An African farmer collects leaves from her vines for a tasty meal. Worldwide, the fresh produce of smallholder farmers remains important to food security and nutritional diversity.

On Universal Health Coverage Day – an appeal to food and health advocates to shape an agenda for ‘Universal Nutrition Coverage’ including joined-up solutions that promote sustainable agro-ecosystems producing healthier foods for people with co-benefits for the planet.

Every year on December 12, the health community marks Universal Health Coverage (UHC) Day. While the technical definition of UHC focuses on health services (‘UHC means that all individuals and communities receive the quality health services they need without suffering financial hardship’), the concept has come to represent more than this. UHC is about equity, the progressive realisation of ‘health for all’, and leaving no one behind.

Nutrition is one of the fundamental determinants of health. Yet globally, the impacts of poverty and other socio-economic determinants of health on the increased prevalence of malnutrition mean that we are off track to meet five out of six maternal, infant and young children nutrition targets and all diet-related non-communicable disease (NCD) targets. Unhealthy diets, combined with sedentary lifestyles, are the leading risk factor for disability and death from NCDs worldwide. It is estimated that about 3 million people worldwide cannot afford a healthy diet.

Industrialized food systems – failing to deliver health

Industrialized foods – failing to deliver health.

Many point to the industrialized food system as the cause. Mounting evidence shows that it is failing to deliver health; a situation inextricably linked to and exacerbated by the COVID-19 pandemic, in which food insecurity has risen and people living with obesity have been especially at risk. Food systems transformation is urgently needed to achieve universal health and good nutrition for all.

The food we eat and how it is produced, packaged, shipped, consumed, and wasted also has a deep impact on animal and ecological health. Food production contributes to more than a third of all greenhouse emissions and is one of the main drivers of catastrophic biodiversity loss today.

Similarly, last week a new study by the UN Food and Agriculture Organization confirmed that soils are one of the main receptors of agricultural plastics — containing larger quantities of microplastics than oceans. At COP26, food systems transformation, and the need for healthy and sustainable diets, was an important theme discussed in many side events, building on efforts begun at the UN Food Systems Summit.

Agriculture Plastic Residues Are Poisoning Soils, Food Systems & Threatening Human Health, Says FAO 

Also last week, the Tokyo Nutrition for Growth Summit (N4G), which concluded on 8 December, put the spotlight on global nutrition goals, aiming to renew and generate new actionable commitments for attaining nutrition-related Sustainable Development Goals and WHO targets, aligned with national priorities. Top of the agenda at N4G was the theme ‘Integrating nutrition into universal health coverage (UHC)’.

UHC  criticised for too much focus on curative health services – nowhere is this clearer than in the case of nutrition

Many consumers globally rely on traditional markets for affordable, accessible, and nutrient-dense foods- but these markets are often poorly positioned to compete with a new world of supermarkets and industrialized foods.

Alongside global health security, UHC is a dominant paradigm in global health. It has, however, been criticised for its focus on individual-based, curative health services, as opposed to population-based, preventative public health approaches.

Nowhere is this clearer than when looking at nutrition. We need stronger health systems to provide services to treat malnutrition in all its forms; but we also need deeper collaboration between food and health sectors so that together we can think more holistically about our shared roles in a whole-of-society approach to improve nutrition outcomes and address the root causes of poor nutrition in ways that co-benefit the planet too.

This UHC day is an opportunity to catalyze further action and progress made in 2021 and imagine what Universal nutrition coverage would look like. To us this means a world where all people receive the nutrition they need without suffering financial hardship, in ways that follows the “one health” approach, and that calls for ensuring equitable benefits to human, animal, and ecological health.

At COP26, we witnessed a huge and timely effort by the health sector to make sure health is at the heart of national climate policies: more than 460 health organisations, representing more than 46 million health workers, in over 100 countries have signed the ‘Healthy Climate Prescription’ letter which calls for stronger action on climate change to protect people’s health.

Interconnected food-health pathways: unhealthy diets & food insecurity; food safety, zoonotic pathogens and environmental contamination; and occupational hazards

Unhealthy, unregulated food is one risk factor for NCDs as well as food-borne illnesses.  Unsafe and poorly regulated food systems can also provide pathways for the emergence of new zoonotic pathogens as well as anti-microbial resistance.

A new narrative by WHO “Food Systems Delivering Better Health” also describes five interconnected and interrelated pathways between food and health: unhealthy diets and food insecurity; zoonotic pathogens and antimicrobial resistance; unsafe and adulterated foods; environmental contamination; and, degradation and occupational hazards.

Yet, there’s still much to do: the links between climate, health and food systems – for example as described in the 2019 Lancet Commission Report, The Global Syndemic of obesity, undernutrition and climate change – are still not being fully capitalised on at the UN Food Systems Summit, COP26, or at the recent N4G in Tokyo.

Governments and the private sector have critical roles to play in improving nutrition and creating the enabling environments for equitable access to healthy and sustainable diets, and health sector professionals are also critical agents of change and influence. Youth, such as medical students and future healthcare professionals, are already advocating for the inclusion of food systems in the public health field.

They are empowering themselves with the required knowledge, skills and competencies, and they are using innovative approaches such as online courses, workshops, small working groups, and simulations to widen the horizon on the interlinkages between food, nutrition, and health. They are engaging their communities through webinars and campaigning based on research and policy analysis.

As we look ahead to 2022, with the annual World Health Assembly in May and COP27 later in Egypt, we must all work together, reaching across geographies, economic sectors and professional silos.  We need to mobilize around the levers of change to which we have access to in order to ensure that healthy, sustainable diets are a reality for all – as we strive towards universal health and universal nutrition. \

We invite all those working in the health sector to consider universal nutrition coverage, and what they can do to ‘leave no one’s nutrition behind’. Youth leaders, in particular, have an opportunity to lead the way forward.

Malnutrition is not an unknown virus, it is a ‘known known’, which we can and must tackle through radical and hopeful food systems transformation.

______________________________

Ruth Richardson is the Executive Director, Global Alliance for the Future of Food, a strategic alliance of philanthropic foundations working together to transform global food systems. In 2020, she was appointed Chair of the UN Food Systems Summit Champions Network.  @RuthOpenBlue / @futureoffoodorg

Mohamed Eissa is a 6th-year medical student from Alexandria, Egypt, and the Liaison Officer for Public Health Issues of the International Federation of Medical Students’ Associations.

