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

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

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

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

‘Insult to humanity’

Mike Ryan, WHO Executive Director of Health Emergencies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

State of the War

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

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

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

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

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

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

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

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

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

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

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

Over a billion people suffer from disabilities 

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

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

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

Females  With Disabilities Are More Affected 

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

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

Healthcare Inclusion is a privilege for many 

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

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

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

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

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

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

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

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

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

Image Credits: clipper round the world .

WHO’s Dr Bruce Aylward

Over 15 million new cases of COVID-19 were reported globally in the past week – by far the most cases ever reported – but deaths have remained constant since last October at about 48,000 a week, according to World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

“While the number of patients being hospitalised is increasing in most countries, it’s not at the level seen in previous waves. This is possibly due to the reduced severity of Omicron as well as widespread immunity from vaccination or previous infection,” said Tedros, addressing the WHO’s weekly COVID-19 briefing on Wednesday.

However, he stressed that while Omicron may cause less severe disease than Delta, it remains a dangerous virus particularly for those who are unvaccinated. 

Referring to the statement made on Tuesday by the WHO’s Europe director, Dr Hans Kluge,  that 50% of Europeans would be infected with Omicron in the coming weeks, WHO lead on COVID-19, Dr Maria van Kerkhove, said this was based on modelling.

“This variant is that it transmits incredibly efficiently between people,” said Van Kerkhove, but stressed that people could still protect themselves through vaccinations, masking and physical distancing.

Van Kerkhove added that the new cases were literally off the charts – the WHO had to readjust the scale of its latest graph to accommodate the explosion of cases.

WHO COVID-19 cases (11 January 2022)

WHO special advisor and COVAX representative Dr Bruce Aylward described the case increase as “absolutely staggering”. 

“We have not, in 30 years working on infectious diseases, seen an epidemic curve like this before, certainly not with a pandemic-prone virus,” he said.

“In the face of a staggering upsurge in a disease, we’re hearing two responses. One group is saying,’ Gosh, throw in the towel, let this thing immunise the world’. While the other group, led by Maria [van Kerkhove], is saying: wear a mask and get vaccinated. And the first response is the wrong choice.”

Kluge reported that there were over seven million new cases of COVID-19 in the first week of January, more than doubling over a two-week period.

“As of 10 January, 26 countries report that over 1% of their population is catching COVID-19 each week,” said Kluge.

“At this rate, the Institute for Health Metrics and Evaluation (IHME) forecasts that more than 50% of the population in the Region will be infected with Omicron in the next six to eight weeks.”

Main barriers to vaccine rollouts

Dr Kate O’Brien

Thirty-six countries have vaccinated less than 10% of their populations while 90 have not reached 40%, said Tedros.

Dr Kate O’Brien, WHO Director of Immunisation and Vaccines, said the “foundational issue” hampering these countries was the constrained and uncertain supply of vaccines.

However, O’Brien cited a number of other issues including lack of financing to roll out vaccines, weak health services, conflict and other humanitarian emergencies.

Aylward decried the “dangerous narrative” emerging in many high-income countries that some lower-income countries can’t use the vaccines or did not want them.

“If you look at the map of polio or measles [elimination] and you see that the same countries that have gotten very low coverage for COVID-19 have eliminated or eradicated polio or eliminated measles or achieve very high routine immunisation for some other diseases,” said Aylward.

“We’ve made it twice as hard or three times as hard for low-income countries to be able to achieve high coverage. We did not share vaccines for six, seven, eight months. What we did share was a lot of misinformation, a lot of bad practice, a lot of false problems.”

COVAX had recently been able to increase its vaccine deliveries to low and middle-income countries and has delivered 980 million doses.

Aylward also criticised vaccine donations with short expiry dates “which make them very, very difficult to use in complex environments”.

“These countries know how to run vaccination at scale. It’s a really tough environment they’re operating in right now. How do we fix that? Number one, we have to provide full support for the financing, for the delivery, the information support, the right products, right time frames.”

A Medical Diagnostic staff member works on the antigen tests.

