Botswana’s representative, Dr Edwin Dikolo, at the WHO Executive Board Thursday – fighting COVID has pushed aside the battle against NCDs in Africa and beyond.

In a long and winding discussion Thursday at The World Health Organization’s Executive Board, low- and middle-income countries (LMICs) pledged to redouble their efforts against noncommunicable diseases (NCDs), such as diabetes and obesity, which are having increasing impacts on health and well-being – in addition to infectious diseases that have been at the forefront of health sector efforts for most of the past half century. 

Some 70% of premature deaths worldwide are now due to NCDs.  And two-thirds of deaths annually in low- and middle-income countries are NCD-related, according to the NCD Alliance. 

Risks of dying young from cancer, diabetes, a heart attack or another chronic diseases are higher in most developing countries, because health systems still don’t offer basic primary prevention measures like cervical cancer screening, diabetes diagnosis or insulin treatment – not to mention more costly and high-tech treatments for conditions like cancer.  

The Thursday session focused on action plans to implement a 2018 political declaration of UN General Assembly on the prevention and control of noncommunicable diseases (NCDs), a cross section of African countries noted that the ongoing COVID-19 pandemic has made it even more difficult for them to combat both diseases and other NCDs.

Among the NCD risk factors, obesity stands as one of the largest – and growing risks. Worldwide obesity has tripled since 2021 and more than 1.9 billion people over the age of 18 are obese today, according to WHO.

Africa – COVID pandemic has sapped resources from NCD prevention and treatment

As with other NCDs, death rates from obesity in parts of Africa, the Middle East and South-East Asia are among the highest in the world – even though there are just as many or more obese adults, per capita, in the United States and other parts of the Americas. That is just one more example of the lack of preventive and other treatment services in LMICs.

Dr Edwin Dikolo from Botswana, speaking on behalf of the African region, noted that resources and manpower that could have been channeled toward tackling the diseases have been repurposed for the COVID-19 pandemic response in member states. 

According to him, there is the need for investments in LMICs to facilitate the emergence and availability of context-specific medical devices and technologies that are more attuned to countries’ health systems capacity and disease responses.

The region also asked for international and regional collaboration, and support for research and measures to promote more transparency in the licensing of Intellectual Property rights. 

“Another demand is improved access to WHO’s pre-qualification list, and support for member states in improving access and affordability of medicines for NCDs,” the statement concluded.

Last October, WHO’s Essential Medicines List (EML) Expert Committee recommended that the Agency establish a pricing committee, as an adjunct team to provide “advice to WHO on policies and actions to make highly priced essential medicines more affordable and accessible” – incorporating pricing issues more directly into the WHO review and recommendations on new “essential medicines.”

But WHO’s senior leadership has been foot dragging on making such a formal recommendation, civil society sources in Geneva have suggested.  

Kenya’s representative, meanwhile, noted that while there are commendable regional efforts to improve access to diabetes care at the primary health care level, and many countries in the region, including Kenya, have integrated diabetes into the universal health coverage packages, diabetes services remain unequitable. 

“Insulin and associated interventions required in the management of diabetes remain unaffordable in many low and middle income countries and out-of-reach for many patients,” the representative from Kenya stated.

Kenya’s representative speaking at the WHO Executive Board in Geneva, Thursday.

Addressing obesity

Mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to adult obesity, and related diseases later in life.

According to the WHO, a major risk factor for diabetes is obesity. Moreover, obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while obese people are up to 80 times more likely to develop type 2 diabetes than those with a body mass index (BMI) of less than 22.  People with a BMI greater than 25 are considered overweight, according to WHO.  Childhood obseity is another growing problem, increasing risks of chronic disease later in life. 

A WHO target set in 2016 called for halting the global increase in obesity in children, adolescents and adults altogether by 2025 .

But countries are far off course in reaching that goal.  As things stand now, one in five adults worldwide will be obese by 2025, with LMICs experiencing the greatest obesity surges, according to the World Obesity Federation.

As a result, WHO has now proposed shifting the target of halting the rise in obesity to 2030.

At the same time, it has etched out more modest “intermediate” targets that countries could aspire to reach.  Those include reducing intakes of free sugars to less than 10% of total energy intake and reducing physical inactivity by 15% by 2030.  Other “process targets” would include increasing primary health care coverage of obesity prevention, diagnosis and treatment, increased regulation of corporate food marketing of unhealthy foods and drinks to children, and national physical education campaigns.

WHO’s interim proposed targets for obesity reduction – very far from the ambitious 2016 goals of halting the rise in obesity altogether by 2025.

At Thursday’s session,  the United Kingdom said it would support the WHO-proposed intermediate targets.   The UK government delegate, however, stressed that countries need to do more on their own as well as bolstering  global collaborations addressing obesity.

“Action to date has been insufficient, and we would therefore like to call on member states for further joint action to address the global burden of obesity and achieve better health worldwide,” the UK  representative said. Sharing the UK experience at today’s session, the representative described how the UK has put in place a policy package that includes front-of-package labeling, taxes on sugary drinks and salt, sugar and calorie reformulation programs. 

“This year we are going further and we’ll be introducing new regulations on advertising, promotions and calorie labeling in the out-of-home sector,” the representative said.  

The UK also is leading WHO/European Region Sugar and Calorie Reduction Network that will be launched next April. 

“The network will provide a forum for countries to share lessons learned, identify and address barriers to sugar and calorie reduction and assist industries in their efforts to make food and drink healthier. We will also be working on addressing the data gaps and increasing transparency and accountability,” the UK stated.

Concerns from China and Thailand that targets are too ambitious 

Diets rich in fresh fruits and vegetables combat obesity – but these are being overtaken by fast and processed foods in developing as well as developed countries. Portrayed here a market in Tamil Nadu, India

Delegations from China and Thailand however expressed concerns that the interim targets for obesity reduction and related programmes remain too high and too difficult to achieve. 

China recommended that the WHO Secretariat should organize in-depth discussions on this issue, building on the development trend in recent years and the indicators “so as to scientifically predict and set the coverage targets to ensure that they are achievable.” 

Addressing the concerns, Dr Francesco Branca, Director of WHO’s Department of Nutrition and Food Safety, said the WHO will support the adoption of healthier dietary and food policies, through development of policy guidelines for: marketing food to children, fiscal policies, and school food offerings, as well as guidelines on the management of obesity in children and adolescents accompanied by practical How to Guides. 

“We’re also developing a service delivery framework for prevention and management. And looking at diagnostic criteria additional to the body mass index. WHO [also] plans to establish benchmarks for the reduction of sugars based on the experience of member states. Nutrition professionals are those trained to pursue a professional career in nutrition [and] are described in most countries as dietician or nutritionist,” Branca said.

Bente Mikkelsen, Director of WHO’s Department for NCDs told China and Thailand that the WHO took national health systems’ contexts and capacities into consideration when developing its policies and in setting the global targets.

“We have developed the targets based on the data from the member states and with the methodology that is developed in the technical paper. The targets seem ambitious but are achievable,” Mikkelsen added.

She added that the NCDs global action plan on tobacco, alcohol health, healthy diet and physical activity also contain similar targets that will “remain and will complement the targets on coverage and treatment”.

Image Credits: Jen Wen Luoh, Paul Adepoju , Political declaration of the third high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases, @veerajayanth03.