 

Image Credits: The Future of Food , Ashley Green / Unsplash, Michael Casmir/Pierce Mill Media, Sven Petersen/Flickr.

plastic

Agricultural plastics pose large and growing threat to soils, food safety and human health – and need to be better managed as well as replaced with more sustainable alternatives, as well as more recycling and reuse of plastics consumed. 

These are the findings of a new report by the UN Food and Agriculture Organization, “Assessment of agricultural plastics and their sustainability: A call for action”, released this week.  

The agriculture sector used a massive 12.5 million tonnes of plastic in plant and animal production and 37.3 million tonnes in food packaging in 2019, according to the report.

But only a small fraction of those plastics are collected and recycled – with potentially toxic microplastics absorbed in soils, accumulating in food chains, and eventually consumed by animals and people.

“This report serves as a loud call to coordinated and decisive action to facilitate good management practices, and curb the disastrous use of plastics across agricultural sectors,” writes FAO Deputy Director-General Maria Helena Semedo, in the report, which is perhas the most high-profile call to action on the issue to date.

“Soils are one of the main receptors of agricultural plastics and are known to contain larger quantities of microplastics than oceans,” she also said in a Foreword to the report. “Microplastics can accumulate in food chains, threatening food security, food safety and potentially human health…..As the demand for agricutlturel plastics contiunues to grow, there is an urgent need to better monitor the quantities of plastic producs used and that leak into the enviornment from agriculture.

In terms of human health, plastics are increasingly ingested by fish, livestock and wildlife – and then consumed by people. That is leading to a gradual increase in the concentrations of microplastic particles, as well as associated toxins and pathogens, in human populations in many parts of the world – which may then increase peoples’ risks to cancers, reproductive and endocrine disorders and a wide range of other chronic diseases.

Torn single-use plastics abandoned, and buried into fields worldwide are leading to the accumulation of microplastics in soils

Growing demand

Today, however, demand for single use agro- plastics is soaring – and there is little awareness of risks or monitoring of actual impacts on soils, animals or people.

The agricultural plastics industry forecasts, for instance, that growing global demand will lead to a 50% increase in the use of plastics simply for greenhouses, mulching, and silage films by 2030 – from 6.1 million tonnes in 2018 to 9.5 million tonnes. 

Crop production and livestock sectors are the largest plastics users, accounting for 10 million tonnes per year collectively. This is followed by fisheries and aquaculture with 2.1 million tonnes, and forestry with 0.2 million tonnes. 

Plastics in surface soil reduce crop yields

Ease of manufacture, physical properties and affordability make plastics the material of choice for many agricultural products. 

And yet while their use is largely intended to increase short-term fruit and vegetable yields, e.g. by protecting plants from extreme heat or cold, over time, the opposite has been found to be true.

The accumulation in surface soils of mulching film plastics  – a major category of agricultural plastic by mass – is linked to reduced yield.  

The report proposes a number of alternatives and interventions to reduce plastic use – and prolong the life cycle of plastics that are used, including:

  • eliminating use of the most toxic plastic products altogether
  • substituting plastic products with natural or biodegradable alternatives;
  • promoting reusable plastic productss. 

These recommendations are based on the 6R model – Refuse, Redesign, Reduce, Reuse, Recycle, and Recover.

Absence of international policies on agro-plastics use

Currently, no international policy addresses all aspects of plastic use in agricultural food chains. 

At the international level, the report recommends a two-pronged approach: 

  1. Developing a comprehensive voluntary code of conduct to cover all aspects of plastics throughout agri-food value chains.
  2. Mainstreaming specific aspects of the life cycle of agricultural plastics in existing international conventions, where appropriate. 

Semedo notes that the FAO will continue to play an integral role in the issue of agricultural plastics.

“Tackling agricultural plastic pollution is paramount to achieving more efficient, inclusive, resilient, and sustainable agri-food systems for better production, better nutrition, and a better life, leaving no one behind.” 

See also the 2019 report on Plastics and Health, by the Center for International Environmental Law, in association with a coalition of non-profit groups.

Report Details Health Crisis Hidden In Plastics Lifecycle

 

 

Image Credits: @Antoine Giret/ Unsplash, FAO – Assessment of Agricultural Plastics and their Sustainability – A Call to Action , FAO – Assessment of Agricultural Plastics and their Sustainability – A Call to Action.

South Africa has increased its vaccination drive in the face of Omicron

The virus reproduction number of the Omicron variant in Gauteng province – the epicentre of South Africa’s pandemic – is 3 – meaning that one infected person will infect three others on average.  That is the highest seen so far in the country’s COVID-19 pandemic history – and testimony to the highly infectious nature of the new SARS-CoV2 variant.

South Africa’s health minister, Dr Joe Phaahla, described this reproductive number as “something we have never seen” at a Friday media briefing.

During the country’s Delta-driven third wave, the number remained below 2. However, in some other countries, Delta’s reproduction number breached five, according to a Lancet study.

South Africa Reproductive Number Dec 2021 (National Institute of Communicable Diseases, South Africa)

Less severe so far – but early days

South African health minister, Dr Joe Phaahla

On the more positive side, Phaahla said that early data from the department’s national hospital surveillance showed that hospitalised COVID-19 patients had shorter stays, and fewer had severe disease, as compared to patients admitted in a similar time frame in the second and third waves. 

Moreover, some 70% of those hospitalised for COVID-19 were not vaccinated, he added.

He defined severity as any patient who developed acute respiratory distress syndrome, received oxygen, ventilation, was treated in high care or ICU or died.

However, he cautioned that severity data “has several limitations at the early phase of the wave when numbers are small”.

“Patients with mild symptoms are more likely to be admitted as a precaution, patients are diagnosed with COVID-19 incidentally when admitted for other reasons, and because there has not been sufficient follow-up time for severity and outcomes to have accumulated, which is typically up to 3 weeks after diagnosis,” explained Phaahla. 

While there had been an initial increase in hospital admissions for children under five (21% of all admissions), this had decreased to 8%. 

