A French official checks a woman’s COVID-19 certificate, providing evidence of vaccination or a recent PCR test.

It may be too late for many European countries to avoid harsh measures to try to curb the intense transmission of COVID-19, according to World Health Organization (WHO) officials on Friday.

“Almost two million cases of COVID-19 were reported in Europe last week, the most in a single week in that region since the pandemic started,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the global body’s media briefing.

“Almost 27,000 deaths were reported from Europe, more than half of all COVID-19 deaths globally last week.”

High rates of infections are being experienced both in more vaccine-hesitant countries in Eastern Europe, as well as in countries with some of the world’s highest vaccination rates in Western Europe – reflecting the fact vaccinations alone are not enough to halt the virus, according to the WHO.

A number of European countries have already started to clamp down on public activities. The Netherlands is poised to introduce a three-week partial lockdown including a 7pm closing time for restaurants this weeked, while Austria expects to introduce more restrictions on unvaccinated people.

Last month, Russia – part of the WHO Europe region – ordered all unvaccinated people over 60 and with underlying conditions to stay at home until February as it battles its worst case load amid vaccine hesitancy.

At least 12 European countries including Italy, France, Germany, Portugal, Greece and Belgium now require people entering public places such as restaurants, museums and concernts to show proof of vaccination or a recent test with a COVID digital certificate, with Denmark being the most recent to introduce such a measure this week. Some countries are also applying the passes in workplaces, particularly schools and health facilities.  

Restrictive measures

“Quite frankly, some countries are in such a difficult situation now that they’re going to find it hard not to put in place restrictive measures at least for a short period of time to reduce the intensity of transmission,” said Dr Mike Ryan, WHO’s head of health emergencies.

“Other countries can re-engage with communities around masks, around avoiding crowded spaces, around limiting their contact with others, work from home and many other initiatives and very importantly increasing vaccine coverage in high-risk populations,” stressed Ryan.

However, each country would have to assess their own unique situations – weighing vaccination levels and “what level of compliance can be expected from the implementation of personal measures versus government-mandated measures”, he added. 

Predictable surge after curbs lifted

WHO’s COVID-19 lead, Dr Maria Van Kerkhove described the surge in Europe as “predictable” given that most restrictions on social mixing and masks had been lifted.

However, the European surge was also showing “quite strongly how effective vaccines actually are in terms of reducing hospitalizations and reducing deaths”, she added.

New research from the UK has shown that an unvaccinated person has a 32 times higher risk of death than a vaccinated person, said Ryan, but these vaccines had to reach the most vulnerable people.

Places with high vaccination rates of vulnerable people were seeing cases increase but this had not translated into pressure on health systems. But in countries where there were significant pockets of vulnerable people unvaccinated, the same incidence or even lesser incidence of disease will lead to pressure on the health system, added Ryan.

WHO remains opposed to boosters in Europe

Despite the stiff WHO warnings about the possible need for stricter lockdown measures, WHO officials have continued to recommend against the wider uptake of booster shots in Europe or other high-income countries.

WHO has maintained that there is insufficient evidence for boosters, which also divert vital vaccine supplies from countries that haven’t even yet had one jab.  And on Friday Tedros once again appealed for a moratorium on boosters until the end of 2021, so that available doses can be channelled to countries that have not yet reached the WHO goal of 40% vaccination coverage.  He pointed out that, every day, there are six times more boosters being administered globally than first or second doses in low-income countries.

Even so, it appears that boosters are being administered with ever increasing frequency in high-income countries seeing surges – with 92 high- to -middle income countries initiating booster programmes for at least some population groups.

US Chief Medical Officer Anthony Fauci recently hailed the successful Israeli booster campaign as a model that others will have to follow. Israel was one of the first countries to initiate mass administration of boosters in August after it became clear that vaccine immunity from the first two shots had waned significantly after five month. The campaign  drove down new infections from one of the word’s highest levels to levels below that of almost any country in Europe or North America today.

There are now signs that boosters are helping to reduce new infection rates and hospitalizations in the United States, although they are only available to people over age 65, and at least stabilise persistently high rates in the United Kingdom, where people over age 50 can now get a third jab.

According to WHO, 25% of the doses administered every day worldwide are now booster doses, as compared to only 5% two weeks ago.

WHO remains mum on COVID-passes requiring proof of vaccination or testing

Resistance to both lockdowns, as well as much milder measures “COVID pass” rules, is strong in a number of European countries. Large protest rallies have taken place recently in a number of Swiss, German and French cities.