Dr Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington

Despite a severe lack of COVID test and serological data in Africa, most people on the continent have probably already been exposed to SARS-CoV2, said the director of the influential Institute for Health Metrics and Evaluation on Thursday. 

And in light of that, and the fact that COVID vaccines do not prevent infection, but rather only serious cases, more investment should probably be placed into testing and anti-viral treatment for older, more vulnerable people, said Dr Chris Murray, whose Seattle-based Institute collaborates closely with the World Health Organization on many of its key global data studies. 

Murray stressed that, “regardless of whether people have got some protection from past infection there’s a strong moral arguments about making more vaccine supply available in Africa – everybody who wants a vaccine should certainly be able to get one as a matter of fairness and equity.”

But he also included a provocative caveat, adding that: “if you are a government in Africa, there are a bunch of questions” that still arise about investment priorities.

He spoke Thursday at an IHME briefing webinar on the latest trends in Omicron infection – and what that means for the pandemic and policymakers going forward.  

IHME data shows vaccine hesitancy in Africa to be among the highest in the world – along with Eastern Europe – with less than 50% of people in some countries saying that they would like to be vaccinated,” Murray said, without elaborating on what that data is. Follow-up questions by Health Policy Watch, submitted by email, failed to yield a reply by publication time. 

“But as vaccine supply becomes available, you’re going to hit that limit to people who want to be vaccinated,” he warned. 

In addition, there is currently no solid “adult vaccination platform in many sub-Saharan African countries.”  

How to prioritize ?

Pfizer’s Paxlovid, an oral antiviral approved by the US FDA in December, has shown 90% efficacy in preventing mortality among those who take it in the first few days of infection.

“So the other very real policy question is  should there be more focus on getting the testing capability and access to antivirals in high-risk, older adults in Africa, and would that strategy have a bigger health benefit. 

“There’s a lot to be figured out for countries in Sub Saharan Africa about what  should be the focus, in addition to vaccination, making it available in terms of reducing harm in the future. 

Throughout most of the pandemic “one of the great gaps” in global data on prior exposure to SARS-CoV2 has been Africa.

“There is a lack of population based seroprevalence data in many parts of sub-Saharan Africa – it’s been something I’ve been asking people to fund since May of 2020. 

“But now that there are more studies coming – we’ve heard of early results. The studies from sub-Saharan Africa suggest that 70-80% of populations in Africa pre-Omicron, have already been infected.  

He cited studies from South Africa in early December 2021, which suggested that people coming for treatment at antenatal clinics and other health settings had a 30% prior infection rate – even before Omicron hit with full force there. 

“So we think the vast majority of Africa has actually had Omicron,” he concluded, based on that and other data available. He did not elaborate on the other data.  And as of publication time, IHME had not responded to follow up questions from Health Policy Watch. 

But he said that the worldwide nature of current Omicron exposures raise new questions about how to prioritize resources going forward.  Pushing aggressively for access to treatments for those who do become ill may now be more important than ever.

“Do you put your energy into securing access and ability to deliver in a timely way the Paxlovid or other antivirals that are coming – which can reduce the fatality rate by 90%, which is a pretty dramatic reduction?” 

Omicron as the ‘great equalizer’ 

People vaccinated & infected (red line) have the strongest immune response against SARS-CoV2, seconded by those who were infected (and survived). Those who are were never exposed, vaccinated or not, are the most at risk. But by March 2022, those groups will comprise less than 5% of the world’s population.

People Vaccinated and Infected Have the Best Immunity 

At the same time, people who have been both vaccinated and infected with COVID appear to have the best immunity today – and thus are likely to be better protected against future SARS-CoV2 variants going forward, added Murray.   

“ Who has the greatest protection?- the red line does – people who are vaccinated and infected. The next category is probably green, previously infected.  And the people in the highest risk categories [blue and yellow] are vanishingly few,” said Murray, pointing to a line graph estimating prevalence of the four groups over the course of the pandemic.

“In some ways, Omicron was the great equalizer… We now know that infection-acquired immunity is as good or better than vaccination – although you run the risk of dying with the former. 

But if you are in the fortunate 99%, or now with Omicron, 99.9% to not die, then you end up with pretty good immunity, and what’s what the studies now seem to suggest. 

“And it (infection derived immunity) may even wane more slowly. There are people who are arguing that you get more diverse immunity because it’s not just the spike protein,” the element used in most vaccines to prompt immunity – “and that may put you in a better place for new variants in the future.” 

His statements echoed emerging findings of other recent research, including a study published this week in the journal Science Immunology, by a team of researchers based at the Oregon Health and Science University. The study’s conclusions, as it’s title declares, is: “Vaccination before or after SARS-CoV-2 infection leads to robust humoral response and antibodies that effectively neutralize variants.”  The study was undertaken before Omicron emerged, but it’s likely the results would be the same for the new variant, one lead co-author, Fikadu Tafesse, was quoted as saying.

Currently available vaccines don’t stop infections – only serious cases 

The dilemmas of investment priorities are all the more striking in light of the fact that the world’s currently available COVID vaccines don’t really to much any more to prevent infection – and never were designed for that in the first place, Murray added.   

And while two jabs still continue to give protection against serious cases – the returns on that score also have diminished significantly over time – even in the best vaccines.  That has bolstered the argument for a third booser jab – recently recommended by the World Health Organization.”  But even that has proved to be of limited value over time. 

As for a fourth dose – since Israel this week extended its approval for any healthy adult to get a fourth Pfizer jab “we shall see” soon how effective that may be. 

“But there is a bit  of a debate amongst the vaccinologists about whether the data supports an every six month dosing against the or every periodic dosing,” he cautioned. 

“You know that the argument against that is that once you start, you never stop.” 

Vaccines as ‘harm reduction’ 

He pointed out that “many governments misinterpreted” the initial results from much trumpeted vaccine clinical trials – confusing results that showed 93% or more protection against symptomatic disease in the Moderna and Pfizer vaccines, per se, as as infection protection. 

“They thought that vaccination was a way to control infection.. But in fact the data was never there,” he said, noting that infection prevention was typically not even measured in the clinical trial data.  

“Some of the immunologists who were involved in setting up the trails, argued strenuously that we should have had infection as an outcome of the trials It didn’t happen.

“Now you have data post vaccination in Israel, UK, Canada and elsewhere that have given us insights that depending on the variant they (vaccines) provide some protection but not enough to think of vaccination as an infection control strategy. 

“So as long as we think about vaccination as harm reduction, we’ll be able to figure out the timing to keep protection up, against hospitalization or death.” 

Asked by email in another follow-up question whether vaccination can nonetheless blunt the emergence of new variants, Murray did not reply by publication time.

Murray is a former WHO director, who pioneered the Organization’s initial health metrics research over two decades ago, leaving to found IHME, which is funded by the Gates Foundation.

While sometimes considered a rival to WHO’s own standing, the Geneva-based global health agency has become increasingly more dependent on IHME for data, modelling and analyses – which it lacks the capacity to do internally.

Image Credits: Pfizer , Science Immunology – Vaccination before or after SARS-CoV2 immune response.

Zsuzsanna Jakab

Only 14 countries are on track to achieve the Sustainable Development Goals to reduce premature mortality from non-communicable diseases (NCDs) by one third by 2030, the World Health Organization (WHO) revealed at its executive board meeting on Wednesday.

