More than 5 million people have officially died from COVID-19 less than two years into the global pandemic. COVID-19 is now the third leading cause of death, after heart disease and stroke. 

There have been 5,003,021 COVID-19 related deaths as of 1 November, according to the Johns Hopkins COVID-19 Dashboard. 

covid-19
COVID-19 Dashboard as of 1 November 12:22 PM EST

In the United States, 746,021 people have died due to COVID-19, making it the country with the highest number of recorded deaths. Brazil has lost the second highest number of people, with over 605,000 deaths by 1 November.

“This is a defining moment in our lifetime,” Dr Albert Ko, an infectious disease specialist at the Yale School of Public Health, told AP News. “What do we have to do to protect ourselves so we don’t get to another 5 million?”

The death toll rivals the number of people killed in battles among nations since 1950, according to estimates from the Peace Research Institute Oslo.

Shifting COVID-19 hotspots: Europe experiencing ‘fourth wave’ 

International passengers at UK border controls – quarantine rules now based on where they were vaccinated, and not what vaccine they received.

Hot spots have shifted over the 22 months since the pandemic began, and parts of Europe are now reporting a “fourth wave”,  the only World Health Organization (WHO) region to report an increase in cases for the fourth week in a row. 

Cases in Belgium, Czechia, Hungary and Poland have  increased by 50% in October, according to the WHO.

Russia and Ukraine also have increased numbers of new cases, with a 15% and a 43% increase, respectively. 

And amid soaring COVID-19 cases in the UK, the government is now prioritising giving third vaccine booster shots to people, banking on the country’s high COVID-19 vaccination rate to prevent severe illness and death. 

“What’s uniquely different about this pandemic is it hit hardest the high-resource countries,” said Dr Wafaa El-Sadr, director of ICAP, a global health center at Columbia University. “That’s the irony of COVID-19.”

Wealthier nations with longer life expectancies have larger proportions of older people, cancer survivors and nursing home residents, all of whom are especially vulnerable to COVID-19, El-Sadr noted.

Decrease in cases in Africa, Western Pacific 

In contrast, the largest decrease in new weekly cases was reported in Africa (21%), followed by the Western Pacific Region (17%). 

India, which had experienced its second wave in early May, now has reported a lower daily death rate than wealthier countries such as Russia, the US, or the UK, though uncertainty remains around its figures. 

The country’s rural areas were devastated by this surge of cases in May, where health infrastructure was rickety and lacked trained healthcare workers, government support, and access. 

Africa remains the world’s least vaccinated region 

Health workers at Juba Teaching Hospital are waiting in line to have their first shot of COVID-19 vaccine.

However, while Africa reports decreased cases, the region remains the world’s least vaccinated region, with only 6% of Africans – 77 million people – fully vaccinated, while over 70% of high-income countries have already vaccinated more than 40% of their people. 

Only five African countries are likely to reach a WHO global goal of vaccinating 40% of their populations by the end of the year. “This devastating milestone reminds us that we are failing much of the world,” UN Secretary-General António Guterres said in a written statement. “This is a global shame.”

Image Credits: Vital Strategies, JHU, @HeathrowAirport/AndrewFell .

G20 leaders pose in front of the Trevi Fountain in Rome, October 2021

There will be no airlifting of COVID-19 vaccines to poor countries struggling to get their immunisation figures into double digits. There are also no concrete plans for wealthy countries to make good on their earlier dose promises to COVAX by giving actual delivery dates. 

And, there is no date for wealthy countries to phase out coal-based power.

Instead, the weekend G20 meeting of the world’s richest nations offered a bland declaration that failed to offer solutions to COVID-19 vaccine equity or the climate change crisis.

Even United Nations Secretary-General Antonio Guterres admitted that he left Rome “with my hopes unfulfilled”.

Ahead of the meeting, the World Health Organization’s (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus wrote an open letter to G20 leaders appealing for their support for the WHO targets to vaccinate 40% of the world by year-end and 70% by mid-2022, saying that  “decisions made this weekend may make or break those targets”.

Earlier, the WHO’s newly appointed Ambassador for Global Health Financing, Gordon Brown, called for a “globally coordinated, month by month operational plan and timetable” to transfer unused vaccines being held by the richest countries of the world to the world’s poorest countries.

“If at the G20 summit in Italy, the world’s richest countries cannot mobilise an extraordinary, expedited airlift of doses to the unvaccinated and unprotected of the world, and do so starting immediately, an epidemiological economic and ethical dereliction of duty will shame us all,” said Brown, the former UK Prime Minister.

In fact, the most decisive action at the Rome meeting came on its margins – when US President Joe Biden issued an executive order enabling the release of “strategic and critical materials from the National Defense Stockpile” to ease global supply-chain shortages related to vaccines.

Vague and non-specific declaration

The Rome Declaration, adopted on Sunday after months of negotiation, is bland and non-specific, particularly as far as concrete commitments of money or vaccine doses are concerned. 

Tedros’s letter, co-signed by the Duke and Duchess of Sussex, asked for four key actions.

First, in order to close the global shortage of 550 million doses to vaccinate 40% of people in every country by the end of 2021,  Tedros asked for the “speeding up existing commitments of dose donations to COVAX, pledging new ones, executing dose swaps with COVAX, and eliminating export restrictions on vaccines”.

The G20’s answer was vague, lacking commitments to any real targets: 

“We will take steps to help boost the supply of vaccines and essential medical products and inputs in developing countries and remove relevant supply and financing constraints” and “we commit to substantially increase the provision of and access to vaccines, as well as to therapeutics and diagnostics”. 

G20 health ministers were also asked to monitor progress and ”explore ways to accelerate global vaccination as necessary”.

No action on COVAX shortfall

Tedros’s second ‘ask’ was for the G-20  leaders to fully fund the Access to COVID-19 Tools (ACT) Accelerator, which currently has a $15.9 billion shortfall in monies needed to fund bigger  rollout of tests, treatment and vaccines.

The G20 simply reiterated its “support to all pillars of the ACT-Accelerator, including COVAX” – without promising a clear amount of new money.

Thirdly, the WHO chief asked the G20 leaders to “hold pharmaceutical companies to higher transparency standards, including publicly shared monthly production projections and delivery schedules to help countries better plan to receive and share doses”.