In Switzerland a national referendum is planned for 28 of November to vote on whether to maintain the new system of COVID passes required in almost any indoor venue outside of a private home.

Scope of Switzerland’s COVID Pass

In anticipation of the vote, a series of large demonstrations have been underway – protesting the COVID certificates that are the main focus of controversy. French and Italian opponents of COVID certificates also are eyeing the Swiss debate and the precedent that may take shape on referendum day.

WHO has largely recommended against the use of COVID vaccine or PCR test passes for international travel – pointing to the inequalities between rich and poor countries in accessing vaccines.

But it has refrained from entering into the fray over domestic use of COVID certificate in countries where vaccines are universally available.

Asked about the issue by Health Policy Watch, a WHO spokesperson responded Friday evening saying that the organization was “still checking” for a response.

–Elaine Fletcher contributed to this story

  • Updated 14.11.2021

Image Credits: Mat Napo/ Unsplash, https://www.ge.ch/en/covid-19-certificate/scope-covid-certificate.

moderna

Moderna has fired back against claims made by US National Institutes of Health (NIH)  that its scientists at the National Institute of Allergy and Infectious Diseases (NIAD) helped to invent the crucial component of the pharma company’s COVID-19 vaccine, stating that the mRNA sequence was “selected exclusively” by Moderna scientists. 

“We do not agree that NIAD scientists co-invented claims to the mRNA sequence of our COVID-19 vaccine,” a tweet from a thread on intellectual property by the company said on Thursday.

The thread continued: “The mRNA sequence was selected exclusively by Moderna scientists using Moderna’s technology without input of NIAID scientists, who were not even aware of the mRNA sequence until after the patent application had already been filed.” 

However, Moderna does recognize the “substantial role that the NIAID has played in helping to develop Moderna’s COVID-19 vaccine,” and has said that it has, in fact, included NIAID scientists as co-inventeres on published patent applications where they have made inventive contributions.  

Genetic sequencing dispute; Moderna turned ‘people’s vaccine into rich people’s vaccine’ 

In a story first reported by the New York Times on Tuesday, Moderna had excluded three NIH scientists as co-inventors of a central patent for the company’s COVID-19 vaccine in its application filed in July. 

But the NIH has asserted that three of its scientists at the NIAD, Dr John Mascola, Dr Barney Graham, and Dr Kizzmekia Corbett, helped design the genetic sequence used in Moderna’s vaccine, and should be included on the patent application. 

Had federal researchers been named as co-inventors in the patent, the government would have almost exclusive right to license the vaccine to other manufacturers, opening access to low- and middle-income countries who are still lagging behind in vaccination rates. 

“Recognition as the vaccine’s joint inventor can help the U.S. government finally responsibly steward the vaccine’s use, including by helping secure access for the billions of people still awaiting a safe path out of the pandemic,” said Peter Maybarduk, director of US-based advocacy group Public Citizen’s Access to Medicine, in a statement.

“But Moderna has turned this people’s vaccine into a rich people’s vaccine; refusing to share technology with WHO or developing country manufacturers and sharing very few doses with COVAX while overcharging poor nations.”

Both Moderna and Pfizer have been lambasted by WHO’s Director General Dr Tedros Adhanom Ghebreyesus in the past for offering and planning COVID boosters while billions in LMICs await their first jab.

NIH not backing down from claims

Speaking to Reuters, NIH Director Dr Francis Collins made clear that the NIH, the government’s biomedical research agency, was not backing down. 

 “I think Moderna has made a serious mistake here in not providing the kind of co-inventorship credit to people who played a major role in the development of the vaccine that they’re now making a fair amount of money off of.”

Advocacy group Public Citizen has pointed out Moderna’s failure to name NIH scientists as joint inventors, imploring NIH to “ensure the contributions of federal scientists are fully recognized,” in a letter to Director Collins last week.  

“NIH is showing a modicum of verve at last, suggesting it will not allow federal scientists’ role in the invention of the NIH-Moderna vaccine to be erased,” said Maybarduk. 

Moderna has received around $10-billion in US government money to develop its vaccine but has not responded to US government pressure to share the vaccine technology with low and middle-income countries.

Image Credits: Gavi .

covaxin
Covaxin

Following World Health Organization approval last week, interim data from a phase 3 trial of BBV152, a COVID-19 vaccine developed in India, reports 77.8% efficacy against symptomatic COVID-19. 

