Panelists at the closing session of the European Health Forum Gastein (EHFG) on Friday.

A new social contract between European governments and their citizens is needed to lay the foundation for a resilient and sustainable recovery from the COVID-19 pandemic, with health at the center, said panelists at the closing session of the European Health Forum Gastein (EHFG) on Friday.

A focus on ensuring social protection and equitable access to healthcare, employing the One Health approach in policies, and strengthening WHO would be essential to tackle the inequities and shortcomings in preparedness and response at national and global levels revealed by COVID.

“We can’t go back to the old normal, we do need a new normal for WHO, for the European Union. It’s not an option to continue with old fashioned health politics or policies. We have to rise like a phoenix,” said Clemens Martin Auer, President of the European Health Forum Gastein, referencing the theme of this year’s conference, “Rise Like a Phoenix” – Health at the Heart of a Resilient Future for Europe.

“We cannot have resilient health systems if we don’t change how our societies and our politics are operating,” said Auer. 

The world must take advantage of the momentum behind health at the moment to push for investment in health systems and innovations, reform of WHO, and prioritization of equitable access to healthcare.

“The issues concerning health have now reached such a high degree of attention that it is impossible for policymakers to neglect them,” said Professor Mario Monti, former Prime Minister of Italy and Chair of the Pan-European Commission on Health and Sustainable Development. “To avoid shifts in discussions, we need institutional structures and policy  processes to help keep the momentum we now have on health going ahead.” 

“We have to keep health in the driver’s seat for the future,” said Auer. 

Clemens Martin Auer, President of the European Health Forum Gastein.

Adopting One Health policy and improving global health governance

Putting health systems on a trajectory to be better prepared to combat future threats will require a One Health approach and the global coordination of health policies, said the panelists on Friday. 

Developing a One Health-based understanding of health is critical to preparing for and addressing future health threats in the animal, human and environment interface, said Monti.

One Health means the design and execution of programmes and policies in which multiple sectors work together to achieve better public health outcomes. Examples include working with the food, agriculture and livestock sector to prevent zoonotic diseases from leaping to  human populations; and working with transport and energy sectors to curb health-harmful air pollution and climate change. 

Operationalizing the concept of One Health at national, regional, and global levels was one of the main objectives from the recent Pan-European Commission on Health and Sustainable Development report published in early September.

The report reflects on the WHO European region’s response to COVID and makes a series of recommendations for the 53 WHO member states in the WHO European region. 

“Our recommendations design a new strategy for health and sustainable development. This requires awareness of the interconnections between human, animal and plant health and their impact on emerging zoonotic diseases; of the links between climate change, biodiversity and human health; and of the need to reinvigorate and extend our national health services,” said Monti.

Professor Mario Monti, former Prime Minister of Italy and Chair of the Pan-European Commission on Health and Sustainable Development.

National governments are encouraged to establish structures to develop cross-government One Health strategies; international agencies, such as WHO, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the UN Environmental Programme (UNEP), are urged to strengthen mechanisms for collaboration; and coordinated action at all levels to reduce environmental risks to health is advised. 

Empowering WHO to assess national emergency preparedness more rigorously

This should be accompanied by efforts to strengthen the WHO – empowering the organization to conduct periodic assessments of national health systems and assess their emergency preparedness and response capacity. 

At the regional level of WHO, a Pan-European Network for Disease Control is proposed to provide rapid and effective responses to emerging threats and to improve health governance in the European region. 

In addition, the report recommends that a Pan-European Health Threats Council is established to enhance and maintain political commitment and to ensure cooperation and accountability between governments.

“We believe that this will be quite a powerful response in terms of adapting our institutions to the huge transnationality of health phenomena that we have seen in the course of this pandemic,” said Monti.

“At the global level, we need to keep all the responsibilities for health with the WHO and strengthen and make WHO more accountable and independent,” said Monti. 

Global coordination of health, economic, and financial policies would be improved by the establishment of a Global Health Board under the G20 – an intergovernmental forum comprising 19 countries and the European Union.

The proposed Global Health Board could support the development of health risk assessment tools and the mobilization of financial resources, ultimately enhancing the “systematic coexistence of the world of health and the world of finance,” said Monti.

“Unless health policy is put more at the center of, let’s say, the table of the Council of Ministers of national governments and global institutions, then we will not make much progress,” said Monti.

Image Credits: EHFG.

Sanofi faces calls for technology sharing after deciding to abandon its promising mRNA COVID-19 vaccine candidate.

Following news that Sanofi, a French pharma company, will abandon its promising mRNA COVID-19 vaccine candidate, Médecins Sans Frontières (MSF) called for the corporation to transfer the vaccine technology and know-how to the WHO-led COVID-19 mRNA vaccine technology transfer hub in South Africa.

Despite the existence of two approved mRNA vaccines and 13 candidates in advanced stages of development, the WHO mRNA hub has yet to receive any technology transfers.

Any mRNA know-how shared with the WHO hub could save time and help the hub’s efforts towards developing a safe and effective mRNA vaccine for low- and middle-income countries, said MSF.

In spite of publishing positive Phase 1/2 study interim results for its vaccine candidate, Sanofi announced on Tuesday that it would not pursue its development due to the dominance of the mRNA COVID-19 vaccine market by Moderna and Pfizer/BioNTech.