In response, the G20 simply committed to “enhance our efforts to ensure the transparent, rapid and predictable delivery and uptake of vaccines where they are needed” and called on “the private sector and on multilateral financial institutions to contribute to this endeavour”. 

Finally, Tedros asked for support for the TRIPS waiver in order to “share vaccine technology and dismantle vaccine production barriers”.

The G20’s response on this was predictable: silence on the waiver initiative – although there was a commitment to supporting “increased vaccine distribution, administration and local manufacturing capacity” in LMICs, possibly via  the newly established WHO-supported mRNA hubs in South Africa, Brazil and Argentina, and non-specified “joint production and processing arrangements”.

Ellen Johnson Sirleaf, former president of Liberia, and Helen Clark, former prime minister of New Zealand, said that “it would be an understatement to say that the decision of G20 Leaders meeting in Rome to respond to 22 months of the COVID-19 crisis by setting up a Health and Finance Minister Task Force, with no money behind it, is deeply disappointing”. 

The pair, former co-chairs of the Independent Panel for Pandemic Preparedness and Response, said that the G20 had both ignored its own financing panel which showed why up to $15 billion a year is needed in pandemic preparedness, and failed to support “specific and urgent action to redistribute vaccine doses around the world”. 

Nothing new to stop planet burnout

The G20’s failure to offer new or substantial measures to address planetary burnout – pointed to a lack-lustre outcome for the COP26 climate conference that opened on Monday. 

Rhetorically, G20 leaders committed to limiting global warming to 1.5 degrees C by 2050. 

But real follow-up on that commitment was marred by the absence of the key leading global polluter, China, which has only promised to reach carbon neutrality by 2060. Similarly Russia has stated that it is in no rush to achieve that goal. 

Climate scientists have said that without faster action on cutting climate emissions now – it will be impossible for the world to keep to 1.5°C – and indeed, temperatures are currently on a course to reach 2.7°C  by the end of the century, even if all current commitments are met. 

While the G20 statement included a promise to end international financing of coal-based power generation outside their own countries, the G20 members also did not commit to a date for phasing out coal-based power in their own territories.

Instead, the G20 statement said only said: “Keeping 1.5°C within reach will require meaningful and effective actions and commitment by all countries, taking into account different approaches, through the development of clear national pathways that align long-term ambition with short- and medium-term goals, and with international cooperation and support, including finance and technology, sustainable and responsible consumption and production as critical enablers, in the context of sustainable development.”

They further committed to cooperate on “zero or low carbon emission and renewable technologies” to enable a transition towards “low-emission power systems” – not zero emissions, and only for those countries that wanted to make this transition.

Lack of climate funds

Lack of funds to assist developing countries to mitigate climate change has been a serious obstacle to progress. Previously, developed countries had committed to making $100 billion available every year to do this from 2020 to 2025. But the meeting noted that this goal was only expected to be met in 2023.

“If the G20 was a dress rehearsal for COP26, then world leaders fluffed their lines,” said Greenpeace executive director Jennifer Morgan. “Their communique was weak, lacking both ambition and vision, and simply failed to meet the moment. Now they move onto Glasgow where there is still a chance to seize a historic opportunity, but the likes of Australia and Saudi Arabia need to be marginalised, while rich countries need to finally grasp that the key to unlock COP26 is trust.”

The G20 is made up of countries that produce 80% of the world’s global carbon emissions, comprising of the European Union plus Argentina, Australia, Brazil, Britain, Canada, China, France, Germany, India, Indonesia, Italy, Japan, Mexico, Russia, Saudi Arabia, South Africa, South Korea, Turkey and the US. 

 

Image Credits: G20.

Disha Shetty, an Indian climate and health journalist, will be reporting for Health Policy Watch from the Glasgow Climate Conference (COP 26).  She provides a birds-eye view on the conference here:

Climate and health activists fear that the bold action needed at the crucial United Nations climate conference, COP26, which began on Sunday, is unlikely to materialise because rich countries are delaying commitments to cut carbon emissions quickly.

Although the world is already witnessing rising extreme weather events, if high-income countries such as the United States fail to make bold moves on key issues like shifting from fossil fuels to cleaner energy, middle-and low-income countries cannot be expected to take dramatic actions themselves, observers in Asia and elsewhere fear.  

For this year’s COP26 to be successful, there are several issues that have to be addressed – and these are inextricably intertwined with commitments that low- and middle-income countries need to receive:

  • All countries will have to increase their voluntary nationally determined contributions (NDCs) under the Paris Agreement to rein in global temperature rise to no more than 1.5℃. 
  • Developed countries also have to commit to finances to fund adaptation in developing countries reeling under the impacts of climate change, and the Paris rulebook on implementation of the Paris Agreement will have to be finalised. 
  • There is also a growing call from developing countries for developed countries to acknowledge and compensate for the loss and damage that they are enduring due to the historically high carbon emissions of a handful of countries. 

In the run-up to COP26, the delivery of the highly anticipated $100 billion climate finance has once again been delayed. The COP26 presidency said on Monday that “it will not be known until 2022 whether the $100 billion goal has been met in 2020,” adding that the pledges expected from the developed countries were not yet ready to be included. 

Many poor countries for long have described climate talks by the rich ones as bullying or a con as the finance that eventually materialises is given as loans and debts. This is particularly worrisome for LMICs that will depend on such finance to meet their NDC commitments – and it will inevitably curb their ambition to set stakes even higher.

“This finance is not charity. This finance is to make sure that the polluters pay the cost, so that it may ensure that the emerging countries can actually do things differently,” said Sunita Narain of the Centre for Science and Environment.

World on the path to 2.7℃ temperature rise

The current updated NDCs too fall short and will mean global temperatures will rise by 2.7℃ by the turn of this century, as HPW reported on October 25. 

In light of the lack of progress, COP26 President Alok Sharma has already begun to talk about future COPs, saying at a Tuesday press conference that if the commitments this year aren’t enough to keep temperature well below 2℃, then in the next few years, “we may need to come back and reappraise the commitments that have been made”.

Around 148 countries have submitted new or updated NDCs according to Climate Tracker. Of these, 85 countries have promised to reduce their carbon emissions, including developing countries like South Africa, Kenya, Pakistan and Argentina.