Many of the children had been admitted for other reasons and tested positive “incidentally”, stayed in hospital for less than five days and did not show features of severe disease, the Minister added.

Hospital at epicentre

Tshwane Omicron cases

Dr Mathabo Mathubela, head of the biggest hospital at the epicentre of South Africa’s Omicron infection, reported that her COVID-19 patients were displaying less severe symptoms than previous waves.

Of the 42 COVID-19 patients in her hospital on 2 December, nine needed oxygen, three were in high care and two in ICU. However, for 33 of the patients, COVID-19 was “coincidental” to their admission, said Mathubela, CEO of Steve Biko Academic Hospital in the Tshwane area of Gauteng.

Only six patients were vaccinated, with 24 unvaccinated and the status of eight unknown, she added.

WHO warns it’s too early to draw conclusions on severity

South African statisticians also are beginning to observe a reduced rate of hospital admissions in comparison to the total number of new Omicron infections, suggesting that vaccines and previous infections are providing some protection.

In a briefing on Thursday, however, the World Health Organization has warned that it is still too early to draw conclusions from the South African data on the severity of the new variant.

WHO Lead on COVID-19, Dr Maria Van Kerkhove, said that the South African population was young and had a high level of exposure to COVID-19 from previous outbreaks, which might lessen Omicron’s impact.

WHO Chief Scientist Dr Soumya Swaninathan also warned that it is too early to come to any conclusions about the efficacy of vaccines against Omicron as the only available studies showed a “wide variation” and samples were small.

In addition, a small South African study released late Tuesday suggested that people double-vaccinated with the Pfizer-BioNTech COVID-19 vaccine had significantly reduced protection against the Omicron variant, now reported in 57 countries.

On Wednesday morning, however, Pfizer reported that a third booster of its vaccine would provide significant protection against Omicron, according to a laboratory study.

Meanwhile, South Africa’s health minister said on Friday that while restrictions had been effective in the past in stemming the rise in COVID cases, these “have had severe economic consequences, thus a careful assessment of risks is needed”. 

The South African government is still considering mandatory vaccination, which has the support of most business associations and large trade unions.

Image Credits: Gauteng Department of Health.

Violence against health workers has increased despite the adoption of a UN resolution in 2017.

Despite death threats from rebel Chechens and Russian forces, Dr Khassan Baiev saved and treated countless lives from both sides of the Chechen wars. He did not waver from what he considered was his ethical duty as a doctor, and yet he was targeted and punished for his actions. 

His story, and the stories of many other heroic healthcare workers, who continued to provide care despite the dangers they faced during conflicts, are brought to life in Leonard Rubenstein’s new book, Perilous Medicine: The Struggle to Protect Care from the Violence of War. 

While there has been increasing discussion regarding the problem of violence against healthcare workers, such conversations often do not include the voices of healthcare workers themselves. 

Rubenstein and other global health experts reflected on the need to humanize these experiences of health workers during a Global Health Centre’s (GHC) launch of Perilous Medicine, and also considered long-term solutions to an increasing trend of attacks against the health sector. 

Leonard Rubenstein, Professor of Practice, Johns Hopkins Bloomberg School of Public Health

“Right now we’re in a situation where the violence continues. There’s been international paralysis, and we need to find ways to assess what is an extremely serious problem,” said Rubenstein, a professor at Johns Hopkins University.

In addition to extensive research, first-hand experience, and compelling personal stories, Perilous Medicine also offers lessons from the international community on how to move forward to protect both people suffering in war and those on the front lines of health care in conflict-ridden places around the world. 

Five reasons why combatants justify attacks 

Rubenstein has created a framework of five reasons why combatants justified attacks on healthcare, namely: to prevent enemies from being treated and returning to fight; to undermine support for rebelling forces; for tactical advantage of taking over a hospital or health centre; refusing to distinguish between military and civilians; and to exploit distrust in government. 

The sources of restraint that can ameliorate or prevent harm to health workers include leadership, domestic or international pressure and accountability, Rubenstein added. 

However, while UN Security Council Resolution 2286, passed in 2016, was one such source of restraint, condemning violence and threats against the wounded and sick, against medical and humanitarian personnel exclusively engaged in medical duties, and against healthcare resources. But the attacks have only increased since.    

More than 700 healthcare workers and patients have died, and more than 2,000 have been injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017, according to a WHO report released in August. 

Rubenstein called on the global health community to draw its attention towards this pressing issue that seeps into other sectors of health. 

“We need to go beyond the humanitarian, human rights community to address the problem. We talk about the need to develop health systems and universal healthcare – both of those are threatened when health systems are destroyed.” 

More than accountability needed 

Maciej Polkowski, Head of Health Care in Danger Initiative at the International Committee of the Red Cross

Beyond holding the right people accountable for these attacks, there is a need to create lasting change and diminish the violence by engaging with both government and civil society. 

“We often see [violence against healthcare] as merely a problem of accountability, as a collection of outrageous incidents that have to be met with international condemnation and criminal prosecution, if possible,” said Macief Polkowski, International Committee of the Red Cross (ICRC). 

But Polkowski notes that “the arsenal of responses we have at our disposal is far greater.”

“A lot can be done in terms of technical responses, advocacy – these can have practical and concrete effects in terms of diminishing some of these attacks.” 

These “untapped avenues” include engaging with Ministries of Health at the national level to working with professional medical associations. But these efforts require global solidarity and support from both parties.

“[Ministries of Health and medical associations] can take the next step of urging policy changes at the domestic level,” said Rubenstein.

This includes changing counterterrorism laws, demanding militaries adjust their rules of operating in the field, and making sure the voices of those in healthcare in conflict settings are heard. 

Local healthcare workers bear brunt of attacks

Aula Abbara, Honorary Senior Clinical Lecturer in Infectious Diseases at Imperial College and Chair of Syria Public Health Network

Shifting the focus away from the humanitarian workers of high-income countries, whose actions and stories often take center stage, Perilous Medicine instead highlights the individual stories of local healthcare workers.

“Healthcare workers that come from abroad, who come into these conflict settings, are often glorified, or treated as heroic. Whereas actually, the local healthcare workers are the ones who bear the brunt of such attacks on health care in their local communities, on their healthcare facilities, day in and day out,” said Aula Abbara of Imperial College and Chair of Syria Public Health Network. 

