twice a week using a series of sensors and control units placed in municipal sewage systems.  The samples collected will be sent to laboratories at Ben-Gurion University where PCR tests suitable for wastewater are conducted. In the event that the results received are positive, an additional test is carried out to quantify the Omicron variant and other variants. Sample results will be feed into a national computer data base that can analyze the results based on big data models and AI.

The entire process takes about 24 hours – from sample to results – but in this case for an entire neigborhood or town – rather than just one individual.

“You can look at wastewater as gigabytes of data running just under the city,” Kando CEO Ari Goldfarb told Health Policy Watch.

An important complementary tool – particularly in light of the increased reliance on rapid tests

Wastewater testing has become even more immediately relevant for tracking COVID, as countries pivot to greater reliance on rapid antigen tests, while gold-standard PCR tests are reserved for older people, those at higher-risk or with more serious symptoms. With people using less accurate at-home tests, which they also often fail to report, sewage surveillance could fill valuable missing holes of data.  

Better data on the relative proportions of Omicron versus other variants is another benefit of such initiatives, explained McGinley of Biobot. 

Her company reports the concentration of all SARS-CoV-2 variants detected in wastewater samples, including Omicron. In addition, Biobot is doing R&D work to detect and measure the percentage of the Omicron variant in wastewater through genomic sequencing. That can help decision-makers know how dominant Omicron has become, in relation to its more deadly but less contagious cousin, the Delta variant. 

“This information helps decision-makers in the current COVID-19 surge to understand the scale of infections, since case data has become significantly less reliable, tailor public health messaging around mask wearing and indoor gatherings, and lastly plan hospital resources accordingly,” McGinley said. 

In the US model, Biobot is sending internally devised wastewater sampling kits to public sector and corporate customers – containing everything needed to collect, package and safely ship the wastewater back to the company’s lab in Cambridge. Once received,  the company screens the samples to identify the presence and amount of the virus in each sample. The results are processed through Biobot’s data pipeline and reports are generated and sent back to the customers. 

Biobot’s open source sewage surveillance in the United States.  Surveillance curve parallels clinical case reports – but with higher absolute levels of disease incidence.

Its customers have included sites in all 50 states, as well as Canada and Mexico. Currently, Biobot’s National Monitoring Network reports data from approximately 200 communities in more than 20 US states. 

Through a partnership with the World Bank, Biobot has also worked on capacity building for wastewater monitoring for COVID-19 in Ecuador and Uruguay. 

US CDC – Stepping up COVID Wastewater Surveillance

CDC, however is now stepping into the scene with it own COVID wastewater surveillance program, which aims to provide a systematic, national network of pathogen-hunting sites, as well as guidance to communities about how to undertake sampling, said Brian Katzowitz, a health communications specialist from the CDC’s Division of Foodborne, Waterborne and Environmental Diseases.

“CDC just began funding a commercial wastewater testing contract which will provide twice weekly SARS-CoV-2 wastewater testing to 500 sites nationwide,” Katzowitz told Health Policy Watch. “With the emergence of Omicron, we were able to include Omicron tracking specifically into the contract. In addition, we are updating our data system to be able to receive, analyze and report Omicron-specific data to health department partners.”

He cautions, however, that “variant detection with wastewater is a little bit tricky” and as a result, “variant tracking data has to be interpreted carefully” – using sophisticated modeling techniques

“Sequencing samples from wastewater cannot confirm the presence of a specific variant because SARS-CoV-2 RNA decays quickly in wastewater,” he explains.  “Instead, variant-specific wastewater sampling looks for specific mutations, and the methods used cannot detect if all of the variant-defining mutations are present on a single genome.”

South Africa, Latin America, Canada and others joining the wastewater Omicron search

Multiple other countries are also using sewage surveillance to help crack Omicron- as evidenced by the proliferation of new projects on the COVID19WBEC.org dashboard.  

Researchers in South Africa, where virus hunters in Tshwane (Pretoria), were able to detect how the Omicron wave there, where it was first identified, was reaching a peak equal to that of the earlier Delta variant in late November – only days after the variant had first been announced and named by WHO.