Pakistan has promised to reduce its carbon emissions by 50% by 2030, a move that was welcomed by COP26. Countries in the middle east like Jordan and Kuwait, Uganda in Africa, and Japan in Asia have also improved their NDCs. China also updated its NDC on 28 October but its targets are being seen as falling short of what is needed at this point.

At last count, there were still 28 countries, including major annual carbon emitter India and other smaller countries like Ecuador, as well as conflict-ridden Afghanistan and Congo, that are yet to submit their updated NDCs. The hope is that ambitious targets would help keep the global temperature rise around 2℃ and keep the 1.5℃ in sight in the coming years.

Many countries’ longer-term commitments are more robust. Major global oil producer Saudi Arabia has announced the plan to turn net-zero by 2060 as has China, while Australia aims to become carbon neutral by 2050.  

But the problem is that the timeline of many countries postpone emission reductions until a time that is too late to avoid the world lurching well above 2.7℃ by 2100 and is being seen as mere shifting of goalposts to avoid drastic action now. 

India, currently the world’s fourth-highest annual carbon emitter after China, US and the European Union, has made it clear that it wants compensation for the damage caused by rich nations since pre-industrial times, focussing on the need for equity and historical context. 

Although India hasn’t yet submitted an NDC, it is likely to submit it before 31 October and is expected to announce a 450GW renewable energy target, up from its current installed capacity of 100GW. Sharma has already gone on record to say he hopes to see this reflected in India’s updated NDC and that it would be a welcome step. 

Rich countries are struggling to end coal dependance

With the COVID-19 vaccine roll-out leaving out many poor nations, the trust between developed and developing countries is at an all-time low. A major bone of contention in the talks is that rich countries like the US are asking poor ones to reduce their dependence on coal are themselves not sure how they will move away from fossil fuels.

US President Joe Biden has been struggling to get domestic support for his ambitious climate agenda at home, with just one senator from West Virginia committed to striking out a key clause of energy legislation that would penalize those that do not switch to renewable energy. 

UN Secretary-General António Guterres told a recent COP26 media briefing that he was “extremely worried but still hopeful”. 

Guterres will address leaders of the G20 countries – a group of the world’s largest economies – during their meeting on Saturday and is expected to ask them to be more ambitious in their targets. Guterres stressed the need for developed countries to phase out coal by 2030 and developing countries by 2040. 

This does not seem practical to experts who point out that even a rich country like Germany with resources at its disposal is looking at a coal phase-out by 2035. 

Meanwhile Sharma counted commitments from countries to end financing of new coal plants as a step forward.

Danger of moving to renewables too quickly

While climate talks paint renewables as a magic cure, countries that rely on renewables are beginning to see the social fallouts of moving too quickly. Electricity from renewable sources like wind and solar fluctuate seasonally and are thus perceived as unreliable as well as expensive by policymakers.

There is also pushback from leaders from Africa on the social costs of renewables. Developing countries transitioning to renewables quickly have little or no understanding of the social impacts of big new hydroelectric, wind power or solar farms on land rights, waterways and fisheries, upon which indigenous communities often depend the most. 

Climate change is already causing an energy crisis in key BRICS countries, disrupting supply chains, hitting both renewable and non-renewable sources. 

India was recently staring at a coal shortage caused in part due to excess rainfall hindering coal movement. Worsening drought in Brazil has hit water levels in hydropower generating dams and in turn the electricity supply. 

Experts say this indicates that future energy needs need to be met from diverse sources as no one source can provide energy security – a nuance that COP26 negotiations pushing for renewables have to be mindful of.

Poorer regions disproportionately affected

While poor nations are now being asked to contribute proportionately just as much as the rich to reach carbon neutrality, they also stand to lose the most from the world’s failure to clamp down on emissions so far. 

The global temperature is already 1.2℃ higher than the pre-industrial times and in 2020 this translated to around 51.6 million people being directly impacted by climate change-related extreme weather events, according to the latest report of Lancet Countdown on health and climate change.

A warmer climate would mean more infectious diseases and 79% losses in labour capacity due to heat waves for those involved in the agricultural sector in low-income countries. The COVID recovery has led to a surge in fossil fuel use instead of decline, making this an additional challenge, as HPW reported on October 21.
This impact on public health and communities that is being felt disproportionately more in the developing world has led to a rise in calls for compensation towards loss and damage due to climate change. 

Climate finance and a push for loss and damage

Ahead of COP26 a lot of the conversation has been around the need for rich countries to deliver $100 billion in climate finance. This figure already reflects a broken promise as the original commitment was to raise $100 billion annually. It has been over a decade since the commitment was first made in Copenhagen in 2009 and then reiterated in Paris in 2015. 

“Twelve years ago, in Copenhagen, developed nations made a promise to channel $100B per year to countries that are developing and vulnerable to climate change impacts,” said Chirag Gajjar who heads subnational climate action in climate programme at WRI India. “In Glasgow, rich nations must provide an implementation plan to deliver on this promise, translating to $500B between 2020 to 2024,” he said.

In an open letter to COP26, Climate Action Network International, a network of over 1,500 civil society organizations wrote, “The projected economic cost of loss and damage by 2030 is estimated to be between $290-580 billion in developing countries alone.”

China, currently the world’s largest annual carbon emitter, is aiming for net-zero by 2060 and the US, which is the world’s largest historical carbon emitter, is aiming to turn net-zero by 2050. 

But if the worst-case scenario of climate change is to be avoided then countries will have to commit to near-term changes instead of long-term ones on a timeline of decades.


Narain said that, according to the IPCC reports, all countries of the world have to turn net-zero by 2050 to limit global temperature rise to 1.5℃. This requires developed countries to turn net-zero earlier so the developing countries have time to transition. 

“If the US is 2050 and China is 2060 then India has to be 2070,” said Narain, who called net-zero “a scam”.

“Let’s get a perspective on this that we all understand the reality and don’t let some new fancy words divert us from the mission of saying: cut now, transform now!”

Disha Shetty is an independent science journalist based in India. She will be reporting from COP26 as a part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security. Follow her on Twitter @dishashetty20

–Updated 1 November 2021

Dr Tedros Adhanom Ghebreyesus.

The incumbent Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, is the sole nominee for his position, which will be decided upon at the 75th World Health Assembly in May 2022. 

With the backing of 28 member states, Tedros is likely to be re-appointed unopposed as the deadline to submit nominations was 23 September. 