After listening for over three hours to countries’ views on the WHO roadmap 2023–2030 to prevent and control NCDs, WHO Deputy Director-General Dr Zsuzsanna Jakab, warned that countries had less than 10 years to meet targets.

The agenda item on NCDs was especially onerous as member countries had to consider a political declaration, that included the roadmap, plus 11 annexures – including one on curbing alcohol consumption.

Alcohol lobby exerted undue influence on WHO draft global action plan – critics charge

Last week, the Foundation for Alcohol and Research Education (Fare) accused the WHO of watering down proposals to contain alcohol consumption despite two years of negotiations.

The WHO’s draft Action Plan to Reduce the Harmful Use of Alcohol (2022-2030) has been revised in response to lobbying by alcohol companies to water down key provisions, according to the Fare analysis.

The analysis compared the first WHO working document with the final draft of the global action plan being presented to the EB this week.

Critical changes introduced include reduced emphasis on policies that target the pricing, availability and promotion of alcohol products to moderate consumption – all reflecting the fingerprints of alcohol industry influence, Fare charged.

Last week, another Fare-commissioned report prepared by the Centre for Alcohol Policy Research at La Trobe University, Australia, described how alcohol companies had worked to undermine the draft action plan, in the two year period since the WHO’s Executive Board first recommended accelerated action” against alcohol harm.   

Unhealthy environments

Aside from the focus on alcohol, a number of member states and NGOs made calls for countries to step up action on “unhealthy environments” that are the norm in many polluted, traffic clogged cities, as well as “commercial” risk factors, like the proliferation of junk food and tobacco promotion, which together contribute to unhealthy lifestyles and the development of NCDs. 

Such risks are highlighted in a draft WHO Road Map (2023-2030) for implementing a Global Action Plan for Prevention and Control of Noncommunicable diseases, under consideration by the EB. 

A new WHO “implementation framework” for improving the health and well-being of 1 billion people by 2030 also targets a wide range of risks and prevention opportunities – from promoting clean and active transport to healthier and more sustainable food systems – which in turn can blunt rising antimicrobial resistance (AMR) as well as food safety risks associated with the emergence of new pathogens and pandemics. 

Slovenia’s Kerstin Petrič

Slovenia’s Kerstin Petrič lamented the lack of member state investment in primary NCD prevention, addressing key risk factors. 

“More cost-effective measures such as rising taxes, bans on advertising and limiting access to for example tobacco, alcohol, transfats and sugar are difficult to adopt due to aggressive lobbying of industry and despite the bulk of evidence that these measures work, particularly in the most vulnerable population,” Petrič noted.

“This is the case in my country, and I believe in many other countries. Many lives could be saved if there would not be constant wavering in our member states between business opportunities and health,” she added, appealing to the WHO to “provide appropriate recommendations, including economic calculations, to generate support for public measures in political discussions”. 

Latin American countries, many of which have made substantial progress in addressing junk food consumption that is fueling NCDs including diabetes and cardiovascular disease.

Argentina told board members about its “healthy environments programme” that included  establishing smoke-free workplaces, and raising awareness of the dangers of alcohol, safe water and the importance of healthy eating and physical activity. 

Argentina has implemented front-of-package labelling on ultra-processed food that contain excessive sugars and saturated fats. 

Conflict-of-interest guidelines

Colombia also stressed health promotion strategies, including collaboration with civil society and academics, as “a vital aspect of prevention of NCDs”,  which should also include addressing  unhealthy environments that in turn create obstacles to healthy lifestyles. 

Meanwhile, Uruguay welcomed the proposed specific targets to respond to diabetes in the prevention and treatment of obesity. 

“We would once again ask the secretariat to give member state clear guidelines on the prevention of conflict of interest in the development of public policies and carry out all necessary efforts to support countries, particularly low and middle-income countries to get the necessary resources for NCD control and monitoring systems,” said Uruguay.

Meanwhile, the US appealed for stronger clauses to address air pollution.

“We would like to see the roadmap provide a more robust response related to air pollution,” said US delegate Loyce Pace. She added that mental health should also receive greater focus: 

“As other delegates have said, the COVID-19 pandemic continues to have a profound effect on availability of mental health services, including for pregnant women, children and adolescents. Greater focus is needed in expanding coverage of mental health and substance use disorders, services delivered via telehealth and similar mechanisms to help mitigate the impacts of COVID-19.” said Pace.

The Executive Board will continue to discuss NCDs on Thursday, as it struggles to catch up with its backlogged agenda.

EB chairperson Dr Patrick Amoth

While three independent review panels concur that the response of the World Health Organization (WHO) to COVID-19 was inadequate, member states made slow progress in charting better alternatives at the executive board meeting on Wednesday.

WHO members are considering three main proposals to improve the global body’s future pandemic preparedness: 

Amid the repetitive hot air that characterised much of Wednesday’s pandemic discussion, US representative Loyce Pace’s clarity and brevity made a welcome change.

“All of the review panels recognise the slow response globally in the early days of this pandemic, and establishing a standing committee is in our view, a commonsense way for the executive board to be more prepared for both current and future health emergencies,” said Pace.

She identified four priorities to prepare the WHO for future pandemics: first, targeted IHR amendments; second, a review of recommendations made by the Working Group on Pandemic Response (WGPR); third, setting up the intergovernmental negotiating body to develop an instrument on pandemic preparedness and finally improving WHO governance “starting with an informal group and then establishing a task team of Member States to work with the Secretariat”. 

“We call upon all member states to dedicate time, resources and efforts to improve WHO governance issues,” she added.

Standing Committee is Stalled

Australia’s Travis Power

The proposed standing committee, reporting to the board, would kick in automatically as soon as the Director-General declared a health emergency, and it could facilitate the immediate transfer of information between the Secretariat and member states, said Austria’s Dr Clemens Martin Auer.

Australia stressed that the standing committee “should focus on governance for the health emergencies programme, allowing for in-depth discussion and reporting to the EB” and it “should not encroach on the technical advisory and leadership roles of the Director-General and the IHR Emergency Committee”.

In response, Director-General Dr Tedros Adhanom Ghebreyesus said that such a committee would be helpful, particularly as the board only meets twice a year. However, a handful of countries indicated that they weren’t yet ready to support the resolution so it was stalled.

Agreement to amend International Health Regulations

The Working Ground on Pandemic Response (WGPR), chaired by the US and Indonesia, has been charged with overseeing the process of discussing targeted amendments to the IHR. IHR amendments are expected to address equity, technology governance other gaps.

“The US led an exclude inclusive and transparent process to develop this decision as we are mindful that updating and modernising the IHR is critical to ensuring the world is better prepared for and can respond to the next pandemic,” said Pace.

“The United States formally transmitted its proposals for targeted amendments to the IHS last updated in 2005 to the Director General consistent with IHR article 55 for circulation to states parties at least four months in advance of the World Health Assembly.”

While supporting IHR amendments, Russia’s delegate, Mikhail Murashko, said that these “should not undermine the sovereignty of countries or regions in ensuring health and or biological security”. 

“We reject any proposals which could be used as grounds for interfering in the international affairs of nations, including the holding of international investigations on the basis of rumours and information unconfirmed by states,” said Russia, a reiteration of China’s concerns.