Abbara notes how tremendously important it is to talk to the healthcare workers directly involved in the line of conflict, as Rubenstein had done in his book.

“We can all state that more than 900 healthcare workers have been killed directly during the conflict, but every single one of those [who died] has a story.” 

Moderator Tammam Aloudat echoed Abbara’s sentiments about Perilous Medicine: “The genuine way of delivering stories in this work, the ability for us to actually see people rather than statistics, to talk about something that hurts rather than something that gets conceptualized as an academic exercise is one of great significance.” 

Image Credits: International Committee of the Red Cross, GHC.

Björn Kümmel, Germany’s deputy head of global health in the Ministry of Health

The way in which WHO is financed is “fundamentally rotten” with excessive financial dependence on just a handful of rich countries and a few private donors. 

But Germany’s deputy head of global health in the Ministry of Health, Björn Kümmel, is hopeful that WHO member states may turn course in coming months – and reclaim responsibility for the financial support of the global health agency.  

A member state Working Group on Sustainable Finance is due to meet Monday, for the fifth time this year, to consider a set of recommendations that would see regular assessed contributions paid by member states to fund WHO rise to 50% of its budget by the 2028-2029 fiscal year.  Currently, the regular annual fees assessed to WHO’s 194 member states represent only about 16% of the agency’s US $3 billion a year annual budget for 2020-2021.

The draft recommendations, which still need approval by the Working Group, also call for exploring a “replenishment mechanism” to broaden further WHO’s financing base – a model that has been successfully used by public-private partnerships like the Global Fund and Gavi to drive higher budget pledges from countries and foundations in high-profile events – but without strings attached to the money. 

If the Working Group of member states gives the greenlight, then the reform proposals would go to the Executive Board in January 2022 and then to the full World Health Assembly for its 75th meeting in May. 

Kümmel, speaking at an event on Sustainable WHO Finance Tuesday, moderated by Suerie Moon, co-director of Geneva Graduate Institute’s Global Health Center.

He said that the Working Group had heard testimony from several different independent committees that had recently reviewed WHO’s operations and performance in the wake of the COVID pandemic, and: 

“All of them shared the view that, in my words, WHO’s financing is fundamentally rotten.”

Piecemeal reforms no longer possible 

“Practically, it’s not possible to come up with piecemeal reforms, but we need to change the way, substantively, how WHO is financed,” said Kümmel, who chairs the WHO Working Group as well as serving as vice-chairman of the WHO Executive Board. 

The Independent Panel [IPPR], in its report, had even recommended that 66% of WHO’s funds should come from regular, assessed contributions by its 194 member states, Kümmel noted. “And the  remaining part should be financed through a replenishment model that we already know, is useful and is well working, working at the Global Fund, Gavi [the Vaccine Alliance] and the World Bank.”

The other key recommendation is that all of WHO’s core budget operations should be funded in a “fully flexible manner”, so that individual donor countries included, can no longer “earmark” those contributions to their pet projects and initiatives. 

Such earmarking, now a trademark of WHO financing, creates distortions whereby WHO’s top leadership cannot prioritize according to wide strategic goals.  

“The donor could, for example, say the funding should be used only in Switzerland and by an officer who is called to do something very specific – and not what WHO, the entirety of the 194 member states have budgeted,” he said. 

In addition, such “voluntary” funding by countries is also unpredictable – and if it arrives too late in the Organization’s two-year budget cycle the funds can’t be effectively applied to activities, and implemented efficiently.   

High dependency on limited number of country donors – and Bill Gates

Top contributors to WHO’s Budget (2018)

The current funding structure has made WHO highly dependent on a “very limited” number of donors, Kümmel noted.  

“I think roughly the top 18-20 donors provide, on a voluntary basis, roughly 90% of what is being implemented.  We member states are always very proud to say that WHO is member-state owned and driven organization.  Well, that is true of 16% of what WHO does.  The rest is owned and driven by individual donors. 

“And I think that is what we need to realize… we need to open our eyes to something that we’ve pushed away, because it’s not comfortable … It means that all of us need to invest more, in order to make it our organization again, and to align, practically, the political will with finances. 

The distortions are so great that had the United States really pulled out of WHO, as former US President Donald Trump had pledged to do last year, one single foundation would have remained as WHO’s the single largest funder of WHO, Kümmel said, in a clear reference to the Bill and Melinda Gates Foundation.  

Added Moon, “And in many ways, this was a bit of a wakeup call to a number of member states, regarding this years-long debate about if it is truly a member state-financed, owned and governed?” 

Political will to move on the reforms? 

Big questions still remain as to whether the World Health Assembly of member states have the political will and financial means to move on the reforms, said Moon at the session, which was staged as a conversation between the GHC co-director and her German interlocutor. 

However, Kümmel pointed out that other reform initiatives currently being considered – such as the $10 billion-a-year pandemic emergency fund – will cost far more than the proposed new assessments on member states to fund WHO more sustainably. 

In comparison, the cumulative cost to all 194 member states of changing the financing structure would be only about $1.2 billion a year. 

“So I think money doesn’t seem to be the challenge here,” Kümmel stated. 

In addition, the Working Group has already moderated the reform proposals made by others, such as the independent panel, to fund two-thirds of WHO’s annual budget with regular, assessed contributions by its member states . 

“Consciously we moved away from the even bolder and more ambitious proposal by the IPPR to start straight away to increase [country’s assessed contributions] to 66%. Our proposal foresees an increase to 50%.” 

Growing momentum at ‘greatest crisis since World War 2’

Kümmel added that he senses “growing momentum” among member states in support of the proposed changes.  During the deliberations of the Working Group, which has been meeting since last spring, some 75 member states submitted written proposals that “explicitly supported both steps forward – especially with regards to substantively increasing the assessment budget.

“I’ve been focusing on WHO’s budget now for most likely a decade,” he said, “and I haven’t seen this coming up [in this way] before – so that it becomes clearer and clearer that member states need to take over.

“We are in the wake of the greatest crisis, from a German point of view, since the Second World War,” he added. “With WHO being in the middle of it, with clear indications that WHO’s ability and expectations far outweigh the given abilities, and that we would be much better positioned with a stronger WHO.”  