“Transferring Sanofi’s mRNA platform to the WHO hub could boost and accelerate the hub’s R&D efforts by giving access to the technical and clinical data generated by Sanofi thus far,” said MSF’s statement. “If successful, the hub would then assist multiple able manufacturers in low- and middle-income countries to start production of COVID-19 and other mRNA-based vaccines for the current and future pandemics.”

“Less than one percent of mRNA vaccine deliveries has reached the poorest half of the world, while willing and able producers in low- and middle-income countries are desperately requesting to access the needed technology and know-how from corporations in high-income countries, to no avail,” said Alain Alsalhani, Vaccines and Special Projects Pharmacist at MSF’s Access Campaign.

The transfer of technology could allow low- and middle-income countries to no longer be entirely dependent on the vaccines produced in high-income countries and would enable their populations to be protected from vaccine-preventable diseases at the same time as people living in high-income countries.

Image Credits: Sanofi.

An infant receiving the RTS,S malaria vaccine in Ghana in 2019. Childhood vaccination campaigns continued to protect against preventable diseases during the pandemic due to healthcare workers.

New statistics from Gavi, the Vaccine Alliance show that routine immunisation programmes have been hit hard by the COVID-19 pandemic. However, the latest data shows that there is extraordinary resilience in immunisation systems, with governments’ efforts to keep childhood vaccinations going despite the impact of the pandemic paying dividends.

In the face of the pandemic, routine and childhood vaccinations held fairly strong, with routine immunisations dropping only 4% over the course of 2020.

Vaccination rates in 2020 were characterised by a significant drop from March to May, but were followed by a strong rebound due to the work of governments and healthcare workers in lower-income countries.

Gavi’s Annual Progress Report shows that there are now 13.7 million “zero-dose” children in the 68 Gavi-supported countries receiving no immunisations. Many of whom live in marginalised communities in rural areas, urban slums, or conflict settings.

“COVID-19 represented a major challenge to childhood vaccination – with parents afraid to venture out to clinics and health care system capacity stretched to deal with a major influx of patients,” said Dr Seth Berkley, CEO of Gavi. “That Gavi countries saw such continuing strength in their vaccination systems is testament to an unprecedented effort from governments, Gavi, WHO, UNICEF and other Vaccine Alliance partners to shelter immunisation programmes from the worst effects of the pandemic.”

See full story here.

Image Credits: WHO.

insulin, an essential medicine
Insulin, a lifesaving treatment for those with diabetes, remains difficult to access and afford in low- and middle-income countries

The World Health Organization published the latest edition of its Model Lists of Essential Medicines (EML) on Friday, making a sweeping move this time to include long-lasting insulin analogues as essential drugs that national health systems should incorporate into their services. 

The decision reverses the EML Expert Committee’s 2019 decision, rejecting the inclusion of insulin analogues – on the basis that these higher-priced formulations could negatively affect access to lower-cost human insulin products. 

The EML, first developed by WHO in 1977 and updated every two years in consultation with experts worldwide, provides a baseline of guidance to national health authorities on the products and services that should be made most widely available. 

Although the prevalence of diabetes has nearly doubled over the past 30 years, rising faster in low- and middle-income countries, high prices have kept many from accessing essential treatments, traditionally involving human insulin, produced by only three firms worldwide. 

This led industry as well as some access advocates to propose WHO’s incorporation of newer “insulin analogues” an altered form of human insulin that can be used to treat Type 1 diabetes, to drive competition and lower prices.  The proposals drew controversy even prior to their rejection in 2019.

Scientific experts, civil society, and patient groups had met the proposal to include analogues in 2019 with stiff resistance, fearing that mainstreaming the newer drugs, which are more expensive, into the EML, could ultimately drive up prices for developing countries. 

But two years later, the use of analogues has expanded much more, while prices have decreased, with treatments no longer under patent protection in many countries. In settings where cost containment and efficient negotiations with insulin producers are in place, prices for insulin analogues are decreasing and aligning with those of human insulin.

This year’s EML decision reverses the 2019 recommendation 

That laid the groundwork for the EML expert committee to reverse their position in this year’s edition of the EML, which is issued every biennium, for almost exactly the same reason – to make insulin more affordable by promoting more insulin alternatives. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus noted that the inclusion of insulin analogues is a ‘step’ in the right direction towards ensuring affordable access to a  lifesaving treatment that only about 50% of an estimated 100 million people requiring insulin, are able to receive, according to a 2017 study led by Health Action International. 

“Too many people who need insulin encounter financial hardship in accessing it or go without it and lose their lives,” said Tedros. “Including insulin analogues in the Essential Medicines List, coupled with efforts to ensure affordable access to all insulin products and expand use of biosimilars, is a vital step towards ensuring everyone who needs this life-saving product can access it.”

Prior rejection of analogues due to high price concerns 

Echoing Tedros’ statement, the EML committee stressed that further price containment measures still need to be pursued to make insulin of all types more widely available: 

The Committee noted the ongoing concerns of some access groups on the effects of including insulin analogues into the EML, stating: 

“[The similar clinical benefits of long-acting insulin analogues and human insulin] make the large price differential between insulin analogues and human insulin difficult to justify…“The Committee was unequivocal that affordable access to human insulin remains a critical priority, globally.”

Another First – EML thrusts high drug prices to forefront of essential medicines debate 

The Committee’s inclusion of long-acting insulin analogues also comes with another unprecedented move – the recommendation of establishing a standing EML Working Group on highly-priced essential medicines, fulfilling long-standing aspirations of medicine advocacy groups that wanted prices to be highlighted more in the EML. 