Similar programmes have been reported by public health departments in Australia, Canada – and beyond.  

In Ottawa, Canada, wastewater collected by the Robert O. Pickard Environmental Center is being measured for coronavirus genetic material.

 “In essence, we are conducting a very broad COVID-19 survey to which we all contribute including those who are not getting tested themselves and those who may not even know they are infected,” Ottawa Public Health’s website explained. It added that wastewater is collected and transported to a laboratory five days per week where viral RNA levels are immediately tested, and results reported the next morning.

“It is very exciting that we can do these things to improve public health,” Goldfarb said. 

Image Credits: Kando , Biobot .

COVID patient in hospital
COVID patient in hospital

Two new treatments for COVID-19 were recommended on Thursday by the World Health Organization’s Guideline Development Group of international experts – one for severely ill patients and the other for those patients who are not severely ill but most likely to develop severe disease.

The recommendations were announced Friday morning in the BMJ. Both drugs, however, are patented and could be expensive and lack accessibility for some low- and middle-income countries, some advocates warned.

The first drug, baricitinib – a type of drug known as a Janus kinase (JAK) inhibitor – was “strongly recommended” for patients in severe or even critical condition from COVID-19. The drug has been used to treat rheumatoid arthritis and it is recommended that four milligrams be given once daily for 14 days in addition to previously-recommended corticosteroids.

“The strong recommendation is based on evidence that it reduces mortality, shortens hospital stays and reduces the risk of requiring mechanical ventilation, with no observed increase in adverse effects,” explained François Lamontagne, Professor of Medicine at the Université de Sherbrooke, who sits on the panel, in an interview with Health Policy Watch.

He explained that JAK inhibitors modulate the body’s response to an infection.

The WHO experts noted that two other JAK inhibitors – ruxolitinib and tofacitinib – should not be used to treat patients with severe disease because “low certainty evidence from small trials failed to show benefit and suggests a possible increase in serious side effects with tofacitinib.”

COVID-19 treatments and vaccines
COVID-19 treatments and vaccines

‘Uncertain’ effectiveness against Omicron

The second treatment that the panel recommended is a monoclonal antibody called sotrovimab, which is meant for patients with non-severe COVID-19 but who are at risk for developing severe disease.

Sotrovimab, Lamontagne said, 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.

The recommendations are based on evidence from four trials (three for baricitinib and one for sotrovimab) involving several thousand people, Lamontagne said. WHO noted that “the panel considered a combination of evidence assessing relative benefits and harms, values and preferences and feasibility issues.”

Baricitinib and sotrovimab join a concise list of drugs recommended by WHO experts, including the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19, and conditional recommendations for the use of casirivimab-imdevimab in selected patients. WHO has recommended against the use of convalescent plasma, ivermectin and hydroxychloroquine.

No formal recommendation yet from WHO on new oral drugs – Paxlovid and monulpiravir

Significantly, WHO has not yet made a formal recommendation on the two new oral drug treatments that have now come on the market – Pfizer’s Paxlovid or Merck’s Molnupiravir. This is despite the fact that both drugs have been approved by the US Food and Drug Administration, and the Medicines Patent Pool has also contracted with Pfizer and Merck to produce generic versions of each drug for low-income countries.  Countries around the world are rushing to secure doses of Paxlovid, in particular, due to its high efficacy and safety profile in the FDA reviews – where it has been reported to be 90% effective in preventing severe disease when administered early in the course of infection.

Asked why the Organization had not yet made a recommendation on either drug, a WHO spokesperson pointed to a WHO Guidelines Development Group meeting that is scheduled to review Paxlovid [nirmatrelvir] on 9 February.

“Based on an assessment of the totality of the evidence, WHO will make a recommendation,” the spokesperson said, saying that safety monitoring, affordability and access all need to be considered in any WHO recommendation on either drug.

The WHO spokesperson, also stressed that “even if proven safe and effective, these drugs will not be an alternatives to vaccines.”

The spokeperson also stressed that any new oral drugs also “should be made available and affordable in all countries”.

Access advocates have complained that the current generic production arrangements for Paxlovid, aimed at 95 low-income countries, still leaves many gaps in affordability and access among lower-middle and middle-income countries which cannot afford the high prices of patented versions.