Tedros, who was the first African to become the chief of the WHO., was nominated by Germany after his home country,  Ethiopia, rejected nominating him for a second term, according to Reuters report. 

A former health and foreign minister of Ethiopia, Tedros has been accused by the Ethiopian Army Chief of supporting rebels in the conflict zone of Tigray in northern Ethiopia. Tedros is from Tigray. This tension is likely to have been the reason why only three African countries backed his re-appointment.  

Since his election in 2017, Tedros has risen to more prominence in 2020 for his response and communication on the Covid-19 Pandemic. As a Director General, he is the chief technical and administrative officer. If re-elected, it will be his last term as the WHO chief since an incumbent Director-General can be re-appointed only once. Each term is for five years and the next term will begin in August 2022. 

Even though Germany called for support for Tedros’s nomination last month, the US, China, and the UK have not endorsed him, as per documents on the WHO website. 

Relations between the US and Tedros soured during former US President Donald Trump’s term, while China’s cold shoulder to Tedros may be traced to July 2020 when he asked China to provide more raw data on the origins of the COVID-19 pandemic and had asked them to be more “transparent and open and to cooperate”. 

“After witnessing up close the world’s response to the pandemic, I have a unique understanding of the dynamics that have brought us to where we are, and a deep commitment to making the global system fit for purpose, with WHO at its centre,” Tedros said in his written statement to the WHO in response to his nomination for re-appointment. 

Simply by promoting cycling, government officials could address a range of problems including non-communicable diseases (NCDs), car crashes, stress and air pollution.

But officials in different sectors seldom factor health into planning transport and urbanisation, said public health experts at a discussion on public health systems hosted this week by Vital Strategies.

“The future of public health demands that we stop looking for single-issue solutions,” said Jordan’s Princess Dina Mired, Vital’s special envoy for NCDs.

“The future of public health also demands that our health ministries be transformed from ministries of diseases to ministries of health. And this can only happen if we think more broadly about the connections that actually make a healthy society,” she added.

“We are asking you to consider how transportation, energy, finance, development and education can be the building blocks to making deep and lasting changes that protect everyone everywhere.”

This “intersectional” approach would see a range of government departments working together on “co-wins”, said speakers.

“What we’re looking for is a policy or a set of interventions that will yield multiple benefits,” said Dr Nandita Murukutla, Vital’s vice-president for global policy and research.

Taxing ultra-processed food

For her, regulating ultra-processed food offers such an opportunity because such foods are linked to NCDs and obesity. They also have a detrimental effect on the environment, as key ingredients such as corn cause biodiversity loss, transporting the goods cause greenhouse gas emissions and their packaging causes wastage.

“A win-win solution would be a reduction in the consumption of ultra-processed products through solutions such as taxes, which would make these products out of the reach of ordinary people, and provide ministries and governments with a source of revenue,” said Murukutla.

The “low-hanging fruit” to address health and get income for post-COVID economic recovery is to raise taxes on tobacco, alcohol and sugary drinks, major risk factors for NCDs, to discourage people from consuming them, said Jeremias Paul, who heads the World Health Organization (WHO) fiscal policies for health unit.

Paul also proposed removing government subsidies on corn, which is a major component of ultra-processed food, and giving small farmers producing healthy food subsidies instead.

Cities that provide the space to enable people to use their bicycles safely was a win-win for Claudia Adriazola-Steil, Director of Health and Road Safety at the WRI Ross Center For Sustainable Cities.

“If we can get people to cycle to work safely, this will bring down traffic crashes. Then we will see the levels of physical activity increasing and this means that we will have less chronic diseases – less heart disease, diabetes, obesity,” said Adriazola-Steil.

She added that while there was a clamour for electric cars, these were not going to be introduced fast enough to keep the world from warming up over 1.5 degrees Celsius.

Referring to research done by Oxford University’s Christian Brand, who found emissions from cycling 30 times lower per trip than driving a fossil fuel car, and about ten times lower than driving an electric one, she appealed to people to switch to bicycles and hybrid e-bikes.

“So if you personally want to make a contribution to climate change, you can chip but of course, we’re not going to ask people to take a bike when it’s unsafe. And we really need to make that cheap,” said Adriazola-Steil, who commended the Heart Association for providing funding to encourage cycling.

Factoring health into climate change

“I think a lot about the public health co-benefits of climate change. And of course, the starting point is the public health consequences of climate change, which are enormous,” said Dan Kass, Vital’s vice-president of environmental health.

Public health has not been considered when governments have made decisions about electrification and industrialisation, such as fuel subsidies for the fossil fuel industry, said Kass.

While converting to renewable energy will cost money, Kass said that the potential savings “in terms of lives, saved, hospitalisations averted, children who thrive from avoidance of stunting or low birth weight”  -– even if only applied to the air pollution aspect of climate emissions – would more than pay for the cost of the interventions necessary to green the economy.

With the international climate change conference, COP26, beginning over the weekend, Kass says an agreement on reducing carbon emissions would be a win for health.

“Countries have still yet to ratify what’s called Article Six, which is a pricing scheme for carbon,” says Kass. 

“Economists globally have near consensus that the most equitable, least regressive way to reduce consumption and emissions is to properly price carbon, and factor in all of the social consequences of business as usual and climate scenarios,” said Kass.

The pricing would be distributed throughout the economic system, paid for by producers as well as consumers – and the effect would be to “incentivize investment in alternate technologies”.

“We need to act like the earth is burning, because it is,” said Kass.

But he warned that there isn’t yet a level of popular support for the urgency necessary to address climate change.

“We need to make the benefits known to people in the near term,” said Kass. “Your air quality is going to be better, your water quality is going to be better, you’re going to have greater access to energy. Those things will drive public support for the hard decisions that have to be made.”

Image Credits: Heybike/ Unsplash.

Virtual World Health Assembly nerve center at WHO’s Geneva headquarters in May 2021, where member states agreed to explore a Pandemic Treaty to improve global health emergency response.

A “Zero Draft” report by a WHO Working Group gives cautious endorsement to advancing negotiations over a new “Pandemic Treaty” among WHO’s 194 member states. 

That endorsement by the Working Group of member states remains couched in highly nuanced, diplomatic language that makes it clear how big the lift may be to actually negotiate a sharp, focused treaty over the most key issues that have slowed and sometimes paralyzed global pandemic response. 