At such a watershed moment, a bigger investment in WHO is “a very good investment, given the fact that much of the crisis we are finding ourselves in now, potentially could have been averted  by a stronger WHO – and all experts share the view that this is not the last global health crisis.  So we better set up a system that really helps us to prevent crises that we are finding ourselves in… .

“For everyone who watched the WHA Assembly Special Session, just last week, there were statements by presidents and health ministers and whoever – all of them said ‘we need a stronger WHO, and a stronger WHO is impossible without tackling this historic challenge of sustainable financing. 

“There’s one way of proving by a member state that they want a strong WHO – and we will see that next week. And that is practically to strengthen the organization.” 

Image Credits: WHO .

Dr Richard Mihigo, WHO Africa Coordinator of Immunization and Vaccine Development,

There has been a substantial increase in COVID-19 vaccine deliveries to Africa in the past four weeks, with around 20 million doses arriving every week at present – but only six countries out of 54 African countries will reach the global target of vaccinating 40% of their population by the end of this year.

This is according to Dr Richard Mihigo, WHO Africa Coordinator of Immunization and Vaccine Development, who said that “millions of people are without protection against COVID-19 and this is simply dangerous and untenable”. 

Most countries had used 60-80% of their allocations, and only two were lagging behind with only 10% of supply used, Mihingo told the regional body’s media briefing on Thursday

However, Mihingo said the WHO, UNICEF and COVAX had appealed to all countries that were donating vaccines to ensure that they were not expiring soon.

“We have seen the issues that have been created by the vaccines that are coming with a very short shelf life, as these pose additional challenges when it comes to the rollout of these vaccines,” he said.

Nigeria faced media criticism this week for destroying one million doses donated from Germany, but it transpired that they had been due to expire within a month of delivery.

Serum Institute of India ‘let Africa down’

In response to the claim from the Serum Institute of India (SII) that it was halving the production of its Astra Zeneca vaccines because of low demand including from Africa, Mihingo pointed out that it was SII that had stopped supplying Africa.

Mihingo said that the SII’s decision to suspend all the export of vaccines to COVAX in April had “created a lot of issues in this region”. 

“Some countries were left without provision of a second dose,” added Mihingo. “In the meantime, countries moved on and looked for alternatives. And if we look at the current pipeline in the COVAX forecasts, this is quite very promising. We are expecting to receive between 800 million to almost one billion doses through COVAX [this year] and this number is going probably to double next year. 

“I think we have now enough vaccines that are going to come through the COVAX mechanisms, and the challenge is now in deploying them,” he added.

Earlier in the day, Dr John Nkengasong, Executive Director of Africa Centres for Disease Control (CDC) said bluntly that the SII had “acted unprofessionally”, let Africa down and created mistrust when it had suspended its vaccine exports despite having committing to supplying African countries via COVAX.

Omicron in 11 African countries

WHO Africa virologist Dr Nicksy Gumede-Moeletsi

While 57 countries worldwide have identified the COVID-19 Omicron variant, only 11 of these are in Africa – and only six in southern Africa, which is on the receiving end of travel bans from around 70 countries.

Of the 14 countries in southern African, Botswana, South Africa, Namibia and Zambia have officially notified the World Health Organization (WHO) Africa of the presence of Omicron, and Zimbabwe is also expected to confirm the variant’s presence, said WHO virologist Dr Nicksy Gumede-Moeletsi. 

Mozambique has also reported cases, according to the Africa Centre for Disease Control and Prevention (CDC).

Gumede-Moeletsi added that around 50 of the 55 African member states had the ability to do genome sequencing of viruses themselves.

A regional genomic sequencing laboratory based in South Africa is currently supporting the 14 southern African countries and has increased its samples sequenced to 5000 every month.

However, the continent has experienced a 88% increase in COVID-19 cases in the past week, with 79% of these new cases coming from southern Africa followed by 14% in the northern region, according to the Africa Centre for Disease Control and Prevention (CDC).

“We are watching the situation in South Africa very carefully and over the past seven days,  we have seen a major increase in the number of cases, almost 255% increase in the number of cases.. And an almost 12% increase in hospitalisations,” said Mihingo.

“Encouragingly emerging data from South Africa suggests that Omicron may cause less severe disease,” he added, with only 6.3% of ICU cases being related to COVID-19 cases.

Africa collaborates on genome sequencing

WHO head of operational partnerships Dr Thierno Balde

Nigeria, Ghana, Uganda, Senegal and Tunisia have also confirmed the presence of Omicron.

Professor Christian Happi, Director of the African Center of Excellence for Genomics of Infectious Diseases (ACEGID) at Redeemer’s University in Nigeria, said that a “handful” of Omicron cases had been detected in Nigeria but the country was not experiencing a surge.

Happi’s centre is providing laboratory training in genomic sequencing to 16 other African countries.

Describing Africa’s genome sequencing ability as “very robust although not consistent in all countries”, Happi said there were also centres of excellence in Ghana and Senegal.

“What is beautiful about what is happening during this pandemic is that there is strong cooperation among African countries. We are collaborating, and we’re supporting all African countries,” said Happi.

Condemning the travel bans against African countries that had detected Omicron, WHO head of operational partnerships, Dr Thierno Balde, appealed to countries to “apply the International National Health regulations, especially by implementing the scientific evidence-based interventions at the point of entries” rather than travel bans.

He said some countries appeared to be reconsidering their “hasty and emotional” decisions, and the WHO hoped to see the reversal of the travel bans that were having a serious economic impact on countries.

Happi described Canada’s refusal to accept PCR tests from South Africa for its citizens travelling back from that country, as “ridiculous”.

“If Canada is accepting the existence of Omicron that was detected in South Africa, then it’s ridiculous for them not to accept testing from that country. It is not only discriminated but very ridiculous,” said Happi.

 

Teachers in Kenya getting vaccinated. Will everyone now need a booster shot?

Shortly after the release of research showing reduced efficacy of the two-jab Pfizer-BioNTech COVID-19 vaccine against Omicron infection, but better protection with boosters, the World Health Organization (WHO) cautioned that more research is still needed to draw definite conclusions about vaccine strategies in the face of the new variant wave. 