CAPE TOWN – A locally produced COVID-19 rapid antigen test that was recently approved by South Africa’s medicines regulator is able to detect Omicron, according to its developer.
This follows some controversy about whether antigen tests were able to detect Omicron, and suggestions that throat swabs might be more effective than nasal swabs as Omicron affects the upper respiratory tract rather than the lungs.
But Dr Lyndon Mungur, COO of Medical Diagnostech, said that his company’s antigen test has been able to detect every COVID-19 variant, including Omicron.
“Most antigen tests detect the nucleoprotein and not the spike protein. There are only two mutations on the nucleoprotein for the Omicron variant, and both mutations are embedded in the centre of the protein, and not on the antigenic sites,” explained Mungur, a biotechnologist who helped with the research and development of the local antigen test.
“We have an ongoing clinical study program so that we can be abreast of new variants as they become evident. Our antigen tests were able to detect every one, and we also compare results to PCR tests on the same specimens,” said Mungur, adding that the Medical Diagnostech test used nasal swabs.

Cheaper than imported tests

“If current tests were able to detect at a lower sensitivity, this would only affect the very beginning and very end stages of infection. There is a very small window at the start and at the end in terms of low viral load.”
The Medical Diagnostech test is likely to be around 35% cheaper than imported tests, and it was approved by the South African Health Products Regulatory Authority (SAHPRA) in December.
Company CEO Ashley Uys said that his company “has a production capacity of 20 million units per annum”.
The company received funding from the South African Medical Research Council (SAMRC) to develop its test.
Medical Diagnostech had already developed a prototype antigen detection test, but required support to increase its sensitivity and complete the testing and approvals for market entry, according to SAMRC official Dr Michelle Mulder,
“The local ownership and manufacture of these test kits will not only increase South Africa’s self-sufficiency in a time of high demand, but also contribute to reducing the trade imbalance with respect to medical devices and local economic development and job creation,” added Mulder.
“This [antigen test] not only benefits the country but will also be made available to the rest of Africa,” said Dr Phil Mjwara, Director-General of the Department of Science and Innovation.

A few months earlier, the country’s regulator approved a locally produced PCR test.

Image Credits: MedicalDiagnostic.

WTO Director-General Ngozi Okonjo-Iweala addresses the meeting alongside General Council Chair Ambassador Dacio Castillo

The European Union (EU) has described India’s call for an urgent meeting of the World Trade Organization (WTO) Ministerial Conference to discuss the body’s response to the COVID-19 pandemic, including a proposed waiver of relevant intellectual property protections, as “premature”.

Addressing the WTO General Council informal meeting on Monday, EU Ambassador João Aguiar Machado said that while the pandemic response was important, it “must not lead to a loss of momentum on the other key components” – including “the fisheries subsidies negotiations, agreeing on a way forward on agriculture, and finalising the Ministerial Declaration with a strong commitment on WTO reform”.

General Council Chair Ambassador Dacio Castillo (Honduras) had convened the 10 January virtual meeting in response to India’s recent proposal – sent in a letter to the WTO last month. 

India and South Africa tabled a proposal well over a year ago to waive certain provisions of the TRIPS Agreement for COVID-19-related vaccines, therapeutics, and diagnostics.

At Monday’s meeting, WTO Director-General Ngozi Okonjo-Iweala urged member states to urgently step up their efforts, suggesting that “with the requisite political will, members can in the space of the coming weeks reach multilateral compromises on intellectual property and other issues so that the WTO fully contributes to the global response to COVID-19 and future pandemics”, according to a WTO statement.

“More than two years have passed since the onset of the pandemic. The emergence of the Omicron variant, which forced us to postpone our Twelfth Ministerial Conference, reminded us of the risks of allowing large sections of the world to remain unvaccinated,” said Okonjo-Iweala.

“We at the WTO now have to step up urgently to do our part to reach a multilateral outcome on intellectual property and other issues so as to fully contribute to the global efforts in the fight against COVID-19,” she added.

‘No better time than now’

The Director-General also updated members on her efforts, together with Deputy Director-General Anabel González, “to support an informal group of members to converge around a meaningful acceptable outcome that can be built upon by the wider membership to bring a successful conclusion to the intellectual property issue.” 

“It is slow but steady progress, and we are hopeful that this approach can help us together find the direction we need,” she said. “There is no better time to build convergence than now.” 

She noted that while pandemic response remained the most urgent endeavour facing WTO members, many members had reached out to her to emphasise the importance of other items on the WTO agenda, including fisheries subsidies, agriculture and WTO reform. She stressed that these areas remained priorities for outcomes, and expressed hope “that we can all agree on getting results as soon as possible.”

Describing the meeting as “useful,” General Council Chair Ambassador Castillo said he would continue to hold consultations with members on the Indian proposal, underlining “the urgency and importance of reaching a meaningful outcome.” A common WTO response to COVID-19 “remains an urgent priority for the membership,” he said.