“[The EML] has never been so explicit about pricing,” said Thiru Balasubramaniam, Geneva Representative for Knowledge Ecology International (KEI), in an interview with Health Policy Watch

“They usually just list medicines and then talk about the reasons for inclusion for each one, but I can’t remember a time when there was a section that basically highlighted the effect of highly-priced medicines.”   

One of the tasks of the Working Group is to be: “the development of a strategy to monitor price and availability trends of essential but unaffordable medicines, to be proposed as part of the next WHO General Programme of Work.” 

For over a decade, advocacy groups such as Knowledge Ecology International (KEI), have pushed the EML to include a section on essential, but unaffordable medicines, making this new recommendation from the Committee a strategic success.   

“[KEI] has asked several times to create a category in the EML, of products that would be essential, if affordable. Now, as someone who has worked on this for over a decade, this is it,” Balasubramaniam said.

KEI had recently advocated for the new category back in June, during the two-week meeting of the Committee.  

Prioritizing cancer treatments and new indicators for cancer 

Cancer medicines were also a priority for this updated EML

In addition to including insulin analogues, the Committee also recommended 20 new medicines to the EML and 17 new medicines for the Essential Medicines List for Children (EMLc), prioritizing treatment for various cancers. 

Four new medicines for cancer treatment were added to the EML:

–    Enzalutamide, as an alternative to abiraterone, for prostate cancer;

–    Everolimus, for subependymal giant cell astrocytoma (SEGA), a type of brain tumour in children;

–    Ibrutinib, a targeted medicine for chronic lymphocytic leukaemia; and

–    Rasburicase, for tumour lysis syndrome, a serious complication of some cancer treatments.

Enzalutamide, also known as Xtandi, was part of a lawsuit from the University of California against generic production in India in 2019. 

UCLA, which originally developed the treatment in 2006, later sold and licensed rights to manufacture and market the drug to for-profit pharmaceutical firms, with those rights eventually acquired by the US-based Pfizer and the Japanese-based Astrellas.

The listing for imatinib was extended to include targeted treatment of leukemia. Additional childhood cancer indicators were also added for 16 medicines already listed, including low-grade glioma, the most common form of brain cancer in children.

The updated list also has new formulations of medicines for common bacterial infections, hepatitis C, HIV, and tuberculosis, to meet dosing and administration needs of both children and adults. 

Médecins Sans Frontières calls for even more action from WHO and pharma companies on insulin access 

While Médecins Sans Frontières/Doctors Without Borders (MSF) welcomed the addition of more insulin products to the EML, the group urged WHO and insulin companies to take an even stronger stance on ensuring access to these medicines. 

“We hope that the WHO and companies manufacturing insulin will waste no time in ensuring the availability of more affordable quality assured biosimilar insulins to meet people’s growing need for this life saving medicine,” said Candice Sehome, Advocacy Officer in the MSF Access Campaign. 

“It is preposterous that this medicine discovered 100 years ago still remains inaccessible to half of the people who need it.”

“Unless the price of all types of insulin and the medical supplies required to inject and monitor this treatment comes down, governments will continue to struggle to manage this controllable disease and people with diabetes will keep dying.”

Image Credits: WHO, WHO.

International passengers arriving at London’s Heathrow Airport border control – quarantine rules now based on where they were vaccinated, and not what vaccine they received.

IBADAN – Following new travel policies that discriminate against vaccinated travellers from African countries, as compared to their European, Asian and Middle Eastern counterparts, African health officials have demanded clarifications, and accused the UK government of potentially festering vaccine hesitancy on the continent.

A British government’ plan to drop a 10-day quarantine requirement for fully-vaccinated travelers arriving from Europe, North America, and a handful of Asian, Middle Eastern and Caribbean countries – but excluding vaccinated Africans, Indians, Latin America and other low- and middle-income nations – has been met with confusion and condemnation alongside calls for calm and clarification.

The new rules, set to take effect Monday, 4 October, will discriminate between the recipients of COVID-19 vaccines, not based on the vaccine received, but on the region in which these vaccines were received — a development which the Africa Center for Disease Control and Prevention (Africa CDC) described as deeply concerning.

“We are deeply concerned that policies and rules such as this carry a risk of deepening vaccine hesitancy across Africa and creates distrust in the community,” Africa CDC said in a statement.

World Health Organization – Still Seeking Clarifications 

Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO’s Regional Office for Africa.

Dr Richard Mihigo, WHO’s Program Area Manager for Immunisation, said the global health body is still seeking clarifications regarding the issues.

“We are still consulting to find out what the real issue is. It looks like the issue is not the vaccine itself but the documentation around the vaccine,” Mihigo told Health Policy Watch, in response to a question at an WHO African Region briefing Thursday. 

The imbroglio is proving to be a major embarrassment for the UK, which is a leading  contributor to the COVAX global vaccine facility, a crucial source of vaccine doses for African countries. 

COVAX is receiving 80% of the 100 million doses of COVID-19 vaccines that the UK is donating to low- and middle-income countries, mostly in the African region.

But the new ruling now means that recipients of its donated vaccines, won’t be recognized as vaccinated if they travel to the United Kingdom. 