Those issues range from a stronger mandate for WHO to enter countries and independently investigate outbreaks as they are unrolling on the ground – which has been a key issue for Europe and other high-income nations – to questions about vaccines and medicines access, which have become an overriding concern for low- and middle-income countries lacking sufficient supplies of basic tools to beat back COVID.   

However, the fact the document attempts to gives space to all of those issues is likely to prove reassuring to countries and civil society – that their diverse interests won’t be ignored.   

Significantly, a senior US diplomat, Colin McIff, is serving alongside Indonesia’s Grata Endah Werdaningtyas as the Co-Chair of “The Bureau” a group of six countries leading the Working Group discussions, which are open to all 194 WHA members. Others members of the leadership bureau include: Iraq, Botswana, Singapore and France. 

McIff’s leading role in the debates also signals a possible shift in the US position, whereby Washington may gradually get behind the treaty concept – after its initial scepticism, observers say.  

Colin McIff, Deputy Director of the US Office of Global Health, HHS has been a key leader in developing the Zero Draft.

A paper published by US Secretary of State Anthony Blinken and US Secretary of Health And Human Services Xavier Beceerra last month in the US medical journal JAMA, had thrown cold water on the pandemic treaty concept  that has galvanized Germany and other leading European Union countries, saying that it could “take years to accomplish.”  They had argued for immediately strengthening the WHO’s International Health Regulations, which govern WHO member states’ responsibilities for detecting, reporting and responding to disease outbreaks that pose global health threats.

World Health Assembly to consider way forward in November 

The World Health Assembly is set to consider a way forward on the pandemic treaty and other global health reforms in a special session scheduled for next month – as per a resolution that was adopted at the May 2021 WHA session. 

The WHA Working Group Zero Draft outlines three options for moving forward, including: reforms to existing International Health Regulations, internal reforms to the WHO, and a new Pandemic Treaty. 

One key conclusion, however, is that the existing IHR framework cannot be adapted to accommodate the raft of issues that the COVID pandemic has raised. And that, in and of itself, signals a growing consensus that a more sweeping and binding treaty arrangement may be necessary. 

“Repeatedly, Member States have returned to two key themes in the discussion: first, that the status quo is not acceptable to anyone and second, that the WGPR [Working Group on Strengthening WHo Preparedness and Response] must be willing to move forward in a flexible way that advances both of its linked mandates,” states a the Zero Draft executive summary.

While acknowledging the “value in exploring the role of existing tools and mechanisms available to WHO for implementing relevant recommendations,” …. the Working Group “identified potential benefits of a new WHO convention, agreement or other international instrument for pandemic preparedness and response,” states the Zero Draft. 

‘Off to a ‘really good start’  

Some influential civil society activists have been wary about the treaty initiative – seeing it as a potential diversion from vaccine and medicines access issues, and specifically a proposed World Trade Organization waiver on intellectual property rights for COVID health products, upon which a number of key groups, such as Médecins Sans Frontières are overwhelmingly focused. 

Civil Society Activists Question Pandemic Treaty’s Ability to Address Global Health Inequalities

But there are signs that those opinions are not entirely uniform.

“We are happy with the zero draft; it identifies most of the issues that we think are important. You have attention to technology transfer, decentralization and manufacturing,” said Jamie Love of Knowledge Ecology International, in an interview with Health Policy Watch on Thursday.  “I don’t know if it will go forward, but I think it’s really off to a good start..

“I think the WHO is the right place to have this conversation. And so far in the pre- meetings, I think the delegates have been talking about, and sensitive to issues about transparency. 

While describing the WTO negotiations over the IP waiver as immediately significant, Love suggested that a pandemic treaty could offer a more permanent, and legally-binding space, to attend to the long-term challenges around IP norms, medicines and vaccines pricing, as well as finance and legal frameworks for more publicly-supported R&D and decentralized manufacture of health products that would, in turn, foster more robust and versatile supply chains. 

“Affordability, access, pricing, technology transfer there is not a sort of handy place to go in the IHR framework,” Love said. 

US leadership of talks is significant

25 heads of government and international agencies have come together in support of the new pandemic treaty

From both the two co-chairs, the US and Indonesia , the contributions have been “very positive,” Love added.

And the US leadership role in the Zero draft formulation could also be a signal that Washington is warming to the treaty idea that it had initially opposed – much to the consternation of EU allies like Germany and  European Council President Charles Michel, which have championed the Treaty along with about two dozen other countries – and WHO’s Director General Dr Tedros Adhanom Ghebreyesus.  

“It’s very encouraging to us that Colin McIff has been so good in terms of the comments that he has been making and the direction that he has steered things,” said Love.

“He’s a career negotiator and a popular guy. Everyone likes him, the drug companies like him, we like him. He’s a good listener.”  

Moreover, “Colin is widely respected in the US government.  And so it does give us some hope that the US position on the pandemic treaty will change.”

Love added that negotiations of a binding pandemic treaty now, ahead of another crisis, could help countries actually adhere to their commitments when a new global health threat actually emerges, as it inevitably will in an era of rapid climate change, ecosystem destruction, urbanization and international travel.

“It’s better to make these decisions now, before people actually know who has the valuable assets [in terms of new medicines or vaccine candidates]. Ideally you can make commitments that make sense globally and locally because no one knows who is going to be the winners or the losers. 

“When there is no emergency people will talk a good game. But when the COVID emergency came along, one country after another peeled off from the solidarity talk. So looking for a more binding commitment actually makes it easier for countries to do the right thing when a pandemic hits.”

Image Credits: EU Council.

The South Sudan Minster of Health, Elizabeth Chuei,received her first COVID-19 vaccine at Juba Teaching Hospital in mid-October as the country’s vaccine drive, interrupted in April with the halt of vaccine exports from India, restarts once more.  Only 5 African countries currently are on track to meet a WHO 40% vaccination goal.

Ahead of a critical G20 meeting this weekend, WHO and its partners are asking the world’s leading industrialized nations  to come up with another US$ 23.4 billion over the course of the coming year to address stark shortages in COVID vaccines, tests and treatments remain dismally low in Africa and other parts of the developing world. 