The study, published in The Lancet, indicated that BBV152 induced a robust antibody response, with the majority of adverse events, including headache, fatigue, fever, and pain at the injection site, were mild and occurred within seven days of vaccination. 

BBV152, also known as Covaxin, is an inactivated whole virion vaccine developed by India-based Bharat Biotech. The vaccine has recently received emergency use approval (EUL) from WHO for people aged 18 and older, and is administered in a two-dose regimen, 28 days apart. 

The trial conducted an efficacy analysis of 24,419 randomly-assigned participants across 25 hospitals in India who received either two doses of the vaccine or a placebo between 16 Nov 2020 – 17 May 2021.

Vaccine cold-chain requirements make it suitable for low- and middle-income countries

covaxin
Covishield and Covaxin Drive in India

Covaxin’s ability to be stored and transported between 2-8 degrees Celsius has made it suitable for  low- and middle-income countries.

Jing-Xin Li and Feng-Cai Zhu of the Jiangsu Provincial Center for Disease Control and Prevention in China, who were not involved with the study, say “the roll-out of BBV152 might ease the ultra-cold chain requirements of other SARS-CoV-2 vaccine platforms, increase the finite global manufacturing capacity, and improve insufficient supply of vaccines which disproportionately affects low-income and middle-income countries.” 

Bharat Biotech said the WHO EUL approval will help countries “expedite their regulatory approval processes to import and administer Covaxin.” 

“It allows procurement by UNICEF, the Pan-American Health Organization (PAHO), and the GAVI COVAX for distribution to countries in need,” a company press release said. 

The Gavi managed COVAX global vaccine facility has not  yet  signed an agreement with Bharat Biotech, with India delaying committing supplies to the COVAX global sharing effort, sources told Reuters.  

The world’s biggest vaccine maker resumed exports of COVID-19 doses in October, for the first time since April. It has sent about 4 million doses to countries such as neighboring Bangladesh and Iran, but none to COVAX.  

The vaccine has, however, been distributed widely already in India, with 121 million doses administered since the beginning of the country’s big COVID surge in the spring of 2021. 

Covaxin gears up for major distribution abroad 

Airfinity’s COVID Vaccines Revenue Forecasting predicts 545 million Covaxin doses to be sold to low-middle-income countries in 2022.

Following the WHO approval and publication of its Phase 3 results, Covaxin is gearing up for major distribution abroad.

Airfinity’s COVID-19 Vaccine Market Forecast 2021 – 2022, which covers global demand scenarios, supply and production, and revenue of COVID vaccine, has predicted 545 million Covaxin doses will be sold to low-middle-income countries in 2022.

As many as 96 countries have already recognized Covaxin, with Hong Kong the latest to approve the vaccine for international travelers. 

Canada, the US, Australia, Spain, the United Kingdom, France, Germany, Belgium, Russia, and Switzerland, are among the 96 nations to recognize both Covaxin and Covishield, another India-manufactured vaccine. 

Further research needed against COVID-19 variants 

The next step for studies of BBV152, noted Li and Zhu, should be long-term monitoring of vaccine efficacy against COVID-19 and its efficacy against variants. 

This is to “identify whether the vaccine provides ongoing protection when any variation of concern replacement (other than the variants of concern investigated in the study) has occurred,” they said. 

Preliminary analysis of efficacy found Covaxin to be 65% effective against symptomatic COVID-19 from the delta variant. 

Additionally, there was no decrease in efficacy against the alpha variant (B.1.1.7) and marginal reductions in efficacy against other variants of concern, including delta and gamma variants.

Image Credits: Mohammed Naseeruddin/Twitter, Airfinity.

COVID-19 Ministerial meeting, convened by US Secretary of State Antony Blinken

Pakistan and eight other countries, mostly in or around conflict zones, face the largest gaps in vaccine commitments needed to reach a WHO goal of 70% coverage by September 2022. 

The data is part of a new “COVID Global Tracker” – launched Wednesday during a first-ever meeting of the world’s foreign ministers, convened by US Secretary of State Anthony Blinken.  At the meeting, the US also announced that it had brokered a deal to deliver more J&J one-shot vaccines to countries in humanitarian crisis.  

Pakistan, which has a population of some 221 million people, is short nearly 60 million doses, according to the new data tracker. Data from the other countries, locked in prolonged crises or conflict, reflects the fact that, so far, most of the doses that will be needed have not yet been secured at all.