‘Baricitinib example of why TRIPS Waiver urgently needed’

Similarly, the cost and availability of both of the newly WHO-recommeded drugs could still also be barriers to their use in low- and middle-income countries, Lamontagne said.

“These additional therapies are newer, not produced on the same scale [and some other drugs], not as available and are more costly,” Lamontagne said. “The panel that makes those favorable recommendations is aware of this and is aware there is a risk that these interventions won’t be available similarly everywhere and that this could worsen the differences in access to healthcare.

“But at same time, in making those recommendations and stating that those are potentially life-saving and important therapies, the panel hopes to stress how important it is to strive to improve the accessibility of these emerging therapies across the board – in lower income areas just like in higher income areas,” he continued.

Médecins Sans Frontières/Doctors Without Borders (MSF) reacted to the recommendations by calling on governments to “take immediate steps to ensure that patent monopolies do not stand in the way of access to this treatment.”

The organization said that in many countries, generic baricitinib will not be available as the drug is under patent monopoly, including in some countries hit hard by the pandemic, such as Brazil, Russia, South Africa and Indonesia. In most cases, the patents do not expire until 2029.

“Baricitinib is another example of why the TRIPS Waiver is urgently needed,” MSF said in a statement.

“As new treatments emerge, it will be simply inhumane if they remain unavailable in resource-limited settings, just because they are patented and too expensive,” stressed Dr.  Márcio da Fonseca, an infectious disease medical advisor who spoke on behalf of MSF. “With these proven therapeutics recommended by the WHO, it’s time now for low- and middle-income countries to finally access these therapies that are already in routine use in many high-income countries.”

Image Credits: Wikimedia Commons, Bicanski on Pixnio.

Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response, WHO Regional Office for Africa

COVID-19 vaccination in Africa may be shifting from a supply challenge – to one of effective vaccine distribution, declared  a senior World Health Organization official in the African Region on Thursday. 

African countries will have adequate access to COVID-19 vaccine supplies in 2022, said Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response, WHO Regional Office for Africa. 

However, significant challenges remain in ensuring that available doses are administered efficiently, and vaccine hesitation is overcome, Gueye stressed. 

“We can tell you that in 2022 in Africa, the countries that express the need to receive vaccines will receive it, and they will receive enough vaccines,” he said at a press briefing hosted by the Africa Regional Office, based in Brazzaville. 

https://twitter.com/i/broadcasts/1kvJpAlZmZZxE

 

“The problem will be though what we are doing regarding operationalizing those vaccines in the countries. From taking them from the capital cities to where they are needed including at the sub-regional level,” Gueye told Health Policy Watch.

In Geneva, however, WHO’s Director General, Dr Tedros Adhanom Ghebreyesus sounded a somewhat different note.  He warned a meeting of WHO’s emergency committee that so far some 1 billion Africans, 85% of the continent’s population, have yet to receive a single vaccine dose, and  “ending the inequitable distribution of vaccines, therapeutics and diagnostics remains the key to ending the pandemic.” 

Need for the right mix of strategies to promote vaccine uptake 

A vaccination site in South Africa, co-sponsored by USAID.  Vaccines are now more available to African countries – the challenge now is for efficient distribution and uptake.

According to Gueye, however, there are now many vaccines within the delivery pipeline for Africa – and countries are now being offered more from various suppliers every day. 

So finding the right strategy in order to provide vaccines to all the people who are demanding vaccines is now a higher priority for the continent considering several studies showed largely wide acceptance of the vaccines among Africans.

“In a World Bank-sponsored study, more than 80% of African participants demanded and accepted the vaccines when they were offered the vaccination. There is a positive side if the governments are working toward a good operationalization of  vaccination,” he added.

Treatment also is now a priority

Gueye stressed that treatment options now need to be reinforced, as well, in the African context. 

“COVID is the first pandemic in our lifetime of this level and it has so much impact but it is not the only pandemic that existed and testing, treating were pivotal resources used to fight those diseases (HIV). I do believe also that in the third year of COVID-19, testing, caring for patients and treating them will be an important pillar to develop in all countries,” he said.. 