The new strategy for the “Act Accelerator” initiative that is funding and distributing  vaccines, tests and treatments to about 92 low- and middle-income nations, comes against the background of a continuing death toll of some 45,000 to 50,000 deaths  a week, said WHO and other leaders of the Act-A  in two separate press conferences Wednesday and Thursday.

“While the world is now producing some 1.15 billion vaccine doses per month, vaccination coverage still ranges from 1 – 70%,” said Carl Bildt, WHO Special Envoy for the ACT-Accelerator, in a press briefing about the new ACT-A strategy on Wednesday, developed by the steering group of leading the consortium, which includes, WHO; UNICEF; the Global Fund; Gavi, The Vaccine Alliance; the Wellcome Trust, the Foundation for Innovative New Diagnostics (FIND), and the Oslo-based CEPI, which is funding vaccine R&D.   

Against that background, “the disease will continue in countries with very low vaccination coverage, and variants will continue to develop,” he said, adding that along with the constantly  mounting death toll, “this is going to come back and affect everyone.”

Today, WHO’s Africa office announced that just five out of Africa’s 54 WHO member states would meet the WHO goal to vaccinate 40% of its population by the end of 2021 (see related Health Policy Watch story). 

Message to G-20 – 550 million mor vaccine doses this year would allow 82 more countries to reach 40% vaccine coverage goal

WHO data on vaccine inequalities around the world & FIND data on testing, as of 6 October, 2021

Speaking at a WHO press briefing on Thursday, WHO’s Dr Tedros Adhanom Ghebreyesus made a special appeal to G-20 nations to come through on promised vaccine donations  – which so far have fallen far short of earlier commitments.  He also called upon G-20 countries to support moves towards a Pandemic Treaty as well as the creation of a new “Global Health Threats Council”. 

“I have three requests for the G20 leaders,” said Tedros speaking at a press conference on Thursday,   

“First fully fund the Act Accelerator, second, support the creation of an overarching framework for global health security that that a legally binding treaty on pandemic preparedness and response, and thirdly, support the creation of a Global Health Threats Financing Board, supported by a financial intermediary fund, and hosted by the UN.”

Dr Tedros’ remarks on a “Global Health Threats Financing Board” effectively combines two separate proposals that emerged from an Independent Panel report on pandemic preparedness and a more recent pan-European Commission on Pandemic Preparedness, which had suggested that a global board to more squarely address health finance issues could be useful. 

Added senior WHO Advisor, Bruce Aylward, “Some 82 countries are at risk of not reaching the 40% goals, only because a lack of vaccine supply. They can meet it [the goal] if the supply is there. They only need another 550 million doses through the COVAX initiative.  So the big question to the G-20 is: are they going to say where those 550 million doses are going to come from? Because those 20 countries control the global vaccine supply between now and the end of this year, we are going to make about 3 billion doses of this vaccines. Can we take about ten days worth and see that it goes into COVAX.

“This is a solvable problem, it is a question of political will and the manufacturers.. It’s a test of global solidarity.” 

Millions more deaths could be averted

Jonas Gahr Store, Norway’s new prime minister

Without global vaccine and treatments access, “We will not be able to achieve true economic and social recovery” added Norway’s new prime minister, Jonas Gahr Store, who made a guest appearance at the WHO briefing.  Getting more vaccines to Africa and elsewhere could lead to “millions more deaths that could be averted” he said, referring to WHO estimate that reaching it’s vaccination coverage goals could save up to 5 million lives over the course of the next year. 

“As long as some people remain are exposed and vulnerable, we all are – in this globalized world,” Store added.

Extreme shortage of COVID tests in LMICs is another hidden driver of the ongoing pandemic

The extreme shortage of COVID tests in the same countries that lack vaccines, is one of the other, more hidden crises associated with the ongoing pandemic, pointed out Bill Rodriguez, CEO FIND at the Wednesday press briefing.

“Roughly 3.5 billion tests for COVID-19 have been administered,” he said, “however less than 0.4% of tests have been performed in low income countries,” he pointed out.

Among groups that aren’t vaccinated, it’s critical to roll our more tests in order to be able to rapidly target treatments to people that are infected – from vital oxygen supplies for the seriously ill to the first-ever COVID anti-viral pill, molnupiravir, that appears set to receive US Food and Drug Administration approval soon.

Recent clinical trials have suggested that the drug reduces by 50% the risks of hospitalization and death among people who are mildly to moderately ill. And Merck, the developer of the treatment, has agreed to allow a generic version of the pill to be manufactured and distributed across most of the developing world.

But in order to even administer such a treatment effectively, people have to be tested to determine if they are ill with COVID – or something else, noted Rodriguez. 

And that is just not happening today in low-income countries. 

“Testing is also critical to be able to do [genetic] sequencing to identify new variants,” he added, noting those variants threaten to bite back at already vaccinated high-income countries. 

To address the testing crisis, the new ACT strategy asks for some $7 billion more in funding for test kits – most of which would be invested in the procurement of rapid tests.   

“We want to try to reach a minimum target of administering one test per 1,000 people per day,” he said, referrring to the new ACT testing strategy. “To reach these targets we will need to test six times as many people as we have been doing in the past six months.  And even if we do, we will still be testing at less than half the minimum rate as in high income countries.” 

Image Credits: UNICEF, WHO COVID dashboard & FIND Test Tracker .

Only five African countries are likely to reach a WHO global goal of vaccinating 40% of their populations by the end of the year, and the continent’s roll-outs may be slowed further by a global shortage of the syringes need to administer vaccines.

UNICEF has reported an imminent shortfall of up to 2.2 billion syringes for COVID-19 vaccination and routine immunization in the coming year, according to the World Health Organization’s (WHO) Africa region.

This includes special 0.3ml syringes needed for the Pfizer-BioNTech COVID-19 doses, for which there is no global stockpile.  

“Early next year COVID-19 vaccines will start pouring into Africa, but a scarcity of syringes could paralyse progress,” WHO Africa Director Dr Matshidiso Moeti told a press briefing on Thursday.

“Drastic measures must be taken to boost syringe production, fast. Countless African lives depend on it.” 

COVAX is trying to secure deals with syringe manufacturers, and through better planning to avoid deliveries outpacing the supply of syringes, the WHO reported.

Only 6% of Africans – 77 million people – are fully vaccinated, while over 70% of high-income countries have already vaccinated more than 40% of their people.