Russia wants IHR amendments to address “improving the priority infrastructure, developing regional and global networks, increasing cooperation between countries on implementing the rules and ensuring free movement of medical staff and technology to fight infections”.

Russia also called for member states to “work harder to fight the distribution of false and unreliable information because this prevents effective scientifically based measures being taken to fight epidemic outbreaks and it undermines international cooperation.” Ironically, Russia has been identified as a key source of COVID-19 misinformation aimed at undermining “Western” vaccines.

Reality check from civil society

KEI’s Thiru Balasubramaniam

The key discussions on an effective pandemic instrument will take place in the intergovernmental negotiating body, which is in the process of being set up. The EU announced that a Dutch official would lead its region, while South Africa indicated it had been nominated for this task by the Africa region.

A wide range of civil society groups breathed some reality into Wednesday’s discussions, reminding delegates that the world was still in the grips of a pandemic and that citizens of the world had been failed by inadequate sharing of rights and know-how on government-funded technologies; bottlenecks in vaccine delivery; and more broadly by health services that have been unable to deliver sexual and reproductive health services and ongoing treatment for people with non-communicable diseases.

“The WHO negotiations on a pandemic treaty are not a quick fix to the current pandemic, but they offer a much more comprehensive and potentially useful response going forward, including for the next pandemics,” said Knowledge Ecology International’s Thiru Balasubramaniam.

He called for delegates to “address policy failures that have accompanied the current pandemic response, and create a better global framework for cooperation”, including “sharing of rights and know-how from government-funded technologies, mandatory intellectual property exceptions, global norms for financing R&D in both the preparatory and crisis stages, and concrete obligations for transparency”.

KEI also called for reforms to the funding and management of clinical trials “so that the public has transparent and unbiased information on the relative effectiveness and safety of countermeasures”.

Pharma leaders, from their side, acknowledged: “society needs to do more and go further, urgently addressing the bottlenecks in vaccine administration while, reflecting on how to achieve ore equitable allocation faster in the future. Manufacturers, governments, academia, NGOs and other global health institutions have a collective responsibility to ensure that no one is left behind in this pandemic and the next outbreak.”

But the statement by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) stressed that private sector collaborations had been critical to the rapid development of new vaccines and treatments, adding that the world should “enhance not hinder the thriving innovation eco-system while building a resilient, sufficiently-resourced, health infrastructure.”

Loyce Pace, Assistant Secretary for Global Affairs at US Health and Human Services

Despite earlier disruption from Ethiopia, Dr Tedros Adhanom Ghebreyesus received overwhelming support for his nomination for a second term as World Health Organization (WHO) Director-General from the body’s executive board on Tuesday.

As the only nominee, Tedros is guaranteed to be re-elected at the next World Health Assembly in May.

All WHO regions expressed their support for is nomination, including the African region which commended the global body for its clear nomination process – the message delivered by a representative from Burkino Faso, a country in limbo since a military coup on Sunday night.

 

As part of the nomination process, Tedros gave an address to the board and answered a number of questions.

During his address, he appealed for “assessed member state contributions” to cover at least half of the WHO’s roughly $3.5 billion a year budget. At present, assessed contributions (fees based on countries’ GDP) account for less than 20% of the budget, with the remainder from voluntary contributions which are usually earmarked for particular issues, preventing flexibility and equitable regional distribution, said Tedros.

WHO funding 2021

Financing dominated the second day of the board meeting, with Germany’s Bjorn Kummel, chair of the Working Group on Sustainable Financing (WGSF) describing the global body’s finances as “rotten and unsustainable for the future”.

In the run-up to the board meeting, Kummel’s group had failed to reach consensus on the proposal that at least half of the WHO’s budget should come from assessed contributions. The board agreed on Tuesday to extend the group’s mandate until May in the hope that a contribution formula can be agreed on.

The US and Japan are holdouts on increased member contributions unless the WHO guarantees to improve its financial governance.

During afternoon proceedings, US representative Loyce Pace called for a “holistic package of measures” to ensure WHO sustainable finance, that included improved governance and transparency on “current funding mechanisms, prioritisation, budget processes, improved cost efficiency and early member state inclusion in the decision-making processes”.

When Japan asked Tedros how he was going to reform WHO’s financing, particularly  “accountability and transparency and financial discipline”, he asked for the country’s support to increase members assessed contributions.

He explained that under his leadership voluntary contributions had risen from around $14m in 2017 to almost $260m – but no progress had been made on increasing assessed contributions.

However, Tedros later assured members that he was committed to increased accountability and transparency, and would deliver this.

Bjorn Kummel, chair of the Working Group on Sustainable Financing.

Transformation plan – where has it led? 

Shortly after taking office, Tedros undertook a massive transformation plan for WHO, aimed at making the organization more transparent and responsive to the needs of member states, and with more “leadership” in developing regions and countries. 

However, COVID-19 forced the WHO to shift focus from internal reforms to responding to an immediate crisis, while a temporary halt in US funding under former US President Donald Trump sparked a short-term financial crisis. 

A key element in the transformation plan, to move more funding and positions to WHO’s six regional and 152 country offices was stymied by the COVID-19 crisis. 

The pandemic also cut short a new WHO system of more regular rotations of staff in and out of headquarters to regions – along the lines of diplomatic missions – to which there was already considerable staff opposition pre-pandemic.

As a result, WHO is falling short of what has been a decades-long target for a 75%-25% split of its budget between regions and headquarters with over 30% of the total budget being spent in headquarters today.

This goal was surpassed in 2016/7, the last budget cycle before Tedros took office, when 84% of the budget was spent in regions, and only 16% at headquarters.  

The net result is the persistent under-financing of African and South-East Asian regions – which generally host the biggest disease burdens in the world. The African Region only gets 22% of WHO funding – although that is supplemented by direct bilateral support from the US and other donors through channels like PEPFAR – the US HIV/AIDS relief plan which has been a backbone of HIV/AIDs battle since 2003 – funnelling some $10.8 billion into AIDS programmes – and hybrid AIDS/COVID efforts in 2021. 

The Western Pacific (including China, Pacific Island States, Australia and Japan) receives only 4.28% of funding. The South-East Asia Region only gets 6% – about the same as the European Region – whose budget is also self-financed by EU member state contributions. In contrast, the conflict-wracked Eastern Mediterranean gets 26% of the WHO programme budget. 

The Americas region gets the least, less than 3% – although WHO support is is massively supplement by the US and other North American donors that fund the powerful Pan American Health Agency (PAHO), as a semi-autonomous agency.  

Not without reason, however, responding to health emergencies has also consumed a huge portion of WHO’s recent budget – some 41 % of resources in 2021.

UN Foundation Vice President of Global Health, Kate Dodson, sent a letter to the Board on behalf of a wide group of health organisations appealing for increased funding, which was read out on Tuesday 

The letter calls for member states to “agree to increase the share of assessed contributions to the WHO base budget to 50% by 2029”, noting that only a “sustainably financed WHO that is not subject to the political influence of its donors or the whims of funding flows can fulfill its role as the leading technical and normative international body”.

Over-dependence on short-term consultants 

Meanwhile, as things stand now, WHO insiders say that the body is overly dependent on short-term consultants that it parachutes into jobs. Approximately a quarter of WHO staff are on short-term contracts, according to insiders. 