“The UK is one of the countries that have provided vaccine donations to countries in the region. So it cannot tell those countries that are using vaccines from the UK that those vaccines are not valid,” Mihigo told Health Policy Watch. He added that the UK policy casts aspersions on Africa’s vaccination programme – even though the continent has been successfully vaccinating its people long before COVID.

“We’ve eradicated wild polio virus on the continent, many diseases have been controlled with a very vaccination programme. The issue is not about the reliability of our vaccination programme so we are trying to understand very well what the circumstances around that are,” he added.

‘Phased Approach’ to recognising vaccine certificates in absence of WHO global policy

Absence of a single WHO policy has left to each country to decide for itself which country’s vaccine certificates to recognize.

Mihigo stressed the importance of ensuring that Africans are not discriminated against nor are prevented from moving freely.

“Indeed anything that can prevent free movement of people, particularly in this time where countries are struggling to put the economy back on track is something that we should avoid,” Mihigo concluded.

But so far, the WHO has also rejected the creation of any unified vaccine certification  programme for international travelers – on the grounds that vaccine certificates shouldn’t be used at all in travel, until more of the world is immunized.  And that has left countries to fend for themselves in terms of determining the validity of other country’s vaccine certificates.

In the absence of a global policy, UK, officials told media that they were taking a “phased approach” to recognising vaccine certificate of other countries that are not on the UK “red list” – from which international travellers may not enter at all, unless they have UK citizenship or residency.

So far, vaccinated travellers entering  just 18 countries, along Europe, can have their vaccine certificates recognised officially, and thus avoid the 10-day quarantine. Those include Australia, Antigua and Barbuda, Barbados, Bahrain, Brunei, Canada, Dominica, Israel, Japan, Kuwait, Malaysia, New Zealand, Qatar, Saudi Arabia, Singapore, South Korea, Taiwan, and the United Arab Emirates (UAE).

Discrimination fuels vaccine hesitancy in Africa  

African public health experts worried that as news of the UK government policy gets more attention, it will also worsen vaccine hesitancy on the continent; the general public may wrongly believe that the policy directions of the UK government imply that vaccines being administered in Africa are not effective or are different from the ones being given to people in the UK and other developed countries.

“They are making it very difficult for us to do our job when they issue those conflicting policies,” Taiwo Abayomi, a community health worker in Nigeria, said in an interview with Health Policy Watch.

Even as health officials strive to convince Africans that the vaccines are safe, such restrictions make it easier for fake news and misinformation to quickly spread, she said.

But it is not only African countries that should be worried officials stressed; developed countries will still be at risk if vaccination efforts falter in Africa due to policies in the global north. 

Fortunate Bhembe, the Kingdom of Swaziland’s Deputy Director of Pharmaceutical Services told Health Policy Watch that the UK and other foreign governments need to be reminded that as long as the pandemic does not get in control everywhere, their country would also be at risk.

“If other countries are not doing well with vaccination, no one is safe. So we have to help each to ensure we vaccinate as many people as possible so as to ensure the safety of everyone. We are liaising with our partners including the UK government in this regard,” Bhembe said.  

Forging ahead


Despite the concerns that the UK government’s travel restrictions could impact Africa’s vaccination plans, and in spite of unavailability of enough doses of the vaccine, the continent continues to expand its vaccination approaches.

On Thursday, the WHO announced that 15 African countries representing nearly a third of the continent’s 54 nations, have fully vaccinated 10% of their people against COVID-19 — meeting the global goal of fully vaccinating 10% of every country’s population by 30 September, the goal was set in May 2021 by the World Health Assembly.

Seychelles and Mauritius have fully vaccinated over 60% of their populations, Morocco 48% and Tunisia, Comoros and Cape Verde over 20%. However, most of the African countries that have met the goal have relatively small populations and 40% are small island developing states.

However, meeting the more ambitious 40% vaccination goal set by WHO for 31 December remains a challenge.  

“The latest data shows modest gains but there is still a long way to go to reach the WHO target of fully vaccinating 40% of the population by the end of the year. Shipments are increasing but opaque delivery plans are still the number one nuisance that hold Africa back,” Mihigo said.

Image Credits: @HeathrowAirport/capt_saini, @HeathrowAirport/AndrewFell .

African drug innovation will get a boost with new partnership.

CAPE TOWN – A drug discovery and development centre based at the University of Cape Town (UCT) has joined forces with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) to strengthen health innovation in Africa.

The three-year partnership announced this week will focus on driving capacity-strengthening for drug discovery and development in Africa by scaling existing initiatives and identifying new opportunities for young and mid-career African scientists.

“The University of Cape Town Holistic Drug Discovery & Development (H3D) centre is the only integrated drug discovery and development platform in Africa,” said Professor Kelly Chibale, who heads both H3D and the H3D Foundation (H3D-F).

“Over the last 10 years, H3D has proven itself as a platform to develop world-class infrastructure, talent, and health innovation that will contribute to improving lives not only in Africa, but all over the world. We are ready to take our work to the next level through partnership and collaboration with key organisations like IFPMA, strengthening capacity far beyond H3D.” 

Chibale, who is a professor of organic chemistry at UCT, is leading research on treatment solutions designed for, and tested on, Africans – rather than western-developed medicine tested on Caucasians that may not be optimal for people with different genetic make-up.

READ MORE ABOUT H3D:

https://healthpolicy-watch.org/south-african-liver-project/

 

H3D-F, which was established to build on the success of the H3D’s capacity development programmes, aims to position Africa as a global player in innovative pharmaceutical R&D by building infrastructure as well as the skills of African scientists and researchers. 