Three African countries – Seychelles, Mauritius and Morocco – have already vaccinated over 40% of their people, while only Tunisia and Cabo Verde are on track to reach this global WHO target by year-end. 

While COVAX has delivered around 50 million vaccines to Africa, the continent still faces a 275 million dose shortfall in order to vaccinate 40% of all Africans.

Wave after wave

Dr John Nkengasong, Director of the Africa Centers for Disease Control and Prevention (CDC), told an earlier media briefing that 82% of the continent had experienced a third wave of COVID, while seven countries had already had a fourth wave.

“We are going to go from wave to wave unless we address the question of vaccinations,” said Nkengasong.

While cases in most of Africa are going down, cases are rising in countries in the Central African countries of Gabon, Congo, Cameroon, as well as Egypt. 

COVID deaths in Nigeria increased by 66% and by 36% in Egypt, added Nkengasong.

Meanwhile, the WHO urged countries to improve their vaccine roll-out readiness. Some 42% of countries have not yet completed district-level plans for their campaigns, while nearly 40% have not yet undertaken “intra-action reviews” which are key to refining and improving their vaccination campaigns,” according to the WHO

The WHO is conducting emergency support missions to five African countries to help support, speed up and improve their COVID-19 vaccine rollouts, with plans for missions to another 10 countries this year.

Image Credits: Wuestenigel/Flickr.

Merck laboratory that developed the new oral COVID treatment, molnupiravir

A potentially game-changing antiviral treatment for COVID-19 that can be administered orally early on, and potentially head off much more serious cases, is set to be licensed for generic production in most low- and middle-income countries (LMICs), in an unprecedented breakthrough in access to a new COVID treatment.  

The historic deal, reached between the pharma company Merck Sharp & Dohme (Merck) and the Medicines Patent Pool paves the way for MPP to sign contracts with generic drug manufacturers to produce and sell the treatment, molnupiravir  at discounted prices to more than105 countries worldwide, once the drug has been approved by the US Food and Drug Administration and the World Health Organization. 

The agreement is the first time in the pandemic that a major pharma company has agreed to such an open-ended license for generic production of a newly developed drug. The drug,  currently awaiting US FDA emergency review, reduced risks of hospitalization or death by about 50% among patients with mild or moderate COVID, according to the company reports of the results of its Phase III trial.  

The deal also represents a major coup for the Geneva-based MPP, a non-profit organization with a long track record of negotiating with big pharma innovators for broader generic production of costly new drugs for treating hepatitis, HIV, and other diseases. 

Until now, however, MPP had not been able to enter fully into the COVID medicines access fray – with pharma producers reluctant to negotiate with the non-profit over broad-based licenses for the generic production of COVID vaccines and drugs.  Other new COVID drug treatments, such as the newly-approved monoclonal antibody cocktail REGEN-COV, remain expensive and hard to access in most LMICs. They are also more difficult to use  – as they need to be administered intravenously.

Charles Gore, MPP Executive Director, said of the breakthrough, “This transparent, public health-driven agreement is MPP’s first voluntary licence for a COVID-19 medical technology, and we hope that MSD’s agreement with MPP will be a strong encouragement to others.”

The MPP is all the more meaningful as the new drug will be the first major COVID medication that can be administered orally to non-hospitalized patients, said WHO in a statement.

‘Best agreement any company has made’    

The announcement was roundly hailed by WHO and other UN-affiliated agencies managing the UN-supported ACT-Accelerator initiative to broaden access to vaccines and drugs.  A number of medicines access advocates who have bitterly criticized pharma for failing to issue more voluntary license deals for for other cutting edge vaccines and treatments, issued particularly warm statements about the Merck deal. 

Said Jamie Love, of Knowledge Ecology International, “The license between the MPP and Merck for the manufacture and sale of molnupiravir is the best agreement any company has made for licensing its intellectual property during the COVID-19 pandemic.

“The 69-page license agreement is fully transparent, unlike the agreements with CEPI, COVAX, Operation Warp Speed, the Gates Foundation, the Wellcome Trust, other companies or most governments,” added Love referring to the other international and UN-supported initiatives on COVID drug and vaccine access.

“The license makes it possible for any generic manufacture located anywhere the world to supply molnupiravir in the licensed territory, and provides a pathway for supplying to countries outside the licensed territory, when patents are not in place or subject to compulsory licenses.

“The licensed area is large enough (more than half the world’s population) to induce efficient generic entry and economies of scale,” he added – while noting that the 18% population coverage in LAC is weakest – although a separate Merck deal with Brazil is reportedly underway. 

Concluded Love: “Given the objectives of scaling up production of molnupiravir at the lowest prices for the lowest income countries, the agreement is an impressive achievement for the Medicines Patent Pool and Merck deserves credit for being the first company to make a deal with the Medicines Patent Pool.”

MSF calls out shortcomings of contract 

Even so, some civil society stakeholders, and notably Médecins Sans Frontières (MSF) said that the licensing arrangement “does not go far enough” expressing “disappointment with the limitations of this license, as its territory excludes nearly half of the world population and important upper-middle-income countries (UMICs) with robust manufacturing capacity, such as in Brazil and China.” 

Yuanqiong Hu, Senior Legal and Policy Advisor, MSF Access Campaign added that: “After more than a year of secrecy of companies’ bilateral deals in a pandemic, it is a welcomed step forward to have the first fully published voluntary license from MPP covering COVID19 medical tool. 

“However, a closer look reveals its limitations for increasing access to one of the first promising antiviral drugs for COVID-19. It’s disappointing…. Middle-income countries excluded from the license had 30 million COVID-19 infections in the first half of 2021, 50% of all infections in low- and middle-income countries.

Medicines, Law and Policy, while generally positive, also called out a clause that would allow MPP terminate a sublicence agreement with a manufacturer of the new drug, in the case of a patent challenge – a clause reportedly included at the request of the drugs initial developers at DRIVE, a subsidiary of Emory University and Ridgeback Pharmaceuticals.

Emory University has in fact waved royalties on the sale of the drug in low- and middle-income countries for as long as the WHO-declared international public health emergency continues.

However the termination of sublicence clause also has provoked protests by students, who say that it could restrict or undermine the flexibility of the generic licensing agreement.