The net result is an organisation that lacks a stable backbone of fixed-term professional staff – from entry to senior levels –  that can dare to question conventional wisdom and take unpopular positions in a large bureaucracy. 

That, along with a weak internal justice system, which was the focus of WHO Staff Association complaints at last May’s World Health Assembly, have reinforced what some WHO insiders describe as “authoritarian” tendencies in the DG’s office and Tedros’ leadership style. This, in turn, also diminishes the independent authority of his Assistant Director Generals – who are anyway all politically appointed. See Related Story: 

WHO Internal Justice Needs Reforms; Staff On “Unequal Footing” With Administration  

Ethiopia’s Permanent Representative to the UN in Geneva, Zenebe Kedebe

Ethiopia may try to disrupt Tuesday morning’s closed session of the World Health Organization’s (WHO) Executive Board meeting where the nomination of the next Director-General will happen via secret ballot.

Incumbent Dr Tedros Adhanom Ghebreyesus is the only nominee, but Ethiopia – which nominated him four years ago – has taken exception to their former health and foreign minister’s criticism of its handling of the Tigray people. 

Ethiopia’s Permanent Representative to the UN in Geneva, Zenebe Kedebe, used Monday’s opening of the board to attack his country’s famous citizen and the first African Director-General, saying that Tedros had “failed to live up to expectations”.

Despite being twice ruled out of order by the board chairperson, Kenya’s Dr Patrick Amoth, Kedebe persisted in trying to read his statement, saying that it was his “sovereign right” to make a statement.

Ethiopia had earlier sent a diplomatic note (called a note verbale) to the board complaining about Tedros, which it has alleged is abusing his position for political gain. 

However, board members had ruled before the meeting that the note would not be discussed, with Amoth noting at the start of the meeting that the note contained complicated legal and political issues.

Relations between Tedros – who has been nominated for re-election by Germany and France – and his home country have deteriorated over the Ethiopian government’s blockage of humanitarian aid to the Tigray region. 

“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,” said Tedros, who is from Tigray, at a recent media briefing.

The WHO has been unable to deliver life-saving medications for nearly six months – a situation it has described as “unprecedented” even in comparison to Syria or Yemen. 

During the afternoon board meeting, Ethiopia’s Health Minister Lia Tadesse thanked member states and the WHO for its effort against the pandemic, but scrupulously avoided mentioning Tedros.

Secret ballot

According to the nomination process, executive board members will vote via secret ballot for their candidate of choice – even although there is only one nominee.

“Board members’ delegations wishing to participate in the decision on the nomination of the candidate for the post of Director-General must be physically present at WHO headquarters in Geneva,” according to a board circular.

“This decision will be taken through a secret ballot vote on the basis of a yes or no vote. The majority required for the proposed candidate to be nominated is a simple majority of those present and voting.”

The nomination will be taken to the next World Health Assembly.

Ethiopia, which is one of the most powerful countries in Africa, has close ties with China. However, it remains to be seen whether it will be able to persuade other countries to vote against Tedros, the most public face of the global response to COVID-19.

 

Dr Cleopa Mailu, Kenya’s Ambassador to the UN in Geneva and a former health minister, speaking at the WHO Executive Board meeting on Monday

Unless a future pandemic ‘instrument’ is properly financed and legally binding, it will not be able to prevent health emergencies, numerous member states told the World Health Organization’s (WHO) 150th executive board meeting on Monday.

Speaking on behalf of Africa’s 47 member states, Kenya’s Dr Cleopa Mailu said there should be a “radical disruption” of the WHO’s programme budget, calling on the board to “take bold steps” to adopt recommendations that will improve the WHO’s financing place it “on a more stable footing as the lead UN agency for coordinating global health”.

The WHO secretariat has requested an increase of $480 million for the emergency programme alone, he noted.

Speaking on behalf of the European Union, France agreed that sustainable financing needs to be at the heart of strengthening the WHO. 

“We cannot ignore the chronic underfunding of the organisation, something that hampers its ability to step up to member state expectations,” said France’s Professor Jerome Salomon.

France also called for the WHO to operate with “increased efficiency through streamlined governance, accountability, and an executive board that is committed to increasing transparency and swift decision making”. 

Even Japan, which has been resistant to an increase in member states’ contributions to the WHO, stated its commitment to “strengthening sustainable financing of WHO”.

However, Japan also called for a “simultaneous in-depth conversation between member states and WHO to further strengthen its financial discipline and transparency”.

Limited changes to International Health Regulations 

In the past, some countries and civil society organisations have stressed that it would be more effective to strengthen the International Health Regulations (IHR) rather than creating a new structure.

Russia appears to favour this approach, asserting that the IHR – the only global legally binding rules that govern countries’ responses to health emergencies – “must remain the cornerstone of preparedness and response to health emergencies”.

However, the EU believes that stronger IHR will complement a new pandemic instrument. It is supporting a US-sponsored  resolution to the board that calls for limited amendments to the IHR to address “specific and clearly identified issues, challenges, including equity, technological or other developments, or gaps that could not effectively be addressed otherwise but are critical to supporting effective implementation and compliance of the IHR”.

Meanwhile, Germany welcomed the proposal from the WHO Secretariat for a Universal Periodic Review mechanism to monitor IHR implementation and compliance, describing it as a “potential game-changer”.

Negotiating a pandemic ‘instrument’

Austria’s Dr Clemens Martin Auer

Negotiating such an international pandemic response instrument would not be easy or quick, but it was urgent and “indispensable”, Austria’s Dr Clemens Martin Auer told the board.

Austria stressed that this instrument – also called a pandemic treaty – should be “legally binding to have full impact”, and have ”strong mechanisms” to share information and technology, especially vaccines. 

But Auer stressed that, in creating such “a new global architecture, we should avoid any motion of further fragmenting the responsibilities and competencies.” 

“When it comes to deal with matters of health emergency, we don’t need additional structures, especially when we would lose inclusivity for all member states and transparency,” said Auer.

Late last year, a special session of the World Health Assembly resolved to set up an inter-governmental negotiating board (INB) to take forward these negotiations.

France’s Salomon, speaking for the EU,  said that a pandemic treaty would provide member states with a “a common roof” to organise multi-sectoral pandemic preparedness and response.

France added that the Dutch Director of International Affairs in the Ministry of Foreign Affairs would lead European negotiations at the INB. 

“The EU and its member states look forward to the establishment of the INB, and to its first meeting in February, and for the working draft to be developed and submitted before the second meeting this [European] summer,” said Salomon.

The US and Germany both supported the inclusion of civil society in pandemic instrument negotiations – something that is opposed by Russia and China.

Katherine O’Brien, WHO director of Vaccines, Immunizations and Biologicals at the Executive Board Technical Brief.

With the delivery of its one billionth dose last week, COVAX, the WHO co-sponsored vaccine facility, has established itself as the main pillar of vaccine supplies to the world’s 92 poorest economies – providing 82% of the vaccines those nations have received so far.  

But even as vaccine supplies now ease up, huge disparities persist in vaccine uptake rate among low-income countries – with some accelerating their vaccine drives and others stagnating due both to logistical and bureaucratic barriers and slack vaccine demand.  