“It will not be only for cases that are severe or critical, it will be for almost all the cases where something may be done. If the treatment is done appropriately and on time, it might limit the infection of other patients. This is why testing, caring and treating are the priorities for WHO and we are working with countries already in order to do the best to scale it up.

Race for Paxlovid

Africa CDC Director Dr John Nkengasong

At an earlier briefing Thursday by the Africa CDC, the Director John Nkengasong, told journalists that talks with Pfizer are underway to assure African countries access to the company’s new Paxlovid treatment.

“We are in really close discussions with Pfizer to see what can be done to make the drugs available on the continent and accessible on the continent, that is, the Paxlovid drugs,” said Nkengasong.

In clinical trials, the treatment has demonstrated a 90% success rate in prevention of severe disease if taken at early stages of infection. 

Already approved by the US FDA and the United Kingdom’s Medicines and Healthcare products Regulatory Agency, the global race for the pills is already underway.

The United States government alone has signed an agreement for 10 million courses of the drug at $530 per course.  

And according to other reports, a handful of rich countries have already secured most of Pfizer’s own supply of the new drug. 

This means that low-income countries will need to rely up generic versions that are to be produced royalty-free, under the terms of a recent licensing agreement between Pfizer and the Medicines Patent Pool – with the first such license with Bangladesh struck just this week. 

https://twitter.com/RebeccaDRobbins/status/1480633419528687617

However, Pfizer’s new agreement with MPP coveres only 95 of the lowest income countries. It thus leaves many lower-middle and middle-income countries out in the cold –  and potentially unable to secure either the discounted generics or the higher-priced Pfizer versions of the pill. 

Is the shift to a focus on treatment – also a reflection of the failure of vaccination campaigns? 

Dr Anita Graham, internist, University of Witwatersrand, South Africa

Meanwhile, Dr Anita Graham, an internist at the University of Witwatersrand in South Africa noted that the decision to commence conversations in Africa around treatment implies failure to protect Africans against severe infection, in addition to dealing with a predominantly unvaccinated population.

“So once we have failed and we are dealing with a population who now has severe disease, we need to think about pharmaceutical management and there definitely are agents like the new Pfizer drug that has a therapeutic advantage — decreases the chance of death or ICU admissions and these drugs have been shown with early evidence to work. H

Hwever, they come with contingencies, and this is mostly cost and availability,” Graham told Health Policy Watch.

“So I don’t think that is an isolated solution, although I do think it is part of the plan, and part of the way forward in treating severe COVID,” Graham said.

Omicron hospitalization in South Africa – unvaccinated cases seem to predominate

With Omicron now accounting for up to 95% of new cases in South Africa, Graham provided said that most of the patients that she has admitted and treated for COVID-19 were largely unvaccinated – or in some cases vaccinated over a year ago. 

“Anecdotally, I can say that I have not had a single patient that is fully vaccinated, hospitalized,” she said, adding, “The patients that were hospitalized are those who are unvaccinated, partially vaccinated, patients who have been vaccinated more than a year ago whose immunity might have waned, and patients who have severe comorbidities,” she said.

For patients with comorbidities, Graham noted that those with comorbidities that are fully vaccinated but are hospitalized are often hospitalized for non-COVID-related disease.

“For instance, they are admitted for cancer and they coincidentally swabbed positive for Omicron,” she said.

Graham also noted that while all answers are not yet available, what is increasingly becoming important is the duration of the first infection to ascertain whether a previously infected individual would have some protection against new infections.

“With time, there is natural waning of immunity and with time there will be no leftover residual antibodies to fight a new variant. However, with a seroprevalence of more than 70% in some parts of Cape Town in South Africa, this high seroprevalence may be contributing to why we are having a less severe fourth wave. But my belief is that it is multifactorial — natural seroprevalence together with vaccination and the Omicron variant possibly being less virulent,” she added.

COVID Infections rising in North & West Africa; waning in South; high test positivity rates reflect under-reporting 

While COVID cases in southern Africa have now plateaued or are declining, those in West Africa and North Africa are now rising at worrisome rates – and overall deaths rose by 64% in the first week of January, the Orgaization said. 