However, the EU Ambassador Machado said that “before any decision to call a virtual Ministerial meeting and topics to be decided, we believe the WTO Director-General and the Chair of the General Council should hold consultations with Members, to assess the way forward on all four issues that I referred to”.

“Any virtual Ministerial should take place only once there is a consensus both on intellectual property rights and on the Declaration and Action Plan on the wider pandemic response,” he added.

“Only a comprehensive trade response to the pandemic can make a difference and address the identified bottlenecks as regards the production and distribution of COVID-19 vaccines such as restricted access to raw materials and other inputs as well as complex supply chains.”

 

“Including the experiences and skills of people living with disabilities in the design and delivery of health systems is fundamental to achieving #HealthForAll,” wrote World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus on Twitter last week.

His tweet was a reminder of the upcoming Thematic Pre-Summit on Disability Inclusion in the Health Sector, which takes place virtually on Wednesday (12 January). 

The pre-summit will formalize a new engagement among participants of the second Global Disability Summit, scheduled for 16-17 February, around the importance of inclusion within the health sector. Discussions around the health theme that will also feed into the larger summit taking place next month, hosted by the governments of Norway and Ghana, and the International Disability Alliance.

The pre-summit focusing on the health sector is a first, insofar as the topic of disability and health services was not part of the first Global Disability Summit held in 2018. 

Wednesday’s two-hour pre-summit will include several panels covering topics such as the need for the health sector to listen to the voices of people who live with disabilities, to how inclusion of people with disabilities could help achieve national health objectives and opportunities for international collaboration. 

The high-level line-up of speakers include WHO DG Tedros; Yannis Vardakastanis, president of the International Disability Alliance; Norwegian Prime Minister Jonas Gahr Støre; and Dr Natalia Kanem, Executive Director of the United Nations Population Fund.

Mental health to be addressed

Atmiyata’s community and volunteer-based support network for people in distress in Gujarat, India.

One other focus of the health pre-summit event will be the need to improve services for persons with mental health conditions and psychosocial disabilities. A panel on that issue will include Olga Runciman, co-founder of the Danish Hearing Voices Network.  A psychiatric nurse, she will discuss her own lived experience with schizophrenia, as well as her experience in the health sector to articulate her views about how mental health treatment needs to change to recognize and empower individuals.

“I hear voices, and I don’t want my voices to be removed or go away,” Runciman told Health Policy Watch. “But when you are given the devastating label of schizophrenia, you lose your voice, you most likely experience abuses within the psychiatric system – forced seclusion, forced medication, being tied to beds. It is really difficult to get people to hear and listen to what you are saying.”

Western psychiatry has harmed people with mental health conditions and psychosocial disabilities, she asserts. Hearing Voices and other rights-based organizations offer models for how treatment can be handled differently. Other alternative models, described in a recent report by the World Health Organization, include the “open-dialogue” approach being practiced in Western Lapland, the Atmiyata community and volunteer-based service in India, and the BET Unit, an open-door psychiatric ward in Norway, which operates around principles of voluntary choice of treatment and minimal drug use.

“The goal is that people will sign on to some of these best practices, quality-of-life programs and help people change their attitudes and to work in different ways,” Runciman said. 

Health systems often neglect people with disabilities 

The idea of bringing the topic of inclusion in the health sector into the summit came following the adoption of a landmark World Health Assembly resolution on achieving the highest attainable standard on health for persons with disabilities in January 2021. The resolution called on countries and health sector partners to move away from an exclusively medical approach to disability towards adopting a comprehensive people-centred and human rights-based approach.

Very often, health systems neglect to consider the needs of people with disabilities, organizers say.  And with around a billion individuals around the world with disabilities, inclusion is essential for countries to reach universal health coverage – something further highlighted by the COVID-19 pandemic. 

Although WHO has been working on disability and health for many years, Wednesday’s pre-summit event represents the building momentum on the issue across a range of WHO programmes, as well as the growing partnership between WHO and the international disability community. 

While the pre-summit will stay focused on disability inclusion in the health sector, the larger summit in February will tackle a broader set of themes covering: Inclusive education, health, employment and livelihood, and inclusion in situations of crises and conflict, including a focus on climate change.

Februrary’s summit will also push for countries to adopt concrete commitments contributing to successful inclusion around themes such as: access to communication and information, enabling independent living; ensuring people with disabilities can access land and property rights. 