And even while most of the focus had been put on vaccine delivery – equally large disparities exist in COVID testing capacity – with clusters of low capacity in parts of central Africa. And that increases the risks that new variants could emerge, under the radar, later spreading to the world.  

Those were among the main messages at a WHO technical briefing to the Executive Board, holding it’s 150th meeting this week in Geneva. 

More shipping in last ten weeks than in previous ten months 

COVAX’s one billionth vaccine dose delivery signals that months of  efforts to ramp up vaccine production, procurement and delivery are finally showing results on the ground. Over the past 10 weeks, more vaccines than in the previous 10 months combined, said Kate O’Brien, WHO’s Director of its Department of Immunization, Vaccines and Biologicals, at the briefing.

But multiple challenges are still hindering the effective rollout of vaccine doses globally, she pointed out.

Some 31 countries, including many in Africa and South East Asia, are showing upward trends in vaccination rates, while another 28 remain stable.  However another 20 countries in both regions are even showing declines in vaccination rates, including countries such as Algeria, Angola and Ethiopia. 

 

“Vaccine supply has substantially improved but challenges remain around short shelf life, doses, transparency from manufacturers on the timing, the variant vaccines and whether their prioritization will be offered to all countries, and the planning on donations,” O’Brien said. 

She added accelerating vaccine delivery capacity, combining intensified efforts and focusing on those left behind are crucial in turning vaccines into vaccination. 

With the unvaccinated still at high risk of falling seriously ill from COVID-19, as well as at risk of incubating more variants, she noted that vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries. She therefore noted that boosting vaccine confidence remains at the heart of the COVAX roadmap and at the top of individual country’s priority lists. 

“The unvaccinated everywhere remain at highest risk. So vaccine demand and confidence are a limiting factor in the impact of vaccines worldwide in all countries,” O’Brien said.

She also called for an improvement in vaccine products which are presently unable to prevent infections, except for severe diseases.

“There is the need to improve vaccine products to enhance the impacts of the current vaccines. [They] are working especially against the severe end of the disease spectrum. These vaccines will reduce the risk (of severe illnesses) but don’t prevent all transmission or infections,” she added.

Inequity goes beyond vaccines

The staggering inequities in distribution are not limited to vaccines considering there are extraordinary differences across countries regarding COVID-19 testing rates, added Dr Bruce Aylward, Senior Advisor to the WHO Director-General Dr Tedros Adhanom Ghebreyesus.  While rates of vaccination in most of central Africa remain particularly low, so do test rates, he pointed out, citing recent data from accross the world. 

Vaccine rates per capita are lowest throughout central and south-central Africa (in red). Similarly, clusters of low COVID testing capacity persist in parts of the same African regions and Latin America.

“Without addressing these gaps, we cannot understand the pandemic, we cannot direct a treatment and we cannot exit the pandemic,” he said.

Despite its drawbacks, the joint donor-supported ACT-Accelerator initiative remains the only mechanism that is addressing those gaps in the global response to the COVID pandemic, Aylward stressed. Alongside the COVAX vaccine facility, the Act-A’s lesser known initiatives include arms for delivery COVID tests, treatments, and for strengthening health systems, including delivery of essential personal protective equipment (PPE) to health care workers.

“The ACT Accelerator is already making a difference. You can see the big numbers: a billion doses of vaccines, 200 million tests out, 140 Oxygen plants, half a billion dollars worth of PPEs out to countries,” Aylward said.

Act-Acclerator: summary of challenges and strategies to overcome them.

 

Going forward, he noted that the ACT-A is not only addressing inequity, it’s addressing issues of access in hard-to-reach conflict zones and corners of the world. 

“The accelerator is crucial to the goal of equitable access in exiting this pandemic. This highlights the crucial importance of the accelerator in getting tools to where they’re needed.”

Through the Global COVID-19 Access Tracker, it is also now possible to transparently track progress towards the global targets for access to COVID-19 vaccines, treatments, tests and delivering PPE, Aylward stressed.

US $20 billion is cost of exit ticket out of pandemic – but journey may not be direct

Aylward called upon donors to step up to the bat  in 2022, by responding to the new ACT-A ask for some US$ 20 billion – to fill the requirements of its new strategic plan, issued last autumn. That plans calls for resources to meet the WHO goal of 70% vaccine coverage – along with higher testing and treatment rates – and consistent access to tools like oxygen and healthworker PPE. 

Act-A strategic plan: a $20 billion pricetag

“That is the cost to exit the pandemic [and] that is less than the monthly cost of the pandemic and obviously the trillions of dollars that have gone into its management and consequences so far,” he added.

But success for the accelerator would also require the continued application of more pressure on vaccine manufacturers, Aylward said – restating a longstanding point that reliance on donations of vaccines and supplies from rich countries is unpredictable and inefficient.

The COVAX facility, crippled by the loss of AstraZeneca supplies from India last spring during the Delta wave, now has an increasingly rich array of vaccines in the pipeline – as long as history doesn’t repeat itself.

“We need your support with pressure on manufacturers, let’s be honest, to get access to the new antivirals and specific vaccines that every country in this room wants, to be able to exit the pandemic.”

Meanwhile, Mike J. Ryan, Executive Director of WHO’s Health Emergencies Programme, added that although the pandemic response plans are more robust today than a year ago, they need to remain flexible and adaptive to changing circumstances. 

“Remembering that there are real dangers with virus evolution, real dangers with the emergence of new variants, this may not be a direct A-to-B journey. We must always be ready to change and adjust our strategies to take account of the situation,” Ryan said.

Image Credits: Gavi , WHO/Act Accelerator .

WHO Director General Dr Tedros Adhanom Ghebreyesus addresses the opening of the 150th session of the WHO Executive Board Monday, 24 January

Even though the end is not yet in sight for the COVID pandemic, the world can end it as a global health emergency in 2022, says WHO DG at the opening of the 150th sesssion of the World Health Organization Executive Board.

While the world will be living with COVID for the foreseeable future, countries can end the acute phase of the pandemic this year, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus Addressing the opening session of a week-long WHO Executive Board meeting in Geneva, the DG warned that the world will need to learn to manage the virus through a sustained and integrated approach to acute respiratory diseases –  which will also provide a platform for preparing for future pandemics.

“Learning to live with COVID cannot mean that we give this virus a free ride. It cannot mean that we accept almost 50,000 deaths a week from a preventable and treatable disease. It cannot mean that we accept an unacceptable burden on our health systems when everyday, exhausted health workers go once again to the frontline. It cannot mean that we ignore the consequences of long COVID which we don’t yet fully understand. It cannot mean that we gamble on a virus whose evolution we cannot control nor predict,” Tedros said.

He added that it is dangerous to assume that Omicron will be the last variant or that the world is in the end game for the pandemic while on the contrary, globally, the conditions are ideal for more variants to emerge.

And he appealed to WHO member states to agree on a fromulat to increase their regular, fixed payments to WHO according to a proposed 5-year scale-up plan, that would give the Agency a greater ability to plan and budget rationally, warning that, if the current funding model, dependent on voluntary contributions continues “WHO is being set up to fail.  A paradigm shift in world health that’s needed must be matched by a paradigm shift in funding.”