A South African study released late Tuesday showed that people double-vaccinated with the Pfizer-BioNTech COVID-19 vaccine had significantly reduced protection against the Omicron variant, now reported in 57 countries.

On Wednesday morning, Pfizer reported that a third booster of its vaccine would provide significant protection against Omicron, according to a laboratory study.

“Sera obtained from vaccinees one month after receiving the booster vaccination neutralized the Omicron variant to levels that are comparable to those observed for the wild-type SARS-CoV-2 spike protein after two doses,” according to a statement from Pfizer.

While double-vaccinated people had a “more than a 25-fold reduction in neutralization titers” against Omicron, they would likely still still be protected against severe disease thanks to their T cells which are not affected by the Omicron mutations, according to Pfizer.

“Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is improved with a third dose of our vaccine,” added Pfizer CEO Albert Bourla.

Late Wednesday, South Africa’s medicine regulatory authority approved boosters for all adults over 18 who had been vaccinated at least six months ago, and for all immunocompromised people over the age of 12 vaccinated at least 28 days ago. No other southern African countries have authorised boosters yet, although the region was the first to detect Omicron.

WHO says Pfizer results are preliminary & top priority remains jabs for the unvaccinated

Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals,

In a press briefing later Wednesday afternoon, Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals, said that the WHO was “very much interested” in the Pfizer findings, but these were preliminary and only concerned one vaccine. 

“We are still very much in a Delta pandemic and so vaccinating all people, especially those at highest risk of disease, with our existing vaccines, continues to be the top priority,” O’Brien told the global body’s COVID-19 briefing on Wednesday.

WHO has spoken out repeatedly against mass administration of booster shots – saying that available vaccine supplies should instead be focused on getting jabs to less-developed countries, mostly in Africa, where less than 40% of  people have yet to get jabs.

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on all countries to share information about Omicron speedily, as what was happening in South Africa might not be the same as the rest of the world.

“Cases in South Africa are increasing quickly,” Dr Tedros told the media briefing. “However Omicron was detected when transmission of Delta was very low so it had little competition. It will therefore be important to monitor carefully what happens around the world to understand whether Omicron can outcompete Delta.”

WHO Lead on COVID-19, Dr Maria Van Kerkhove, added that the South African population was young and had a high level of exposure to COVID-19 from previous outbreaks, which might lessen Omicron’s impact.

WHO Chief Scientist Dr Soumya Swaninathan also warned that it is too early to come to any conclusions about the efficacy of vaccines against Omicron as the only available studies showed a “wide variation” and samples were small.

New South African findings also show reduced efficacy from two-shot vaccines against Omicron

On Tuesday night, Alex Sigal of the Africa Health Research Institute in South Africa released research on 12 double-vaccinated people, which found a 41-fold reduction in neutralising Omicron. Six of the 12 subjects had also previously been infected by SARS-COV2 and five of these showed a high level of protection against Omicron.

However, the research showed that the variant still used the ACE receptor to bind to the spike protein.

But Swaminathan stressed that “[these studies] are only looking at one element, just the neutralising antibodies”.

“It’s premature to conclude that this reduction in neutralising activity would result in a significant reduction in vaccine effectiveness. The immune system is much more complex, with the T cells and the memory B cells. What we really need now is a coordinated research effort and not jumping to conclusions, study by study,” she added.

The WHO expects information about how infectious Omicron is on Friday, and said that a number of high-level scientific committees were examining Omicron.

WHO Chief Scientist Dr Soumya Swaninathan

WHO expert bodies are examining Omicron

“The technical advisory group for virus evolution is assessing Omicron’s effect on transmission, disease severity, vaccines, therapeutics and diagnostics and the effectiveness of public health and social measures,” said Dr Tedros.

The joint advisory group on COVID-19 therapeutics is analysing the possible effects of Omicron on treatment of hospitalised patients. 

The Research and Development Blueprint for Epidemics is convening researchers to identify knowledge gaps, and the studies needed urgently to answer the most pressing questions. And the technical advisory group for COVID-19 vaccine composition is assessing impacts of Omicron on current vaccines, said Dr Tedros.

Describing the idea that viruses became less virulent as they evolved as “something of an urban myth”, the WHO’s Assistant Director-General for Health Emergencies, Dr Mike Ryan, said that even if this was the case with Omicron, if it generated more cases this would put pressure on health systems and more people die. 

“That’s what we can avoid. We cannot do anything about maybe the inherent qualities of a virus but we can prevent our systems coming under pressure,” stressed Ryan – through vaccination, masks and reducing social contact. 

Lift the travel bans – end ‘travel apartheid’

Dr Tedros thanked Switzerland and France for lifting their travel bans on southern Africa and called on other countries to do the same.

However, on Monday the UK added Nigeria to its red list, while many countries are only likely to reassess the bans after a month – way too late to salvage the Christmas tourist season in southern Africa.

The moves by developed countries to shut out travelers from southern Africa, or all of Africa in some cases, were last week denounced as “travel apartheid” by UN Secretary General Antonio Guterres.

Guterres said it was “unacceptable to have one of the most vulnerable parts of the world’s economy condemned to a lockout when they were the ones who  revealed the existence of a new variant.”

His comments were echoed this week by Nigeria’s Ambassador to the UK, Sarafa Tunji Isola, who told the BBC that “the reaction in Nigeria is that of travel apartheid.”

“Because Nigeria is actually aligned with the position of the UN secretary general that the travel ban is apartheid, in the sense that we’re not dealing with an endemic situation, we are dealing with a pandemic situation, and what is expected is a global approach, not selective,” Isola said.

Image Credits: Wish FM Radio.

Dr Michel Sidibe, WHO’s Mariangela Simao and representatives from African medicine national regulatory authorities.

The newly constituted African Medicines Agency (AMA) will be key in assisting the African Union (AU) to achieve its aim of producing 60% of vaccines on its own soil by 2040.

This emerged at a two-day meeting of the Partnership for Africa Vaccine Manufacturing (PAVM) hosted by Rwanda this week. The PAVM was set up six months ago by the AU and Africa Centre for Disease Control and Prevention (CDC) to drive vaccine development. 