To sign up for the pre-summit event, click here. To maximize inclusion in the pre-summit, International Sign Language and American Sign Language, closed captioning in English, as well as language interpretation in English, Spanish, French, Chinese, Russian and Arabic will be available.  

To learn more about the larger summit, visit https://www.globaldisabilitysummit.org/. 

Image Credits: Rasmus Gerdin/ Unsplash, Amiyata, Gujarat, India.

Bexlovid, the world’s first generic of the successful Pfizer antiviral, is already on sale in Bangladesh.

The first generic version of Paxlovid, the Pfizer pill that has proven highly effective in treating COVID-19, is already available in Bangladesh.

However, Indian generic company Dr Reddy’s, which has started to produce the Merck antiviral, molnupiravir, might be in trouble after the country’s National Task Force for COVID-19 resolved on Monday that there were too many safety risks associated with the drug for it to be included in national treatment protocols, according to the Times of India.

Molunpiravir, which has been shown to reduce hospitalisations by 30% in clinical trials, has also been associated with birth defects and other issues.

However, Bangladesh’s generic company Beximco started distributing its version of Paxlovid – called Bexlovid – last week after Bangladesh’s Directorate General of Drug Administration issued an Emergency Use Authorisation (EUA) for its production on 30 December.

A week earlier, the US Food and Drug Administration (FDA) had issued an EUA for Paxlovid, allowing doctors to prescribe a five-day course for adults and children 12 years of age upwards within five days of symptoms for people who “are at high risk for progression to severe COVID-19, including hospitalization or death”. This includes people with obesity, diabetes and those over the age of 60.

The antiviral is a combination of two drugs – nirmatrelvir and ritonavir – and has been found 89% effective in preventing at-risk people with mild to moderate COVID-19 infections from severe disease and death.

“Having previously introduced the world’s first generic COVID-19 treatments of remdesivir and molnupiravir, we are pleased to add this breakthrough therapy to our portfolio,” said Beximco managing director Nazmul Hassan.

“It is further testament to our commitment to making affordable treatments accessible as soon as possible. As data continues to emerge demonstrating the effectiveness of nirmatrelvir and ritonavir against the the fast-emerging Omicron variant, we believe that Bexovid has the potential to be a powerful tool in combating the ongoing pandemic.”

Nirmatrelvir inhibits a SARS-CoV-2 enzyme to stop the virus from replicating, while ritonavir slows nirmatrelvir’s breakdown to help it remain in the body longer. 

Voluntary licenses for Pfizer pill

Last November, Pfizer signed a voluntary license agreement with the Medicines Patent Pool (MPP), enabling the MPP to grant sub-licenses to qualified generic medicine manufacturers, to produce and supply Paxlovid to 95 countries, covering up to approximately 53% of the world’s population. 

According to the agreement, Pfizer will not receive royalties on sales in low-income countries and will waive royalties on sales in all countries covered by the agreement while COVID-19 is classified as a Public Health Emergency of International Concern by the World Health Organization (WHO).

Unlucky Dr Reddy’s?

After entering into a voluntary licensing agreement with Merck late last year, Indian generic company Dr Reddy’s announced this month that it will sell its generic version of Merck’s COVID antiviral, molnupiravir, for about $0.50 per capsule, or $20 for a five-day treatment course of 40 capsules – in comparison to Merck’s US price of around $700 per course.

But although India last week gave EUA to molnupiravir, the head of India’s Council of Medical Research, Dr Balram Bhargava, said that the drug had “major safety concerns” and would not be included in the country’s treatment protocols.

Meanwhile, wealthy nations have ordered around 30 million doses of Paxlovid, according to Luis Gil Abinader,, a researcher with Knowledge Ecology International (KEI), who has been tracking the orders. 

 

 

Members of a community group in Ghana vote on measures to address malaria.

In the wake of the COVID-19 pandemic, putting communities and countries at the centre in the fight against Neglected Tropical Diseases, which affect some 1.5 billion people globally, is more important than ever before. New digital health tools can help us increase transparent reporting on progress and setbacks in achieving the NTD-related Sustainable Development Goals.

The severity of neglected tropical diseases (NTDs) has been overlooked and underestimated for generations – and in the wake of the COVID pandemic, multiple WHO and other reports have revealed how longstanding prevention, diagnosis and treatment measures have stagnated or even rolled backwards in many countries.