Germany now WHO’s largest donor – says US$ 20 billion needed for vaccines, tests and treatments in low-income countries

Svenja Schulze, German Minister for Economic Cooperation & Development

The WHO Director General spoke shortly after holding a joint press conference with Germany’s new Economic Cooperation and Development Minister, Svenja Schulze, where he told reporters that Germany was now WHO’s largest donor.

“As you all know, Germany has been an important friend and longstanding partner to WHO and in fact it is now WHO’s largest donor,” said Tedros Adhanom , speaking alongside Schulze who assumed her post in Germany’s new government elected late last year.

Traditionally the United States has been WHO’s largest financial backer, contributing about US$250 million a year in “voluntary contributions” alongside about about $115 million in regular “assessed contributions” – the paid by virtually all 194 member states, according to a fixed and scaled formula.  But that was outpaced by Germany, which was contributing to the tune of about $560 million a year as of the third quarter of 2021 – most of it in voluntary contrbutions.

But Germany has emerged as one of the strongest political backers of WHO over the course of the pandemic.  Last year, Germany opened a WHO Hub for Pandemic and Epidemic Intelligence in Berlin – to step up surveillance.

And it is also leading the charge for a deeper change in the Organization’s financing formulas. According to that proposal, fixed, “assessed contributions”  by WHO member states would gradually rise to 50% of WHO’s US$ 3.5 bilion-a-year budget to ensure more predicatable funding.  Germany, along with European and other African states have been pushing hard for a clear signal on the measure at this week’s EB, but that is unlikely in light of the continued resistance from several other rich and middle-income countries, including Japan, the United States, Argentina and Brazil. See related story here.

As WHO Executive Board Meets – Handful of Countries Stall Plans to Reform WHO Finance

In the pre-EB press conference, Schulze also said she’d use Germany’s new G-7 leadership role to ensure sufficient pandemic response funding was available to low-income countries in 2022 – noting that some US$ 20 billion would be needed from donors.

“We know that around $20 billion will be needed this year to supply the poorer countries with vaccines, tests, and therapeutics. The G7 will play an important role in that organization for the world. We will be pushing for the world’s bigger economies to contribute their fair share of that financing,” she said, adding that the world needs a “massively accelerated truly global vaccination campaign – along with stronger health systems overall.

But she admitted that Germany remains opposed to a proposed World Trade Organization waiver on COVID-related intellectual property, contending that voluntary licensing of available know-how is a better way to jump start more manufacturing efforts in low- and middle-income regions.

“We are convinced that patent protection encourages innovation; it led to the development of these vaccines,” she said, adding that the world, “will need further innovations in order to deal with the further variants of COVID, but also the many other diseases that we have in the world, where we will need vaccines.” 

Dangerous to assume Omicron will be the last variant or the end game

Executive Board 150 – The 34 members of WHO’s governing body and obserers meet in Geneva in a hybrid session.

Speaking later at the EB Opening, Tedros warned that while “there are different scenarios for how the pandemic could play out…. it’s dangerous to assume Omicron will be last variant or we are in the end game. On the contrary, globally conditions are ideal for more variants to emerge.

“To change the course of the pandemic, we must change the conditions that are driving it. We recognize that everyone is tired of this pandemic,” he added.

But even if the virus becomes endemic, the world can end the pandemic in 2022 – and reduce the risks of new variants emerging with more universal COVID vaccine coverage, and the deployment of other public health measures. 

“If countries use all of these strategies and tools in a comprehensive way, we can end the acute phase of the pandemic this year,” Tedros said.

“We can end COVID-19 As a global health emergency, and we can do it this year.” 

He restated the aim of vaccinating 70% of the eligible population of every country by mid-2022 – with a focus on the most at risk groups.  COVID mortality can be reduced by enshrining strong clinical management beginning with primary health care, and equitable access to diagnostics oxygen and new oral antiviral drugs at the point of care. 

Other essential elements include the need to further increase COVID testing and genetic sequencing of virus samples globally to track the virus closely – and monitor the emergence of new variants.  Identification of new variants early on will improve countries’ ability to calibrate the use of public health and social measures when needed – as happened in South Africa with the early identification of Omicron. 

But as the world enters what is now the third year of the pandemic, a renewed focus also needs to be placed on other long-neglected health services, he emphasized.

“It [also] means restoring and sustaining essential health services. And it means learning critical lessons and defining new solutions now, not waiting until the pandemic is over. We can only do these with engaged and empowered communities,” the WHO DG said.  

Progress despite COVID

An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines, which hold promise of significantly reducing childhood infections and severe malaria, are now being rolled out more widely in Africa.

Despite the strains on global health as a result of COVID-19, the WHO DG noted that several giant strides were still recorded on several health issues in different parts of the world.

 WHO issued a historic recommendation for widespread use of the world’s first malaria vaccine, which Tedros said could save tens of thousands of young lives each year. 

“China and El Salvador were certified by WHO as malaria free last year, and the Islamic Republic of Iran recorded three consecutive years of zero in cases of malaria,” he added, noting the continued progress against elimination of what remains the world’s most deadly parasitic disease. 

He added that eight countries achieved “90-90-90” percent targets for testing, treatment access and viral suppression of HIV by the end of 2020, while a further 20 countries are close. 

Moreover, a total of 15 countries have eliminated mother-to-child transmission of HIV and/or syphilis with Botswana in 2021 becoming the first high burden country in Africa to achieve Silverchair certification on the path to elimination of mother to child transmission of HIV.

Progress was also recorded in the global fight against hepatitis, neglected tropical diseases and eradication of wild polio, he pointed out.

Health is not a byproduct of development

The WHO DG noted that the COVID-19 pandemic has shown the world that health is not merely a byproduct of development nor an outcome of prosperous societies — or a footnote of history.

“It’s the heartbeat, the foundation, the essential ingredient without which no society can flourish,” the DG said.

Considering health is dependent upon the fullest cooperation of individuals and the states, WHO DG warned that the continuing inequitable pace of development in different countries, with respect to the promotion of health and control of disease, remains a common danger for everyone.

Beyond that, he underlined that reaching “the highest attainable standard of health is one of the fundamental human rights of every human being” – echoing the vision set out in the original WHO Constitution.

Rising Tensions with Ethiopia

The DG’s speech received a positive receiption from most WHO member states – but with the notable exception of Ethiopia.

Ethiopia’s EB representative took the floor in an attack on Tedros’ his statements about the health and humanitarian situation in the countriy’s blockaded Tigray region, saying that the WHO DG was “using his office to adance his personal political interests.”

But he was cut off by EB Board Chair Patrick Amoth of Kenya who said that he was out of order since the EB had decided to set aside a  “note verbale” on the allegations, which had earlier been submitted by Ethiopia to the board. Amoth declined to disclose the full contents of the note verbale, saying it was “complicated” and fraught with legal and political implications.  

There has been a rising chorus of Ethiopian government media and social media mudslinging against Tedros and other UN groups, recent accusations against the DG of misconduct.

That comes as WHO and DG Tedros protested the Ethiopian government’s months-long blockade of the rebel Tigray region – asking officials to permit entry to humanitarian aid for medicines and other basics like insulin.  In a recent press briefing, the DG noted that the current ban on the entry of international relief workers is unprecedented even in the annals of the world’s most bitter civil conflicts.