The IFPMA will be an “anchor partner”, offering short- to mid-term support to increase awareness of H3D-F activities to develop and strengthen the capacity of human resources for health innovation in Africa. 

It will also facilitate networking and visibility across the innovation ecosystem through its membership and offer opportunities for collaboration from drug development to market. 

“Global product development research, driven by local needs, is pivotal to achieving shared global goals,” said Greg Perry, Assistant Director-General of the IFPMA. 

“Some of our partners, including Johnson and Johnson, MSD, and Novartis, already work with H3D. With H3D-F, now is the time to forge long-term relationships that lay the foundation for scientific coordination, communication, and discovery in Africa. IFPMA is proud to support H3D-F’s efforts.”

Africa only conducts approximately 2% of world research on new infections, despite shouldering 20% of the global disease burden.

The COVID-19 pandemic has highlighted the urgent need to bolster Africa’s ability, including its drug innovation capabilities, to face future health emergencies. 

While the continent is better prepared now to contribute to new healthcare threats as they emerge compared to a few decades ago, the disease focus remains narrow and is often not fully aligned with regional priorities. 

In addition, the continent needs “an integrated health innovation ecosystem, investment in robust infrastructure, technology platforms, a critical mass of skilled talent, and job creation”, said Chibale.

While Africa currently hosts over 250 research sites and 73 vaccine clinical trials, fewer than 10 universities offer vaccinology courses and only two local universities engage in vaccine-related pre-clinical studies. 

 

Image Credits: PATH/Eric Becker, Moderna, INC.

Healthworkers raise awareness of Ebola virus in the community in Beni, DRC. Massive recruitment of a predominantly male emergency teams, inadequately screened or trained, created the conditions for sexual abuse to flourish alongside the virus, the Independent Commission found.

A WHO independent commission concluded  that 83 emergency responders to DR-Congo’s 2018-2020 Ebola outbreak, including some 21 WHO employees and consultants, had likely abused dozens of Congolese women, obtaining sex in exchange for promises of jobs – also raping nine women outright.  

But the panel’s findings, which validate reports first published in September 2020 in an investigation by the New Humanitarian and Thomson Reuters Foundation, were billed as only a first step of investigations  – with no judgments or sentences meted out – or high-level WHO managers yet named as accountable.  

“Acts took place in hotels and in other cases in houses rented by the presumed perpetrators.  Most of the victims heard by the review team were women – but 12 men also said they were victims of sexual abuse and exploitation,” said Malick Coulibaly, a former Minister of Justice of Mali, speaking at a press briefing on Tuesday. 

Coulibaly was one of the members of the five-person panel commissioned to investigate claims by some 75 women, against 25 WHO staff and other UN workers, during the 2018-2020 Ebola crisis in Ituri and North Kivu provinces.

An inquiry directed by the commission interviewed some 3063 women witnesses, aged 13-43 years, along with 12 men – all alleged to have been exploited and abused by the Ebola response teams that included about a dozen other UN organisations and NGOs, coordinated by WHO with the DRC government. 

WHO Africa Regional Director Matshidiso Moeti, who personally supervised much of the massive WHO response to the deadly Ebola outbreak in DRC’s North Kivu and Ituri provinces that killed some 2299 people, said the report had left her “humbled and horrified.” 

Field Staff recruited without background checks 

Malick Coulibaly, former Minister of Justice and President of the National Human Rights Commission, Mali.

The circle of sexual abuse cases multiplied as large numbers of local and international staff were recruited by WHO to combat the outbreak – “without call for tender “& without background checks”  Coulibaly said. 

He recited a long litany of allegations first reported in the press and confirmed by the commission, including rape, perpetrators’ refusal to use protection, forced abortions, and intimidation: 

 “Victims were promised jobs in exchange for sexual relations, in order to be able to keep their jobs.” Coulibaly said. 

“Most victims were in a very precarious, economic and social situation during that response. Very few had completed secondary education, some had never gone to school at all.  

“Most victims did not get the jobs that they were promised in spite of the fact that they agreed to sexual relations. Some women declared that they continue to be sexually harassed by men. And they were obliged to have sexual relations to be able to keep their job, or even to be paid, and some were dismissed for having refused sexual relations, 

The WHO perpetrators included staff medical officers and consultants recruited both locally and internationally – as well as some drivers and security personnel, the commission found, 

In 29 of the cases investigated, Congolese women became pregnant at the hands of their abusers, with 22 women giving birth while others were forced by their abusers to abort, Coulibaly added. Nine victims also said they were raped. 

“In spite of poignant narratives of the SEA victims, most perpetrators denied the facts & even stated that the sexual relations were consensual,” added Coulibaly. “Everything contributed to increased vulnerability of the alleged victims – they did not benefit from aid and assistance.” 

Higher-level WHO coverup? Report Leaves questions unanswered 

WHO Director General Dr Tedros Adhanom Ghebreyesus

WHO’s Director General Dr Tedros Adhanom Ghebreyesus called it “harrowing reading” and said he held himself personally responsible. 

But Tedros, who visited DRC 14 times during the Ebola outbreak, also said that he had never heard word of the widespread abuse when he was in DRC on the ground.

“The issue was not raised to me, probably I should have asked questions. As for the next steps.  What we’re doing is we have to ask questions,” he said.