For instance, Afghanistan, with a population of 39 million people, remains short 22 million vaccine doses.  Yemen, with a population of 30 million, is short some 18 million doses.  And the Democratic Republic of Korea (PRK), with a population of some 26 million people, is some 16 million doses.  The gaps between demand and supplies available to the countries with the biggest long-term needs would be narrowed if one-shot J&J shots are deployed. 

Syria with a population of 17.5 million people is short 11 million doses, and Haiti (HTI), with 11.4 million people, is short some 7 million doses. Other countries on the list include Papua New Guinea (pop: 9 m), Nicaragua (pop: 6.6 m) and Laos (pop: 7.3 m).  

Top 9 Countries with Largest Gaps to Reach 70% Coverage (millions of doses)

Data published on the “COVID Global Tracker, highlights in vivid detail the shortfall in vaccine access that low- and middle-income countries face, including a large swathe of Africa – and which is likely to persist throughout 2022.  

First-ever meeting of foreign ministers on COVID pandemic 

The meeting marked the first time that the US had convened foreign ministers to discuss responses to the COVID-19 pandemic since it began in February of 2020. 

Ït brought together some 40 ministers, including China’s, said Gayle Smith, State Department coordinator for global COVID-19 response in a press readout following the meeting. 

Noting that the pandemic is not just a health crisis but a security, economic and humanitarian crisis, Blinken said, “we need foreign ministers to step up and lead as well.” 

In press statements after the meeting, Blinken also called for expanded government and private sector collaborations to expand vaccine manufacturing, unlock supply logjams, and support expanded vaccination efforts in low- and middle-income countries.

Only 13% of COVAX contracted doses delivered so far – ministerial meeting fails to yield more concrete commitments on delivery 

But the meeting did not translate into any immediate commitment to close the gap in dose deliveries to low- and middle WHO Director General Dr Tedros  Adhanom Ghebreyesus, asked ministers to immediately set up a working group to deliver the estimated 514-680 million vaccine doses that would be needed needed to ensure 40 percent of each country’s population is vaccinated by year’s end.

Some some 74 countries, mostly in sub-Saharan Africa, remain off track for meeting that 40% coverage goal, according to the data on the newly-released COVID19 Global Tracker.  Sixty of those countries are among the 91 low- and middle-income countries that are primarily depending on COVAX, or the African Vaccine Acquisition Task Team (AVATT), for deliveries. The remainder are in fact  upper-middle income countries that have fallen through the cracks. 

Expected Effective Vaccine Supply at End-2021 (% of Total Population): Most of sub-saharan Africa, and parts of Asia, could, at best, only reach 10-20% coverage – as compared to the 40% WHO goal.

Only 13% of doses contracted by COVAX, and 6% of doses contracted by AVATT have actually been made available for delivery so far by manufacturers, the COVID Global Tracker also shows. That translates into a whopping 3.45 billion COVAX doses still missing from supplies, according to the Global COVID Tracker. 

Civil Society groups issue new call to prioritze LMICs in new dose deliveries as well as donations

Along with WHO’s call on rich countries to release more dose donations, civil society groups called upon the ministers to let low- and middle-income countries jump the line – and receive first priority for forthcoming vaccine deliveries. 

The ministers should  “agree to share all doses between those needed for domestic demand, as soon as they come off the production line,” in coordination with COVAX and AVATT, stated the open letter signed by nearly 40 civil society groups, including the Rockefeller and Open Societies Foundations:  

“HICs must publicly commit to send their expected deliveries straight to COVAX and regional mechanisms in Q4 2021 and organize this without delay with pharmaceutical and delivery companies. Ministers must use all routes available, including donations and ‘queue swaps’, to deliver doses to LMICs quickly.”

But far those appeals have failed to get a response – including at the recent meeting.  G-20 countries also remain far off course in delivering doses against promised donations. 

Insufficient progress on delivering pledged doses to COVAX – across most high-income countries

Waiving Indemnity – eases vaccine delivery to crises regions

On a brighter note, the US deal with J&J should ease the flow of those one-shot vaccines, including US vaccine donations, to a range of states in crises. The arrangement involves the company’s waiving of liability requirements that vaccine manufacturers typically demand of countries before vaccine acquisition deals are signed. 

“I’m pleased to share that the United States has helped broker a deal between J&J and COVAX to facilitate the first delivery of J&J vaccines to people living in conflict zones and other humanitarian settings,” Blinken said at the meeting.   

“We’re eager for people in these difficult circumstances to get protection against COVID-19 as soon as possible. We know the urgency of this fight,” he added.  “We’ve got to be relentless because this pandemic is relentless. And we have to be coordinated, united, because that’s what a global health emergency like this requires.”