WHO Slams Ethiopia’s ‘Blockade’ on Health Relief to Tigray Region as ‘Catastrophic’ and ‘Unprecedented’ Even in Conflict Zones

The WHO stance and DG’s comments have been widely echoed by other UN and humanitarian groups, confirming the dire situation that has left hundreds of thousands of people on the verge of starvation, as well as unable to acces medical care. But the fact Tedros is Tigrayan, as well as the sole WHO candidate running for re-election to head the agency, have left him open to personal political attack, observers say.

European Union officials recently charged that the Ethiopian state-controlled media also have been circulating “Fake News” about European humanitarian aid efforts and the WHO.

At the EB in Geneva, Kenya’s Ambassador to the UN in Geneva, speaking on behalf of WHO’s African group, also gave Dr Tedros tacit backing, saying that WHO should remain focused on it’s main health mission.

“The African member states wish to underscore the importance of WHO maintaining focus on the needs of those most vulnerable through providing the required support to member states at the country level in pursuit of their national, global commitments and the SDGs,” said Dr Cleopa Mailu, who is also a former Kenyan Health Minister.

Dr Cleopa Mailu, Kenya, speaking at the WHO Executive Board meeting on Monday

–Elaine Fletcher Ruth contributed to this story. 

Image Credits: WHO.

People wear face masks to prevent the spread of coronavirus as they commute inside a metro station amid the COVID-19 pandemic.

Experts are divided on whether or not Omicron could offer a COVID-19 reprieve.

As the Omicron wave hits its peak in parts of the world, leaving more people infected than in any previous outbreak, some scientists believe that respite is on the way, while others argue another variant could emerge that will be even more infectious or deadly than Omicron.

In the more hopeful camp, scientists say that the accumulation of population immunity – including a high percentage who will have “hybrid immunity” from vaccination and infection – could slow the pandemic at least for a while, if not forever. These experts think that after Omicron, COVID-19 could be reclassified from an epidemic to an endemic disease – a regularly circulating respiratory virus like the flu.

“We have to evaluate the evolution of COVID from pandemic to an endemic illness,” Spanish Prime Minister Pedro Sanchez said last week in an interview with a local radio station that was widely reported by English-speaking media.

On Friday, America’s Dr Anthony Fauci predicted in a White House briefing that background immunity, updated booster shots and new therapies will mean that even if a new variant developed it would “not disrupt us as much as we would have been disrupted” – a sentiment shared by Pfizer CEO Albert Bourla, who told Israeli TV over the weekend that the world should return to “near-normal” within the next few months.

Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC's Today Show in mid February.
Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, in an interview with NBC’s Today Show in mid February.

Prof Stephen S. Morse, a professor of epidemiology at Columbia University Mailman School of Public Health, told Health Policy Watch that a pandemic reprieve after Omicron crashes is not only possible but “even seems likely.”

“Omicron has proved highly transmissible,” said Morse. “Its current progress suggests that almost everyone who is susceptible will be exposed fairly soon. At that point, there won’t be enough susceptible people left to keep the infection going.”

Infection is driven by infected people who come in contact with susceptible individuals, he explained. So, the number, or relative proportion of susceptible people is a key factor.

“Once susceptibles are reduced below a certain threshold, which depends mostly on how contagious the virus is, it’s much harder for the virus to find new people to infect, and the rate of infection slows down dramatically,” Morse explained. “This is the promised land of ‘herd immunity’ we often hear about.”

There are already four known endemic human coronaviruses, which surface around the same time as the flu each year, and “we don’t know what the initial introduction of a new human endemic coronavirus looked like, but I suspect it may have been similar to what we’re seeing now with SARS-CoV-2,” Morse said. “With its high transmissibility, Omicron could well be a step on the road to SARS-CoV-2 becoming another endemic coronavirus. Historically, that seems to be how these respiratory virus pandemics ‘end.’”

He said that although immunity to respiratory coronaviruses usually does not last exceptionally long, reinfection often causes only mild or even asymptomatic disease.

“Fingers cross, but there are no guarantees,” Morse said.

‘No law dictating a virus must become milder’

Others are less optimistic.

In a nine-part tweet, Antoine Flahault, director of Geneva’s Institute of Global Health, explained that “endemic refers to a disease that is constantly present in a certain area, irrespective of severity [and] future severity remains a big unknown.

“There is no law dictating that a virus must become milder over time,” he continued. “It is very hard to predict the evolution of virulence.”

“If there is one word every scientist and policy maker must embrace right now it is humility,” Dr Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) in Minnesota, told Health Policy Watch.

He said he agrees with the idea that the world could go three to five months after Omicron with limited activity like it did last spring after the big January surge. However, he recalled how just as the world started to declare victory, along came Delta and now Omicron.

This could happen again, he said.

“We could see another variant emerge that could evade the current vaccines and could be highly transmissible,” stressed Osterholm, “we just have to be prepared for that too.”

He said the world would be better off to put its money and efforts behind better vaccines and new treatments that could manage future pandemic waves.

CIDRAP is working on a research and development roadmap for better, more effective coronavirus vaccines, though in the meantime Osterholm said getting the world vaccinated with existing jabs plays a key role.

White House Coronavirus Response Coordinator Jeffrey Zients said during Friday’s briefing that fully vaccinated individuals are 16 times less likely to be hospitalized from COVID compared to those who are unvaccinated.

Moreover, according to Centers for Disease Control and Prevention Director Rochelle Walensky, protection against infection and hospitalization with the Omicron variant is highest for those who are up to date with their vaccination, meaning those who are boosted when they are eligible.

A study released Sunday by Israel’s Health Ministry claimed a fourth dose of the Pfizer vaccine for people over the age of 60 protects three times more against serious illness and about two times more against infection compared with people who had only three doses.

Israel's Health Ministry said Sunday that people over 60 who received a fourth shot were two times more protected against Omicron infection than people who received three doses of the Pfizer coronavirus vaccine.
Israel’s Health Ministry said Sunday that people over 60 who received a fourth shot were two times more protected against Omicron infection than people who received three doses of the Pfizer coronavirus vaccine.

But Osterhold stressed, “if we have to keep boosting, we are in trouble.”

Even in the US, where booster doses are readily available, only about a third of those who got two shots are willingly getting the extra jab.

‘Hope is not a strategy’

He said that developing a universal vaccine could take years, however, so in the meantime the focus should be therapeutics.

“We need to do much more in the way of developing a global system for very rapid testing and then making it very clear that these results are returned within hours to individuals and make drugs readily available to people at high risk for developing severe disease,” Osterholm said. “This is something we could do globally and that could occur very quickly – even within a few months.”

The World Health Organization has so far approved a handful of drugs for various stages of COVID-19 and has developed a roadmap for the evaluation and approval of several others. Merck’s oral COVID-19 antiviral medication molnupiravir, which has already been approved by the US Food and Drug Administration, has already signed agreements with 27 generic manufacturing companies to make the treatment readily available in 105 countries, including middle- and low-income countries, the Medicines Patent Pool said last week.

Pfizer’s Paxlovid, which is being widely administered in the US, has also proved to stop severe infection in around 90% of high-risk patients if administered within the first five days of diagnosis.

But in the meantime, Osterholm said, “hope is not a strategy.”

And even those who are hopeful must still be cautious, Morse added.

“We can’t afford to get complacent.”

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, NBC, Israeli Health Ministry.