Africa carries nearly 40% of the NTD burden. And with a disproportionate number of people and communities continuing to suffer from malnutrition, stunted growth and cognitive impairment caused by diseases like intestinal worms and lymphatic filariasis, we need to look at new ways to keep this agenda uppermost in the minds of policymakers.

More transparent, digitalized reporting of progress and setbacks can be part of the solution – insuring that NTDs remain priorities in global and continental health agendas. Digital Health Week observed in early December has reminded us of how better data can help enhance decision making and propel action.

ALMA scorecards and hub

A page from Rwanda’s digital malaria and NTD scorecard

The African Leaders Malaria Alliance (ALMA) Scorecard Hub, launched this year by Kenyan President Uhuru Kenyatta, is a game-changing digital health solution that can help revolutionise how countries and national programmes can share information.

 The hub is the first open-access platform dedicated to scorecards including on health-related NTDs, allowing countries to regularly post their scorecards on the website for every citizen to have access to the latest data. 

It also is a knowledge platform, sharing country best practices to improve scorecard management tools for accountability and action in malaria, reproductive maternal neonatal and child health (RMNCAH), and NTDs as well as online learning material.

The platform makes use of the ALMA Scorecard for Accountability and Action as well as country-owned scorecards,  which track progress, enhance community engagement, quickly identify bottlenecks and steer action in the fight against NTDs.

The ALMA scorecard, which provides key data in a colour-coded user-friendly way, is used primarily by Heads of State and Government, ministers, other high-level national leaders and key partners to strengthen accountability and action to address public health priorities.  

It tracks progress in the fight against malaria, RMNCAH, HIV/AIDS and more recently NTDs.  

Over 40 African countries have scorecards

Over 40 of Africa’s 55 countries have developed malaria, RMNCAH, NTDs, nutrition and/or community scorecards. Reviewing such scorecards, allows one to see where bottlenecks to access remain – such as children’s access to HIV/AIDS diagnosis and treatment, and in the case of NTDs, coverage of Mass Drug Administration. 

For example, the third quarter of the year illustrated strong progress in the total population living with HIV who have access to antiretroviral therapy at 64%, up from 58% in the previous year. 

The percentage of children receiving the same treatment, however, is almost half of this, at 39%. In addition, only 54% of children have access to vitamin A, despite this being a simple and cost-effective intervention. These figures highlight the notable challenges that countries in Africa face when addressing these critical diseases. As the health crisis goes beyond national borders, it must also be addressed by regional and global actors.

In the fourth quarter of 2017, ALMA in collaboration with WHO and Uniting to Combat NTDs, added the NTD coverage index to the ALMA scorecard. This is an indicator on NTDs used to track progress in the coverage of drugs distributed for the five NTDs amenable to preventive chemotherapy (trachoma, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths). 

The index is based on the geometric mean of coverage rates for those interventions for which data are routinely reported by countries to WHO and is calculated by WHO/Headquarters on an annual basis and submitted to ALMA for dissemination via the ALMA scorecard. 

To accommodate the scorecard “traffic light” system, countries are categorized as “On track” (green) when the coverage index is >75%; “Progress but more effort required”,(orange) when the coverage index between 25-75%; and “Not on track”, (red) when it is below 25%.

The 75% threshold is based on the WHO NTD Roadmap target coverage overall for the five NTDs eligible for preventive chemotherapy. The NTD coverage index is methodologically comparable to the Universal health coverage (UHC) index. The ALMA scorecard is helping to ensure that these often-forgotten diseases are visible at the highest level.

The national scorecards are composed by priority indicators selected from the national strategic plans and other country guiding documents. The data are real-time data coming from the country’s Health Information System and programmes.  

Scorecards are country-managed and used within the national systems, hosted on the Scorecard Web Platform which is an online service to manage the scorecard tool. The scorecard accountability mechanism serves to visually highlight in which specific areas countries are doing well and in which areas they are experiencing bottlenecks to facilitate action, as a key step towards identifying African-owned and led solutions. ALMA continue to maintain, support and update the online service and to train countries on the proper use of the tool.

Demonstrated to lead to better health outcomes

The ALMA scorecard has demonstrated how a data-driven approach can contribute to better health outcomes, leading to rapid policy change, enhanced donor and domestic resources, accelerated procurement to avoid stock-outs and addressing emergencies.

The Republic of Congo is an example of a country that has adopted the NTD country scorecard with positive change. The development of the scorecard there revealed supply chain problems, which allowed the Ministry of Health to react quickly and restock. 