In the written report published Tuesday, the Independent Commission said that it had “”no information at this time that would give rise to personal responsibility on the part of Dr Tedros Ghebreyesus, Dr Michael Ryan or Dr Matshidiso Moeti in relation to wrong handling of incidents of sexual exploitation and abuse by WHO staff or in relation to allegations of sexual exploitation and abuse published in the press.”

Investigation of any senior WHO staff left to WHO internal justice  

Aïchatou Mindaoudou, former Minister of Foreign Affairs and of Social Development, Niger.

All but four of the WHO staff and consultants alleged to have been  directly involved in the abuse were no longer working for the organization – and those last four were recently terminated, the director-general added, noting many of the alleged abusers were on short-term emergency contracts in the first place.  

Two senior WHO staff also have been placed on leave while an investigation proceeds about their possible role in alleged cover-up of the sexual abuse activities in DRC, Tedros also confirmed. “And we have taken steps to ensure that others who may be implicated are temporarily relieved of any decision-making role.”   He did not name names.

But the Commission’s work, which included over 3,000 interviews on the ground in DRC, stopped short of detailed examination of WHO staff in Geneva or regional offices, who may have sanctioned or protected colleagues involved in the abuse. 

“We did not know, at the beginning of our investigation, that there were some at higher level, who were aware of what was going on, and did not act.  We only discovered this during our investigation,” said Dr Aichatou Mindaoudou, a UN special representative in the Ivory Coast, and Commission co-chair.  

Julienne Lusenge, DRC human rights activist and commission co-president.

Julienne Lusenge, the Commission’s other co-chair, said the group’s mandate had been to confirm the existence and extent of the sexual abuse allegations, first reported in the media September 2020 and again in May 2021. It lacked any mandate to judge and mete out sentences to the perpetrators.   

“It is now up to the WHO,” Lusenge said. “They are going to have a mechanism to be in charge of a deepening investigation … it is not up to us to say this person should be arrested and sentenced.”

The Commission did recommend, however, a range of follow-up measures, including reparations to victims, genetic testing of alleged abusers and their  offspring, as well as  an overhaul of WHO hiring practices and sexual exploitation and abuse (SEA) training, as well as of the ways in which the internal justice system responds to alleged victims with claims.

Speculation about high-level WHO cover-up has revolved mostly around the WHO Emergencies Official, Michael Yao, who was reported by the Associated Press to have received a series of confidential emails naming some of the alleged abusers, including Dr Boubacar Diallo – but did not take action against the alleged perpetrators. 

Diallo described by colleagues as having connections to WHO’s senior leadership, reportedly denied the wrong-doing. In one WHO photo, Tedros, Yao and Diallo are pictured smiling together during one of Tedros’ trips to Congo during the Ebola outbreak.   

Neither man was mentioned by name at Tuesday’s media briefing.  But the panel’s written report does refer to the “case of M. Boubacar Diallo, stating that “Dr Tedros Ghebreyesus, during his interview with the investigators, acknowledged that he had instructed Mr David Webb, who had come to inform him in January 2021 of incidents involving Mr Diallo, to defer any internal investigation until the publication of the conclusions of the Independent Commission and to transmit to the latter all the information at his disposal. This version of events is consistent with that given by Mr David Webb to the review team.”

The report leaves open the question of whether the investigation is continuing now.

June 16, 2019, Dr Boubacar Diallo, WHO Director-General, Dr Tedros Adhanom Ghebreyesus and WHO Emergency Response Team leader, Dr Michel Yao, pose for cameras during a visit to DRC by the WHO Director General.

Sweeping Reforms Needed – And Survivor Support  

At Tuesday’s presser, Tedros pledged an overhaul of the current policies – saying that the investigation would lead to sweeping reforms in the process of staff recruitment and sensitization around sexual abuse issues.

Along with terminating the contracts of four alleged perpetrators still employed by the organization, WHO is pursuing investigations of still unidentified perpetrators, and would refer allegations of rape to national authorities in DRC or elsewhere, he added.

It’s a “sickening betrayal of the people we served… a dark day for WHO,” Tedros said. “But we want the perpetrators to know that there will be severe consequences for their actions. We will hold all leaders accountable for any suspected incident.“

“We will undertake wholesale reform of policies and processes to address sexual exploitation and abuse,” Tedros added. “But we must go further to identify and address any shortcomings in our culture or leadership that failed to adequately protect the people we serve.”

Gaya Gamhewage, WHO director of Prevention and Response to Sexual Exploitation and Abuse

Gaya Gamhewage, WHO’s Director of Prevention and Response to SEA, said that the organization also would seek funds to help rehabilitate vulnerable women and the children born to them, as a result of the abuse.  

“We need funds on the ground for victim & survivor support,”  Gamhewage said, noting that as of now:  “There is no provision in the UN system for financial reparations to the SEA victims. But that does not stop us from making sure funds are allocated for support & assistance as we move forward.”

Until now, that is support has been far from forthcoming, Coulibaly observed, saying: 

“In spite of poignant narratives of the SEA victims, most perpetrators denied the facts & even stated that the sexual relations were consensual. Everything contributed to increased vulnerability of the alleged victims – they did not benefit from aid and assistance.” 

Image Credits: WHO/Chris Black, Twitter/@OMSDRCONGO, WHO.

Mothers take their babies to receive vaccinations at a mobile unit in Molumbo district, Mozambique.