Merith Basey, Executive Director for Universities Allied for Essential Medicines, a student-led movement that aims to change universities’ licensing practices told us: “Emory University has betrayed its mission to serve humanity by stifling global access to a potentially life-saving COVID treatment. Molnupiravir was developed on Emory’s campus with massive amounts of tax-payer funding, yet this license includes a stipulation demanding a no-patent challenge. We call on the institution to remove the clause and favor people over profit in the midst of a global pandemic that has killed over 5 million people so far.”

Image Credits: Merck , Merck .

October is Liver Cancer Awareness month, and Europe has a liver cancer problem. Over the past two decades, there has been a 70% increase in liver cancer-related mortality in the region. 

In 2020, 87,000 Europeans were diagnosed with liver cancer while 78,000 died from the disease in the same year.

Late diagnosis is a serious problem. About half of patients are only diagnosed in an advanced stage of cancer and have less than a year to live.

Liver cancer is the sixth most common cancer and the third biggest cause of cancer-related deaths globally. 

In the US, the rate of deaths from liver cancer increased by 40% from 1990 to 2004 while the overall rate of non-liver cancer deaths declined by 18%.

Projections for the US estimate that in 2030, liver cancer will be the third-leading cause of cancer-related deaths, surpassing breast, colorectal, and prostate cancers.

There are many risk factors for developing liver cancer, and chronic liver diseases caused by viral hepatitis, alcohol, or fatty liver disease are the most important.

Diabetes and obesity 

Non-alcohol fatty liver disease (NAFLD), which is often a consequence of obesity and diabetes, is the leading cause of death among 35 to 49-year-olds in the UK, making NAFLD a health threat that should not be underestimated. (The more severe form of NAFLD is called nonalcoholic steatohepatitis, or NASH).

Outside of COVID-19, NAFLD is also about the fastest growing disease globally. It occurs in about one in four people around the world and has emerged as the most prominent cause of chronic liver disease. 

Experts predict that, over the next decade, NAFLD will become the leading cause of end-stage liver disease and liver transplantation. It is already the fastest-growing cause of hepatocellular carcinoma (HCC), the most common form of liver cancer worldwide.

Faced with a ticking public health time bomb in Europe, we are clearly in a race against time to both prevent and treat this disease before the epidemic worsens and overwhelms health systems.

Better treatment access

Treatment of chronic liver diseases to avoid their progression to precancerous states like cirrhosis significantly reduces the risk of liver cancer, and this has been convincingly demonstrated. 

Improved and equal access to state-of-the-art management of these diseases is a core element in the fight against liver cancer.

Although liver cancer remains one of the few cancers with increasing incidence and mortality, public awareness of liver cancer is much lower than for other cancers. 

As a consequence, patients who have liver cancer and patients who are at increased risk for liver cancer often face stigma in their social lives, and also in the medical settings.

Treatment options for liver cancer have significantly improved over the recent years, which makes early diagnosis the most critical point. Case-finding strategies need to be implemented, at least in at-risk patients, as strongly recommended by clinical guidelines.

Hepatitis B vaccinations

Finally, we must directly tackle the key environmental factors that cause liver diseases and liver cancer. In addition, successful Hepatitis B vaccination programmes need to be continued and expanded as the core element of primary liver cancer prevention as it has the potential to prevent roughly twice as many cancer cases as HPV vaccination.

Earlier this year the European Commission launched its Beating Cancer Plan in response to the fact that the EU region is home to a quarter of the world’s cancer cases and is facing an annual economic impact of €100 billion if urgent action is not taken. 

This plan is precisely what is needed to bring scientific societies, experts and patient groups together to move forward measures that can go a long way towards stopping liver cancer in its tracks.

But these measures need to be coordinated across the region, led by the European Commission, and implemented by EU Member States.

A starting point has to be the setting of standards for awareness, prevention, and management of liver cancer across the region. It is pivotal that we educate and raise awareness amongst everyone: healthcare professionals, patients and families, risk groups, policymakers and the general public.

Liver cancer usually occurs as a consequence of underlying chronic liver disease and cirrhosis. Thus, the EU and Member States should implement preventive measures that include evidence-based strategies to reduce the burden of liver disease, focusing on reducing alcohol consumption and obesity, and on early detection and treatment of chronic liver disease.

Early detection is critical for those patients with liver diseases associated with a high risk of liver cancer such viral hepatis B and C, alcohol-related and non-alcoholic fatty liver disease. The EU and Member States should add liver cancer to their screening list, at least for patients with underlying risk factors. In addition, existing programs providing the opportunity of early case finding of liver diseases should be leveraged where possible. The salivary screening for Hepatitis C using point of care testing is a good example and complements the WHO HCV program aiming at fighting HCC as well.

Inter-disciplinary disease management

But we also need improved access to better disease management for patients with liver cancer across all member states of the EU. This means a more structured pathway for the diagnosis and treatment of patients when they are receiving care in hospital, as an outpatient and then at home. 

That will require better inter-disciplinary cooperation between hepatology, oncology and other relevant disciplines and ideally collaborative clinical guidelines that are driven by comprehensive scientific evidence.

Basic research continues to be a critical element for improving patient outcomes in liver cancer. There is still further knowledge needed about aetiology, rare liver cancer entities, markers and diagnostics which might facilitate early detection even in primary care. 

The EU and Member States should support such research projects and cross-country collaboration by setting up EU-wide platforms with the aim of sharing data and closing the gap between medical knowledge and clinical practice.

The high standard of care in the EU is based on high-level science and research. In order to maintain these standards furthermore and drive improvements, it is essential to collect data collaboratively across all member states. The EU and Member States should support the setting up of specific patient registries for liver cancer. 

The collation of this data would facilitate surveillance, research and the overall management of patients with liver cancer.

Care must be patient-centric. People living with liver cancer and their families should have unrestricted access to information, medical treatment, and measures to improve their quality of life, regardless of their life situation and ethnic origin. All patients with liver cancer should benefit from the same high standards of care wherever they are in Europe.

Thomas Berg is the Secretary-General of the European Association for the Study of the Liver (EASL) and Head of the Division of Hepatology at Leipzig University Medical Center in Germany.

 Maria Buti is the EASL EU Policy Councillor and Professor of Medicine and Chief of Internal Medicine and Hepatology at the Hospital General Universitari Valle Hebron in Barcelona, Spain.