This resulted in significant improvement of therapeutic coverage for onchocerciasis and Lymphatic Filariasis, from 79% in the second half of 2018 to 83% in the first half of 2019, illustrating the game-changing impact of this tool.

The scorecard is now incorporated in the country’s NTDs Annual Report. In 2019, using the scorecard to present the programme gaps, the National NTDs programme mobilised funds from the government and a budget line on NTDs was created with a commitment of 100,000 million CFA francs (nearly US$170,000) to support the four NTDs programmes.

Community scorecard tools

Community scorecard tools, in particular, are used to engage the community for assessment, planning, monitoring and evaluation of health services, and joint action.

Used during routine community meetings such as town halls, they allow members of the community to rate the local health facilities, using quality of care indicators such as waiting times or availability of medicines.

Actions are then taken and monitored to improve the quality of service and facilities. The Community scorecard approach is a crucial initiative in global health as it provides a mechanism for accountability that is community-owned and led.

Civil Society are critical partners

Civil Society Organisations (CSOs) are a critical pillar, working as active community agents driving change through health campaigns but also playing a powerful and critical role in health campaigns, bringing together communities for collective action, mobilizing the population to articulate demands, and voicing concerns across all levels of society. The involvement of CSOs, combined with utilising mechanisms like the community scorecards, will see an increase in accountability for countries across Africa, fuelling progress in the fight against NTDs.

The results of civil society action are evident. The CSO Network on NTDs, established in 2019 is providing a platform for CSOs to consult and collaborate to beat NTDs, with the ambition to increase sustainable funding and accelerate progress across the continent. Already the No to NTDs Civil Society Network has engaged more than 647 stakeholders across Africa. Through this network parliamentarians in Guinea are now committed to increasing the budget allocation to the National NTDs Programme, helping 6.5 million people who are unable to receive fundamental treatment in the country.

To achieve the 2030 sustainable development goal and reduce the number of people requiring NTDs treatment by 90%, greater, and more urgent action is needed. As we come to the end of another challenging year, shaken by the COVID-19 pandemic, we must make sure we are utilising all the available tools to end suffering from NTDs once and for all.

 

Joy Phumaphi is the Executive Secretary of the African Leaders Malaria Alliance. She also serves as co-Chair of the Independent Expert Review Group, for Every Woman Every Child, reporting annually to the UN Secretary General on developing country progress on Women’s and Children’s health. She also sits on the Board of several international non-profits in Global Health, including CIFF (Children’s Investment Fund Foundation); ACHAP (African Comprehensive HIV/AIDS Partnership; MMV (Medicines for Malaria Venture); RBM (Roll Back Malaria Partnership), and is an advisor for Hilleman Laboratories, the Gates Foundation Malaria Program, and the Harvard Health Ministerial Leadership program. 

 

Yacine Djibo founded Speak Up Africa in 2011 to discover and implement effective, sustainable solutions to the most challenging problems facing the African people. Focusing on strategic communications, policy and advocacy, Speak Up Africa is dedicated to empowering African leaders and citizens to take on issues such as malaria, neglected tropical diseases and sanitation in order to save and improve lives. Previously, she worked as the Senegal country director for Malaria No More, where she developed and managed high-profile national programs and campaigns to promote malaria prevention and treatment.

A Palestinian health worker administers a COVID-19 test to young child

Some researchers and governments are questioning the accuracy of rapid antigen tests to identify Omicron – and it has been suggested that rapid tests based on throat- instead of nasal swabs might be more accurate in detecting the highly infectious COVID-19 variant.

Last week, a small pre-print study reported that 29 fully vaccinated and boosted individuals who became infected with Omicron during December were diagnosed by PCR tests three days sooner on average than testing positive with antigen tests (also called lateral flow tests). 

The study, which tracked COVID-19 in five workplaces in New York and California through daily employee testing, used saliva-based PCR tests and antigen tests using nasal swabs.

Lead author Dr Blythe Adamson told Health Policy Watch that the median time from the first positive PCR to the first detectable antigen-positive test was three days and that the viral load appeared to peak in an individual’s saliva as much as one to two days before in their nasal cavities. 

“We did epidemiological investigations and contact tracing and had four confirmed transmissions in the time period between phase zero and one, when the antigen test was negative and the PCR was positive,” added Adamson.

All individuals developed symptoms within two days of the first positive PCR test results, but the antigen tests only revealed a positive result after they developed symptoms. 