“South Africa, where Omicron was first reported, saw a 9% fall in weekly infections. East and Central Africa regions also experienced a drop. However, North and West Africa are witnessing a rise in cases, with North Africa reporting a 121% increase this past week compared with the previous one,” WHO’s Gueye stated.

Nkengasong also revealed that the case fatality rate (CFR) of COVID-19 in Africa is 2.3% which is higher than the global average of 1.8%. Africa also accounts for 4.3% of deaths reported globally – disproportionate to the number of overall cases reported. 

Regarding testing, Africa has conducted over 91 million COVID tests with a cumulative positivity rate of 11.1%.  That high positivity rate also suggests high levels of under-reporting of overall infections, experts say. 

60% of African-acquired doses have been distributed while expired dose donations from rich countries also remain an issue 

Some 241 million unused COVID-19 vaccine doses purchased by the G7 and EU will expire by March, 2022 – Airfinity.

As of now, Africa CDC reports that a total of 563 million COVID-19 vaccine doses have been procured by 54 Member States out of which 340 million doses have been administered (60.4% of Africa’s total supply). So far only 10.1% of the African population has been fully vaccinated.

On Thursday, the global health analytics firm Airfinity estimated that 241 million COVID-19 vaccine doses purchased by the G7 and EU will go unused and will expire by March 2022. Airfinity said its forecast is based on analysis of G7 and EU vaccine supply while accounting for doses administered, boosters for everyone over 12 years-old, vaccine hesitancy and donations.

Rasmus Bech Hansen, Airfinity’s co-founder and CEO said the numbers illustrate, once more, how vaccinating the world is now largely a distribution problem, rather than a supply issue. 

“Even after successful booster rollouts, there are surplus doses available that risk going to waste if not shared very soon. The emergence of Omicron and the likelihood of future variants shows there is no time to waste,” Hansen said in a press release.

In a separate interview, Seth Berkley, the CEO of Gavi, the Vaccine Alliance and a leader of the WHO co-sponsored COVAX global vaccine facility, also underlined the distribution challenges faced. He said that by July 2022, it is possible for the world to produce vaccine doses sufficient to immunize 70% of the global population, as per WHO’s global target for 2022.

He added that there are “between 20 and 25 coutries that have been problematic on absorption. And those are getting special attention.”  

“In terms of the number of doses that will exist in the world, it is possible in terms of what we have visibility on. But at the end of the day, we don’t know what’s going to happen with Omicron, boosters, new variants, manufacturing problems, etc.,” he told Politico.  “The critical issue is what does each country want? At the end, we will serve what the countries want…”

Image Credits: Paul Adepoju, USAID, Airfinity .

At a WHO press briefing, the organization’s Director General described the grim status of the health and humanitarian crisis in Ethiopia’s conflict-torn Tigray region.

The leadership of the World Health Organization (WHO) has slammed Ethiopia’s “complete blockade” on health and humanitarian aid to Ethiopia’s Tigray region, saying it has been unable to deliver life-saving medications for nearly six months – in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. 

“Humanitarian access even in conflict is the basics. Even in Syria, we had access, even during the worst of conflicts in Syria. In Yemen, we have the same access. We delivered medicines. Here [however], it’s a complete blockade especially since mid-July. Nothing. This is six months without medical support, without food without all the rest of the things I have said. It’s been impossible,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus who hails from the Tigrayan region himself.

The region  is at the heart of the ongoing civil war that began on 3 November 2020, displacing hundreds of thousands of people. Despite recent Ethiopian government signals that it might now consider peace talks with Tigrayan rebel forces, WHO’s attempts to deliver health and humanitarian relief to the war-torn region continue to be denied for nearly six months now, said Tedros and WHO’s Executive Director of Health Emergencies, Mike Ryan at a Wednesday press briefing.  

‘Insult to humanity’

Mike Ryan, WHO Executive Director of Health Emergencies

Ryan noted that the government of Ethiopia has refused the global health body access to the Tigray region to deliver basic insulin, other oral antidiabetic drugs, and drugs for other diseases since last summer. He said that the region is quickly running out of essential health care commodities, including IV fluids.