The World Health Organization (WHO) aims to eliminate bacterial meningitis by 2030, primarily by increasing access to vaccinations and treatment.

This emerged at Tuesday’s launch of the first-ever global ‘roadmap’ to tackle the disease, which causes inflammation of the membranes that surround the brain and spinal cord, mainly as a result of infection from bacteria and viruses.

Around a quarter of a million people – mostly children – die from meningitis every year, while one in five of those infected suffers from long-lasting disabilities including seizures, loss of hearing and vision, and cognitive impairment.

“Wherever it occurs, meningitis can be deadly and debilitating; it strikes quickly, has serious health, economic and social consequences, and causes devastating outbreaks,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“It is time to tackle meningitis globally once and for all –by urgently expanding access to existing tools like vaccines, spearheading new research and innovation to prevent, detecting and treating the various causes of the disease, and improving rehabilitation for those affected.”

 

Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks.

“More than half a billion Africans are at risk of seasonal meningitis outbreaks but the disease has been off the radar for too long,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. 

“This shift away from firefighting outbreaks to strategic response can’t come soon enough.” 

Four organisms are responsible for 50% of deaths – Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus. 

Effective vaccines that protect against disease caused by the first three organisms are currently available and research is underway to develop vaccines group B streptococcus bacteria

But not all communities have access to these lifesaving vaccines, and many countries are yet to introduce them into their national programmes.

High immunization coverage, speedy diagnosis and optimal treatment for patients, data-driven prevention and control and better care of those affected are key pillars of the new strategy.

The roadmap follows the first resolution on meningitis passed by the World Health Assembly and endorsed unanimously by WHO member states in 2020.

“The meningitis roadmap provides a clear blueprint for defeating this devastating disease,” said Professor Robert Heyderman, head of infection research at University College London.

“Crucially it identifies the gaps in our knowledge and the tools required. To achieve the Road Map’s ambitious goals, a team approach will bring together countries, global policymakers, civil society, funders, researchers, public health specialists, healthcare workers and industry to generate and implement innovative new strategies.”

 

Image Credits: © UNICEF/Claudio Fauvrelle.

Health workers in Cape Town, South Africa, getting vaccinated against COVID-19.

As Africa waits for COVID-19 vaccines promised by the US and other countries to arrive, the continent’s Centers for Disease Control (CDC) plans to scale up antigen testing to identify and address pandemic hotspots.

“We are only at 4% vaccination rate, which means we have to continue to advance basic public health tools at our disposition, including rapid antigen test scale-up and enhanced community work so that we can know exactly where the hotspots of this virus are and flush it out while waiting for vaccine coverage to increase,” said John Nkengasong, Africa CDC Director, late last week.

He added that Africa CDC and partners would be launching its “2.0 response plan” in the coming weeks that aimed at scaling up testing, and expanding the outreach of community health workers. 

“There can be no doubt we need to test at scale, and we need to decentralise testing and put it in the hands of our community health care workers,” added Nkengasong in an address to an international audience organised by the US Ambassador to the African Union and the International Federation of the Red Cross and Red Crescent Societies (IFRC).

He added that, over the past 18 months, over 18,000 community health care workers had been deployed in 38 countries to conduct about 2.6 million household visits. They had also  conducted around 1.6 million tests to identify those who are infected, and their contacts.

Nkengasong described community health care workers as the “nexus for universal health coverage and health security”, essential to fight the current pandemic and to prepare for subsequent disease outbreaks.

Although there is an assumption that Africa has been comparatively less affected by COVID-19 infection than other regions, excess mortality figures of the few African countries that monitor these figures – notably Egypt and South Africa – indicate a huge under-estimation of the impact of the pandemic.

A recent comparison of World Bank regions put the Middle East and North Africa as the third-worst affected region in the world after Latin America and South Asia.

Meanwhile, Egypt outstrips a number of hard-hit countries including the US on excess mortality.

There has been an increase in demand for COVID-19 vaccines across Africa in the past few weeks – from Zimbabwe to Morocco, according to Nkengasong.

However, he acknowledged that in some countries, including Uganda, there had been a slowdown in demand.

“We will be looking at those countries to understand why the uptake has slowed, and what can we do with the community and religious leaders to improve uptake of vaccines, and create champions – sport, celebrities, and local musicians – to promote vaccines.

Image Credits: Western Cape government.

Clockwise from left-right: Richard Hatchett, Coalition for Epidemic Preparedness Innovations, Clemens Martin Auer, President EHF-Gastein, Ahmed Ogwell Ouma, Africa CDC; Hans Kluge, Director, WHO European Region

Multilateralism has “failed” to help Africa solve the COVID crisis and regional approaches to solving common problems could help the continent forge a “new public health order” said Africa Centers for Disease Control Deputy Director Ahmed Ogwell Ouma, speaking at the opening of the European Health Forum- Gastein. 

His statement at at the traditionally “Eurocentric” conference, palpably illustrated the way in which lack of access to COVID-19 vaccines and treatments is forcing leaders on the continent to look inward for new solutions – following the failure of international initiatives like the COVAX vaccine facility to bring adequate responses. 

The five-day European forum, which traditionally draws hundreds of participants from across the region to the Austrian spa town of Bad Gastein every autumn, is happening this year on an primarily virtual platform. 