UK sticks to rapid tests

The US Food and Drug Administration (FDA) recently warned: “Early data suggests that antigen tests do detect the Omicron variant but may have reduced sensitivity.” 

However, the FDA acknowledged that antigen tests “are generally less sensitive and less likely to pick up very early infections compared to molecular tests”, adding that “if a person tests negative with an antigen test but is suspected of having COVID-19, such as experiencing symptoms or have a high likelihood of infection due to exposure, follow-up molecular [PCR] testing is important for determining a COVID-19 infection”. 

Meanwhile, the UK Health Security Agency reported last month that the antigen tests it was using “indicate a comparable sensitivity [to Omicron]  to that observed for previous strains of SARS-CoV-2 including Delta, which has been the predominant strain in the UK from May to December 2021”.

Rapid tests are accurate once symptoms start

A Cochrane review of 64 studies measuring the accuracy of antigen tests published in March last year, before Omicron emerged, found that the rapid tests detected almost three-quarters of COVID-19 cases once people showed symptoms but only 58% of cases in people without symptoms.

“Tests were most accurate when used in the first week after symptoms first developed (an average of 78% of confirmed cases had positive antigen tests). This is likely to be because people have the most virus in their system in the first days after they are infected,” according to the review.

“In people who did not have COVID-19, antigen tests correctly ruled out infection in 99.5% of people with symptoms and 98.9% of people without symptoms.”

Meanwhile, in the face of its growing COVID-19 caseload, Israel recently switched to home testing, opting to reserve PCR tests for older people. However, this week it urged those who have come into contact with someone with the virus to take an antigen test 72 hours after exposure rather than 12 to 24 hours and asked people to put the swab in the throat and not just the nose.

Scientists believe that one of the reasons the antigen tests may be less effective is that Omicron infects the throat more than the lungs so throat swabs or saliva tests would be more effective.

“The method of testing only from the nose probably misses Omicron,” said Dr. Gili Regev-Yochay, director of the Infectious Disease Epidemiology Unit at Sheba Medical Center in an interview with Israeli media. “The swab should be inserted into the pharynx and from there into the nose, and only then will the sensitivity increase.”

However, most health professionals have been slow to give such advice for fear that users would swab their throats too deeply or in a way that could cause them harm. 

“You have to use the right test at the right time,” Adamson continued. “Omicron will not be the last variant. We need to make sure we are ready and able to better identify variants as they come.”

 

Image Credits: Alia Ameen/Twitter .

WHA special session in Geneva in November 2021 meets in a hybrid form to approve negotiations on a new global Pandemic Accord.

China wants to delete language supporting rapid World Health Organization (WHO) access to outbreak sites in future pandemics from a critical document that maps out a way forward in future pandemics, a diplomatic source has told Health Policy Watch.

This emerged at Monday’s start of a three-day meeting in Geneva of the global body’s Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR).

The WHO working group is negotiating over an  interim draft report summing up 131 proposals from member states, four panels and various committees on how to improve global pandemic preparedness and response.

The draft report, which also zeroes in on vaccine and medicines equity, pathogen sharing, stronger “One-Health” approaches, and “adequate and sustainable financing” for WHO, is to go before the WHO Executive Board’s 150th session, 24-59 January, for “guidance”.  Further rounds of talks are then planned for February, March and April before a final version is submitted to the 75th World Health Assembly (WHA), set for 22-28 May. 

The final report, presuming it is approved by the WHA, would then form the backbone for future intergovernmental negotiations on a new global pandemic accord. A special November session of the World Health Assembly agreed to move ahead on intergovernmental negotiations over a new legal instrument to govern preparedness and response to future pandemic threats.  

Along with China veto, other parts of draft riddled with additions and deletions 

Colin McIff, USA co-chair, along with Indonesia, of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies (WGPR)

However, in the first day of discussions, China took exception to the suggestion that the WHO should have rapid access to “relevant sites during an outbreak to facilitate public health investigations”, particularly ”explicit power to investigate”, according to diplomatic sources.

China requested Paragraph 11 (d) be deleted altogether from the report, so as to wipe out any reference at all to the issue, the diplomatic source told Health Policy Watch. It was backed by Syria, sources said.

The paragraph states in full: “The four panels and committees came to the same conclusions regarding the need for WHO access to relevant sites during an outbreak to facilitate public health investigations.  However, there was divergence over the means by which this should be implemented: some advocated that WHO should be given explicit power to investigate, while others suggested that WHO be limited to offering immediate technical support to the concerned Member State(s).