“Our access has not improved and quite frankly, it’s very upsetting. In fact the situation is getting worse” Ryan said. “They’re running out of IV fluids for managing diabetic ketoacidosis. The doctors and nurses can’t even manage the more severe complications of a disease like diabetes which has catastrophic, immediate health consequences for people. The politics of it are beyond me. 

“Whatever the cause of that situation, those who have no access to the very basic life-saving interventions that we in the West, that we’re sitting here in Geneva, would expect immediately, instantly,” Ryan added.

“This is an insult to humanity to allow a situation like this to continue. To allow no (zero) access. Access is the lifeblood, the starting point for humanitarian intervention and we simply do not have that access. Access for our staff access to the field, getting basic medical supplies in there.” 

He called on all parties involved in the situation in the region to  find a solution to allow humanitarian and healthcare workers, including doctors and nurses, to do their jobs which he said is to treat patients and save lives.

WHO DG: Tigray under “complete blockade” since mid-July – barring humanitarian relief 

A family from Samre, in south-western Tigray, walked for two days to reach a camp for displaced people in Mekelle.

Confirming the impasse, Tedros added that the situation in the region is getting more complicated and deteriorating – despite recent talk about peace overtures between the government and rebel troops. 

The region with a population of seven million people – about equal to that of Norway and Estonia combined – has been under a humanitarian blockade for more than a year – which has only worsened in past months with the denial of health emergency relief too, he said. 

“Imagine a complete blockade of seven million people for more than a year and there is no food, no medication, no medicine, no electricity and no telecommunication. No media, nobody can report and when there is no telephone, I think accessing families is difficult. No cash, no bank service. Imagine the impact of all of these. 

“Lack of medicine has a direct impact and people are dying, but lack of food also kills,” the Director General said. 

Apart from the Tigray region, other areas of Ethiopia also are being impacted by the crisis, including the Amhara Region and Afar regions. However, while WHO has been granted access to the other regions – it has not been allowed to bring supplies or support to Tigray.

“Since July, no medication was allowed from WHO, none whatsoever. We have approached the prime minister’s office, we have approached the Foreign Ministry. 

“We have approached all relevant sectors, but no permission. So there is a blatant measure which has been taken that is blockade and siege against more than 7 million people,” the DG added.

A few weeks ago, the Ethiopian government did finally allow UNICEF to provide measles vaccines to the Tigray region.

But the WHO DG noted that the measles vaccine alone cannot significantly improve the overall health and humanitarian crisis. He described that as “unprecedented” considering that the global health body was granted access during previous worse wars.

“Humanitarian access even in conflict is the basics. Even in Syria, we had access, even during the worst of conflicts in Syria. In Yemen, we have the same access. We delivered medicines. Here [however], it’s a complete blockade especially since mid-July. Nothing. This is six months without medical support, without food without all the rest of the things I have said. It’s been impossible,” he added.

Meanwhile, African Centers for Disease Control officials have also been unable to access the region for nearly a year now, Africa CDC Director, Dr John Nkengasong, said in a separate briefing on Thursday.

A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer – since then a blockade on all health supplies has devastated the region even more.

State of the War

In December the Geneva-based Human Rights Council agreed to set up an international probe on the Tigrayan conflict, after the Deputy High Commissioner for Human Rights Nada Al-Nashif said that an estimated 400,000 people in Tigray were living in famine-like conditions.

Official accounts traced the commencement of the war to minutes before the clock chimed at midnight on 3 November 2020. Tigray Special Forces and allied local militia attacked the Ethiopian National Defense Force (ENDF) Northern Command headquarters in Mekelle, the Fifth Battalion barracks in Dansha, and other Northern Command bases. Several people were killed and the Tigray People’s Liberation Front (TPLF) claimed the attack was carried out in self-defense or preemptive self-defense.

According to Human Rights Watch, all sides in the war have committed war crimes during the conflict with the war creating a deepening humanitarian crisis. More than 10,000 people have died since war began, and rape has reportedly been used as a weapon.