But the conference, taking place under the slogan, “Rise Like a Phoenix” – Health at the Heart of a Resilient Future for Europe still includes the rich array of European and global health policymakers for which the forum has become known, including Stella Kyriakides, European Commissioner for Health and Food Safety, the European Medicines Agency’s Emer Cooke and WHO’s Director General Dr Tedros Adhanom Ghebreyesus. 

It also features a wide range of global health trend-setters, such as Michael Marmot, of University College London, who led WHO’s cutting edge work on the Social Determinants of Health a decade ago and Wellcome’s Sir Jeremy Farrar, who has been a leading voice on policy challenges around the pandemic.  And there are dozens of experts presenting at, or attending, more specialised sessions covering topics ranging from brain health to marginalized groups, to a new “Oslo Medicines Initiative” which aims to foster new modes of public-private collaboration wider facilitating access to more affordable medicines. 

New public health order should be part of ‘Pandemic Treaty’

Ahmed Ogwell Ouma, deputy director general, Africa CDC, at Gastein Forum

But the kickoff sessions were a vivid reminder that Europe is not an island – and that the failures of regions like Africa to get access to critical COVID tools and treatments – are echoing in the global north and beyond.  

“Where we sit here at Africa CDC, indeed on the African continent, multilateralism has failed,” said Ouma, at a press briefing opening the conference’s first day, and just after WHO Regional Director Hans Kluge made a plea for European countries to share excess vaccine doses with low- and middle-income countries  – in the spirit of multilateralism.  

“It [multilateralism] has been very successful in meeting rooms and webinars and probably some negotiating tables, but on the ground in Africa, it has failed,” retorted Ouma.  

 “Going down the path of regionalism,” may be more effective now, Ouma remarked, “where  neighbouring countries who share the same aspirations, countries who are willing to support each other during good times and bad times, can be able to come together and work towards a common good.”

He said that Africa needs to aspire to a “new public health order, including four key pillars:

  • Strengthened African health institutions at regional and country level;
  • A stronger African health workforce;
  • More reliable supply chains for medicines, vaccines and equipment, including more local manufacturing capacity;
  • Global partnerships that are “respectful and action-oriented.”

All of these elements should be incorporated into negotiations for a new Pandemic Treaty, or revisions in the existing WHO International Health Regulations, which current governing health emergency responses.

“Is a new treaty necessary?  We can discuss that if it captures these four points,” he said.  “Is reviewing of the IHR necessary? Absolutely.  We have seen a spectacular failure of the IHR. But we must tackle what is wrong and not just what is convenient to discuss.”   

Warns against regional competition

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Centre in Geneva.

At the same time, Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, said that regional solidarity should pave the way to more effective global cooperation. A stronger and better financed World Health Organization, and new collaborative frameworks such as a proposed ‘European Health Union’ consolidating national health agencies regionally, could help go beyond the rhetoric.

“The pandemic has shown that there were at least three areas in which we cannot afford not to work together globally. That is global health, the environment, and the digital transformation,” said Kickbusch.

“All three hang together to bring better health to people all around the world.

“It has become clear that regional efforts are ever more important to bring countries together and to develop new initiatives,” she added.  “However, regions should not compete with one another but rather work together at a multilateral level….. This is why we hope that the European-African partnership, that already exists, will be slowly strengthened through better financing and will lead to a new kind of global coalition that will be absolutely critical”.

Kluge – On boosters & dose-sharing – 1.2 billion excess doses means there are enough “to do it all”

The Austrian alpine setting which usually hosts hundreds of EHF-Gastein participants – this year was the setting only for a video clip and key conference organizers/ presenters.

Touching on the controversial issue of COVID vaccine boosters, Kluge veered away from the line of his boss, Dr Tedros, who has repeatedly called for a booster moratorium, in order to free up more supplies to reach the global south.

Instead, Kluge asserted that there should be enough vaccines to go around if they were used more efficiently – quoting United States Chief Medical Advisor Anthony Fauci who said in August that “we should do it all” – providing boosters to already-vaccinated groups in high-income countries – as well as vaccinating the world.

“My principle has been, and this was the same principle as … Dr. Anthony Fauci whom I discussed this with in August, from my mission to Washington, is: “Do it all,” declared Kluge at the presser kicking off the first day’s proceedings.

He pointed out that by end 2021, rich countries will have amassed an excess of 1.2 billion vaccine doses – if they don’t share them. “So the key issue is the political leadership and coordination to get them to those countries in need.”

One key barrier to more efficient distribution, Kluge added out, has been that countries often prefer to share their excess doses “based on geopolitical considerations, instead of a need basis:

“While I understand this, there has to be a bit of a balance.”

Another obstacle, is that countries are “waiting too long to share their excess doses – too close to expiry dates, and then for the receiving countries, this is too difficult.”

At the same time, he added that recent research has suggested that expiry dates may be extended under the right circumstances, noting a recent decision by Israeli authorities to extend the shelf life of Pfizer vaccines from a total of six to nine months.

He also said that receiving countries need to do their part: “to do the homework to register the new products and the manufacturing sites” – although he did not elaborate as to what countries in the global south may have been slow to register new vaccines or  manufacturing sites.

Overall, however, the biggest problem is political leadership to unlock more massive quantities of excess doses, he stressed:

“I mean, it’s nice that countries say 1 million, sharing, and 300 million sharing, but we should be sharing in terms of billions…And that’s what we need.”

Image Credits: European Health Forum Gastein.