“On this topic, there has been some discussion within WGPR on this as a critical gap that needs to be addressed, while several Member States have also cautioned the need to move forward in a way that fully respects national sovereignty.”

The draft text published Monday appeared sure to undergo further significant revisions – as member states entered dozens of other proposed additions and deletions in bracketed texts, color-coded in green, sources said. 

Since WHA decisions are customarily approved by consensus, opposition by just one or two countries to a concrete measure – like onsite inspections of outbreaks – can thwart approval altogether.  

Other key recommendations in the draft report include stronger action to ensure: 

  • Timely sharing of pathogens and genomic sequencing data;
  • Sustainable financing for pandemic preparedness; 
  • A “One Health” approach to preparedness that recognizes how environmental degradation, animal health and zoonotic diseases can feed outbreaks; 
  • “Equitable and timely access to countermeasures, including personal protective equipment, diagnostics, therapeutics and vaccines;”
  • More investments in R&D along with “effective and scalable supply chains”;
  • “Timely technology transfer”, including knowledge sharing. 

The recommendations were drawn from a series of external reviews of pandemic responses conducted over the last year. These include reports by: the Independent Panel for Pandemic Preparedness and Response, the Review Committee on the International Health Regulations (IHR) during the COVID-19 Response, and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme.

China also standing fast on its refusal to allow further investigation of SARS-CoV2

Zeng Yixin, Vice Minister of the National Health Commission, at a press conference on 23 July 2021, slamming proposals for another WHO mission to China to investigate the origins of SARS-CoV2.

China has long been at odds with the WHO and member states, and particularly the United States, over its refusal to allow a second phase of on-site investigation into the origins of the SARS-CoV2 – in Wuhan and elsewhere. 

It also has refused a panel of scientists convened by the WHO access to Chinese medical and other records related to the outbreak in Wuhan.

In July, Zeng Yixin, China’s Vice Minister of the National Health Commission, described the WHO’s proposal for a more rigorous Phase II investigation of the origins of the SARS-CoV2 virus, including renewed consideration that the virus may have escaped from a laboratory, as “impossible” at a press conference.   

“We will not accept such an origin-tracing plan as it, in some aspects, disregards common sense and defies science,” said Zeng at the press conference organized by the Chinese State Council Information Office. 

Pandemic ‘instrument’ agreement

The working group of WHO member states, co-chaired by Indonesia’s Ambassador Grata Endah Werdaningtyas and the USA’s Colin McIff, deputy director of Global Affairs in the US Department of Health and Human Services, was widely credited with brokering last year’s historic agreement on the need for a global instrument to improve the world’s response to future pandemics.

Virtually all 194 member states committed to negotiating a new global accord to guide the response to future global pandemics at the WHO’s World Health Assembly Special Session (WHASS).

Equity recommendations also a lightning rod

The reference to on-site investigations was not the only clause in dispute in the report today. 

Most other paragraphs in the draft report were also being red-marked extensively, with proposed additions and deletions by various member states. 

Section 12 (d) addresses equity, for instance, and the draft Working Group report states that “Member States agree that equity is critically important for global health both as a principle and as an outcome”.

“Member States emphasized that equity is essential in particular in prevention, preparedness and response to health emergencies, including with respect to capacity-building, equitable and timely access to and distribution of medical countermeasures and addressing barriers to timely access to and distribution of medical countermeasures,” the report notes.

It also noted that “related issues such as research and development, intellectual property, technology transfer and empowering/scaling up local and regional manufacturing capacity during emergencies to discover, develop and deliver effective medical countermeasures and other tools and technologies,” were important.

A civil society representative monitoring the session indicated that the United States wanted to add the word “voluntary” sharing of licenses “on mutually agreed terms” to that text. Low-income countries such as Ghana, meanwhile, stressed that “equity is a priority” as member states ploughed word by word through the language. 

The equity language is additionally charged in light of the ongoing push by over 100 countries, led by India and South Africa, to approve a waiver of intellectual property rules in the World Trade Organization that would also facilitate more compulsory forms of tech transfer during the pandemic.  

In addition, Argentina pointed out that there needs to be stronger equity rules around the sharing of pathogens, from which new vaccines and medicines are typically developed. 

It proposed that the text on equity include reference to “the fair, and just participation in the derived benefits of the use of the exchange of pathogens”. 

Image Credits: China Daily.