In December Ethiopian government officials sent out an olive branch, saying they would pause at their current positions.  And just last week, the Ethiopian government announced it was exploring political dialogue to end the war, starting with the release of some opposition leaders.

“The key to lasting peace is dialogue,” the Ethiopian government stated.

Image Credits: UNICEF/Christine Nesbitt, Paul Adepoju, UNOCHA/Saviano Abreu.

A child with disability plays oin Brazil.People with disabilities have been some of the biggest silent sufferers in the COVID-19 pandemic, according to speakers at the Pre-Summit of the Global Disability Summit 2022 on Wednesday.

“Now, more than ever, if we want to be ready for a new pandemic, we need to ensure that disability inclusion in the health sector becomes a reality,” said Yannis Vardakastanis, President of the International Disability Alliance. “Nothing about us, without us.”

This pre-summit was co-hosted by the governments of Norway and Ghana and the International Disability Alliance, in collaboration with the World Health Organization (WHO) ahead of the summit on 16-17 February, which is expected to see participants commit to the inclusion of disabilities in the health sector. 

“In many low and middle-income countries, persons with disabilities are among the most marginalized people in the world. They are also often the last to gain access to health care,” the Prime Minister of Norway Jonas Gahr Støre said.

He added that while poverty and disabilities are mutually reinforcing, the pandemic has only compounded the situation more for the marginalised communities. “We must take steps to safeguard the health and well being of persons with disabilities including mental health.” 

Over a billion people suffer from disabilities 

WHO Director-General Dr Tedros Adhanom Ghebreyesus highlighted at the pre-summit that the way individuals with disabilities suffered during the pandemic was “unacceptable”, particularly considering that over a billion people in the world have some form of disability.

“Recognizing what needs to be done is only the first step; the second step is committing to building a disability-inclusive health sector,” he said. He added that such inclusion makes it easier for people with disabilities to access the health services they need and work with other sectors to foster greater inclusion in society more broadly.

The conversation at this pre-summit was more around making the health sector more inclusive. This is in tandem with the adoption of a landmark World Health Assembly resolution on achieving the highest attainable standard on health for persons with disabilities in January 2021. The resolution called on countries and health sector partners to move away from an exclusively medical approach to disability towards adopting a comprehensive people-centred and human rights-based approach.

Females  With Disabilities Are More Affected 

According to Dr Natalia Kanem, Executive Director of the United Nations Population Fund, nearly one-fifth of women have disabilities, and these women are up to 10-times more likely to experience gender-based violence.

Kanem said that for women and girls with disabilities, the right to health is not just about being able to obtain health services without judgment or discrimination also about the right to make their own decisions about their own bodies and sexuality, free from coercion or violence. 

Healthcare Inclusion is a privilege for many 

People with disabilities and rehabilitation need more attention and have different needs but the country’s healthcare system and its recognition of these needs matters.

“Rehabilitation often does not have high priority within the health systems,” said Dr Tom Shakespeare, Professor of Disability Research at the London School of Hygiene and Tropical Medicine.

He believes this is because it is seen as “less attractive” by funders due to the nature of rehabilitation being enabling a better life rather than curing. 

He said that his condition of dwarfism was recognised in the UK and it enabled him to get free vaccination and booster shots for COVID-19, but those with intellectual disabilities may have lost out on this and perished.

“Globally, many people both with my condition, and many, many others don’t have access to needed health care or rehabilitation. And that violates article 25 of the Convention on the Rights of Persons with Disabilities,” said Shakespeare.

Israel has tried to make its hospitals more inclusive during the pandemic which is in accordance with legal obligations in the country to make medical services accessible at all levels, said Nitzan Horowitz, Israel’s Minister of Health.

He added that information was presented in sign language, transparent masks were worn at hospitals so that people with hearing difficulties were able to understand and communicate with their physicians. 

However, that is not the case in many countries which do not prioritise or include disabilities in all aspects. Individuals with disabilities need to be included at the table while policies are being designed.

“If a health system is not inclusive and accessible for people with disabilities prior to a crisis, it’s not likely to be enough when a crisis hits,” said Robert Mardini, Director-General, International Committee of the Red Cross.  

Image Credits: clipper round the world .