Major global pharmaceutical companies Pfizer, BioNTech, Moderna and Johnson and Johnson told delegates that vaccine manufacturing required long-term, capital intensive investment.

But they also stressed the need for a harmonised regulatory environment to ensure the smooth and speedy assessment and registration of vaccines and medicines.

That’s something that the AMA, could provide, once the agency is fully operational.  The AMA Treaty formally came into force on 5 November after the AMA treaty was formally signed and ratified by 15 African countries.  Altogether some 28 of Africa’s 55 countries have aligned with the treaty by signing and or ratifying it, as the continent ‘counts down’ to full buy-in from AU nations – with Uganda as the most recent country to ratify the treaty instrument.

But major countries like South Africa, Nigeria and Kenya are among the 27 countries that have yet to sign. 

Differing skills

Michel Sidibe, the AU Special Envoy for the AMA, said that the agency needed to “create a safe environment for investment”.

“You will not attract investors if you have some countries with 40% of fake drugs or substandard drugs,” said Sidibe. “A harmonised regulatory system will help us to create a safe environment for investment from our own continent, and with partners who want to come and invest in our countries.”

He added that “if we produce vaccines and drugs and we don’t have a mechanism on our continent to fast track the authorization process, it will not be helpful for our countries”.

Country medicine regulators appeal for training

While skills at the different country medicine regulators differ considerably, a panel featuring five national regulators, including South Africa, Morocco and Ethiopia, appealed for more support as the continent prepares to manufacture vaccines.

Tumi Semete-Makokotlela, head of the South African Health Products Regulatory Authority (SAHPRA), said that harmonisation of processes across all 55 African states was important “so that we can rely on each other’s decisions”.

She also appealed for investment in the regulators’ capabilities so that they could “do full lifecycle product management” from oversight of the clinical trials to product approval, pharmacovigilance and post-regulatory monitoring of products. 

Professor Bouchra Meddah, Director of Pharmacy and Medicines in Morocco’s Ministry of Health, also appealed to the Africa CDC, AMA and the World Health Organization (WHO) to provide technical assistance and staff training to all the regulators so that they were “all at a sufficient level in order to manufacture the vaccine”. 

Heran Gerba, Director-General of Ethiopia’s  Food and Drug Authority, called for medical products’ approval processes to be expedited and efficient, adding that Ethiopia had an electronic regulatory information system for licencing,  registration, pre-import permits and for imports, which had improved efficiency.

The regulators have some experience in working together at the African Vaccines Regulatory Forum (AVAREF), which was set up in 2006 by the WHO to improve regulatory oversight of clinical trials conducted in Africa. AVAREF has also played an important role in accelerating the review of Ebola vaccines.

AU Special Envoy for the AMA, Michel Sidibe

WHO benchmarks

The WHO benchmarks regulators and currently only two on the African continent – Ghana and Tanzania – have maturity level three, defined as a “stable, well-functioning and integrated regulatory system”.

However, Dr Mariângela Simão, WHO Assistant Director-General or Drug Access, Vaccines and Pharmaceuticals, said 44 African countries had been assessed using the global benchmarking and “a few others are on a fast track to achieve maturity level three”.

“Ideally, I would like to have at least half of the countries in five years times with maturity level three,” said Simao.

Dr Margareth Ndomondo-Sigonda, Head of Health Programmes at the AU Development Agency, NEPAD, said the AU wanted to assist countries to get maturity level three primary through regional centres of excellence.

These regional centres could, amongst other things, create legal frameworks to support harmonisation of vaccine manufacturing regulatory models; develop vaccine manufacturing knowledge; build leadership skills and develop sustainable financing mechanisms, she said.

Sidibe urged that AMA “should become a reality quickly”. 

“We should do whatever we can to quicken the pace of implementation and operationalisation,” he stressed. “It will help us to tap into the African Free Trade Agreement”.

The AMA treaty has been ratified and deposited by 18 African countries at present, with Uganda the most recent to have signed.  See the interactive map here: 

 

 

An AU session early next year is to determine the seat of the new Agency.  Meanwhile, the buy-in from other major AU nations, particularly South Africa and Kenya, as well as Nigeria, will be much-awaited milestones in the full operationalizing of the AMA vision. 

See more resources and details on the developing African Medicines Agency here on our Health Policy Watch ‘countdown’ site.

The ‘African Medicines Agency Countdown’

 

USAID has assisted Sudan with its cold chain storage for COVID-19 vaccines.

The US Agency for International Development (USAID) has set up a new global initiative to accelerate COVID-19 vaccination efforts, called the Initiative for Global Vaccine Access (Global VAX), the agency announced on Monday

Global Vax’s aim according to USAID, is to “get COVID-19 shots into arms and enhance international coordination to identify and rapidly overcome access barriers to save lives now, with a priority on scaling up support to countries in sub-Saharan Africa”.

Global VAX will coordinate the US government’s COVID-19 vaccination efforts. The US government has already committed more than $1.3 billion for vaccine readiness, and USAID Administrator Samantha Power announced an additional $400 million in American Rescue Plan Act funds, from the  US Congress, to augment this work. 

“Global VAX includes bolstering cold chain supply and logistics, service delivery, vaccine confidence and demand, human resources, data and analytics, local planning, and vaccine safety and effectiveness,” according to the agency.

The announcement was made at a ministerial meeting of key international development partners from around the world, convened by Power.

“The emergence of COVID-19 hotspots and variants including Delta and Omicron further underscore the importance of our global fight. Vaccinating the world is the best way to prevent future variants that could threaten the health of Americans and undermine our economic recovery,” according to USAID.

Global VAX includes:

  • $315 million to support vaccine delivery and get shots in arms in low and middle-income countries.
    This investment will support country-specific needs to ramp up vaccination rates and get more shots in arms. These activities include investing in cold chain and supply logistics to safely store and deliver vaccines; supporting national vaccination campaigns; launching mobile vaccination sites for hard-to-reach and rural populations; assisting countries in vaccine policy-making and planning for strategic health care worker and resource deployment; and supporting the development of health information systems to better evaluate vaccine distribution equity and monitor vaccine safety.
  • $10 million to support in-country vaccine manufacturing.
    This investment will support countries poised to produce vaccines themselves to help them build regulatory capacity, transfer “know-how” to train emerging manufacturers, and provide strategic planning and other assistance. This will enable countries to boost vaccine manufacturing locally, which not only diversifies international production, but also has the potential to drive new investments in local economies and create jobs. This investment strategically complements the U.S. International Development Finance Corporation’s investments to scale regional manufacturing of COVID-19 vaccines.
  • $75 million for additional support for USAID’s Rapid Response Surge Support.
    USAID’s Rapid Response Surge Support delivers life-saving resources to COVID-19 hotspots, or areas experiencing surges in cases. This investment will help strengthen oxygen market systems to improve reliable oxygen production and delivery—often the most critical and in-demand resource needed in communities experiencing COVID-19 surges.

 

Image Credits: USAID.

 

Pharma Panel: Moderator Glaudina Loots (South African government), Sai Prasad (Bharat), Holm Keller (BioNTech), Patrock van der Loo (Pfizer), Adrian Thomas (J&J), John Lepore (Moderna) and Charles Wolf (Sanofi)

The African Union has made steady progress to manufacture vaccines on the continent, but this is a complicated, expensive endeavour that required long-term commitment, Big Pharma companies warned.

Welcoming delegates to the Partnership for African Vaccine Manufacturing (PAVM) reportback six months after it was set up, Rwandan President Paul Kagame said building pharmaceutical manufacturing on the continent had become a matter of life-and-death.

“Africa’s challenges during the COVID pandemic in securing timely access to tests, therapeutics and vaccines have served as a constant reminder that we need to be doing things for ourselves,” said Kagame.

“That does not mean acting alone. Vaccine research and production is fundamentally a global enterprise. We therefore have to work in partnership with each other as Africa and also with key partners around the world,” said Kagame.

He said that the recent ratification of the African Medicines Agency treaty was an important development.

“It is essential to maintain the momentum and fully establish this agency without which Africa cannot independently authorise and register medicines and vaccines,” said Kagame.

He also hailed agreements reached between Rwanda and Senegal and the German company, BioNtech, to start the production of mRNA vaccines as early as next year, as well as the mRNA tech transfer hub set up in South Africa by the World Health Organisation (WHO), which “is working with South African companies to build valuable knowledge best for our continent”.

“These initiatives underway in various countries are evidence of a strong momentum which must be supported and sustained. Because of this terrible pandemic, an opportunity has been created to fundamentally change the pharmaceutical production landscape on our continent,” he concluded.

Africa CDC’s John Nkengasong

Dr John Nkengasong, executive director of the Africa Centres for Disease Control and Prevention (CDC), stressed that partnerships were central to the continental goal of producing 60% of vaccines it needed by 2040. Currently, this figure is 1%.

Nkengasong said one of the meeting’s aims was to get agreement on “an AU-endorsed approach for facilitating regulatory approval processes, which will be packed with what we call potential pathways that we can use because of the speed at which the continent is moving in producing vaccines”.

Options for vaccine authorisation, as presented by Dr Nkengasong.

Complexity of vaccine development

Later in the day, a panel addressed by key Pharma companies stressed the complexity and expense of vaccine development.

Sanofi’s Charles Wolf said that “very long term agreements, and stable negotiations, are vital, vital for vaccine stability”.

Pfizer representative responsive for Africa, Patrick van der Loo, said that for most of his company’s vaccines, tech transfers for formulation and fill finish took around three years.

In July, Pfizer signed a letter of intent with the Biovac Institute in South Africa to manufacture the Pfizer-BioNTech COVID-19 vaccine for distribution within the African Union. 

“To facilitate Biovac’s involvement in the process, the tech transfer, the onsite development, the equipment installation activities, have begun basically immediately,” said Van der Loo.

“We expect that the Cape Town facility will be incorporated into our supply chain by the end of this year,” he added, saying that the company would get the drug substance from facilities in Europe soon and manufacturing of finished doses will commence early in 2022.

“At full operational capacity, the annual production there will exceed 100 million finished doses and all these doses will exclusively be distributed within the 55 member states that make up the African Union,” he added.

However, he warned that challenges experienced in South Africa included unstable power supply and water shortages.

Step-by-step approach

Adrian Thomas of Johnson and Johnson (J&J), which has a partnership with the South African pharmaceutical company, Aspen, said that this relationship was being built in a “thoughtful way, step-by-step building on strength and experience”.

“The overarching message that we have for Africa is that we support, and want to be part of, the long-term strategy for manufacturing internally and across the industry. But it’s it is going to be critical to look at multiple platforms and make sure that we distribute the risk across platforms across diseases and have stepwise progress. It has to be sustainable for the long term,” he stressed.

Moderna’s John Lepore said it was exciting that Africa had a continental strategy for vaccine manufacture – the only region in the world to do so.

“We have committed to spend up to $500 million to produce a factory that can make up to 500 million doses. And it’s really the [PAVM] strategy that gives us the confidence to make that investment,” said Lepore.

“We’re currently doing our own due diligence to make the final site selection, and when we look at the key criteria we need to be successful, they match very well with the strategy that already been developed by the African Union, and the African CDC.”

Production of Sinopharm’s inactivated COVID-19 vaccine candidate.

Not just fill-finish

Unlike the other companies that were mostly involved in fill-finish arrangements with African companies, BioNtech’s Holm Keller said that it wanted its malaria and TB vaccines be manufactured in Africa “end-to-end for drug substance and drug product”

“We have started working on a factory set up that would produce formulated drug bulk,” said Keller. “BioNtech’s focus will be on drug substance and not on fill-finish.”

He added that his company intended to  start building the first factory in a few months in 2022, although he did not disclose where this would be other than to mention meetings in Ghana and South Africa.

Sai Prasad, CEO of Indian manufacturer Bharat, stressed that the “complexity of vaccine  development and manufacturing cannot be overstated”. 

“It takes sometimes decades to develop vaccines. It takes a big amount of investment – usually more than $100 or $200 million, irrespective of whether it is fill-finish or drug substance. 

“And when you make those investments, there has to have stability over a 20 or 30 year period for a vaccine manufacturing company or a product development company to take root and take shape.”

The PAVP meeting continues on Tuesday.

Image Credits: Sinopharm.