Only a handful of other  Chinese firms have also waived such indemnity requirements, including: Sinopharm and Sinovac, which have WHO-approved jabs on the market, as well as the biotech firm Clover, whose vaccine R&D was has been supported by the Oslo-based Coalition for Epidemic Preparedness (CEPI), followed by a recent IPO that raised $240 million on the Hong Kong stock exchange just last week.

While still undergoing WHO review, Clover has already signed a deal with Gavi, the Vaccine Alliance, to supply its vaccine to COVAX following successful results of a Phase 2/3, multi-country trial of 30,000 people.

In that trial, Clover announced that it’s vaccine had been 84% efficacious against moderate-to-severe COVID, and 100% efficacious against severe COVID. 

Image Credits: US Department of State, https://covid19globaltracker.org/, https://covid19globaltracker.org/.

COP26 president Alok Sharma

A draft agreement released by UN Climate on Wednesday “calls upon parties to accelerate the phasing out of coal and subsidies for fossil fuels” – as countries work toward reaching consensus by the time the Glasgow Climate Conference (COP26) ends on Friday.

The word ‘health’ also was noticeably absent from the draft text, reflecting the continued failure of the global community to recognise and address the intrinsic linkages between planetary and human well-being.

Despite a recent spate of promises, including new pledges by the US and China, limiting global warming to 1.5° Celsius remains well out of reach.  Even if all commitments are met, the world would still see 2.4°C warming by the end of the century, experts now predict.

That was the conclusion of the non-profit Climate Action Tracker, which added up the most recent country pledges – or Nationally Determined Contributions (NDCs) – for CO2 reductions – translating those into forecasts for expected temperature rise. 

Target shortfalls reported by Climate Action Tracker.

Earlier calculations had estimated a 2.7°C temperature rise – showing slight gains in the slow race to carbon neutrality.  

Dr Stephen Cornelius, the World Wildlife Fund’s chief advisor on climate change, described the country pledges as “woefully inadequate”.

“COP26 has gotten further than Paris, but we are nowhere near the 1.5°C needed to avoid the worst impact of climate change,” Cornelius told a media briefing on Wednesday.

However, he welcomed the draft’s recognition of the importance of science, including reference to the “code red” warning contained in a recent report issued by the Intergovernmental Panel on Climate Change (IPCC) on the urgency of climate action.

‘Wreckers’ like Saudia Arabia and Australia will try to weaken text

Greenpeace International Executive Director Jennifer Morgan described the draft declaration as “a polite request that countries maybe, possibly, do more next year”. 

“We’ve just had a landmark study showing we’re heading for 2.4°C of warming,” said Morgan. “The job of this conference was always to get that number down to 1.5°C, but with this text, world leaders are punting it to next year.”

Greenpeace wants an agreement that is much stronger on finance for countries to mitigate and adapt to climate change.  

It also wants a commitment from countries to report annually – instead of every five years – on “new and better” plans until the world is able to reduce the global warming trajectory to the 1.5°C goal. 

While the language calling for an accelerated phase out fossil fuel subsidies, estimated to exceed $5 trillion annually, is seen as a signal of progress, there is no timeline for that to take place. 

And Morgan predicted that “wreckers like the Saudi and Australian governments” would try to delete the call for an accelerated phaseout of coal and fossil fuel subsidies from the draft. 

UK Green MP Caroline Lucas also condemned the draft, saying that it “utterly fails to rise to the moment” by failing to phase out all fossil fuels not just coal.

COP26 delegates ignore warnings that fossil fuel subsidies are dangerous to health 

Fossil fuel subsidies have been repeatedly decried by the World Health Organization and other health experts at a series of health-focused COP26 events as particularly pernicious. 

Such subsidies, WHO points out, fuel dirty energy and transport sources – leading to air pollution emissions that kill an estimated 7 million people a year – while also discouraging investments in cleaner solutions that would be more cost-effective for societies overall.

But the draft final COP statement had nary a word about health – or the climate-air pollution nexus plaguing many developing cities, particularly in South-East Asia.  

“Nearly half a billion will suffer severe health harm from north India’s air pollution even as COP26 offers up unambitious targets to a world at the brink of extinction,” stated the Indian NGO Care for Air. 

Paradoxically, COP will be concluding just as northern India’s seasonal air pollution emergency begins – a situation seen every autumn when smoke from crop stubble-burning in rural areas drifts toward Delhi, where it combines with a potent mix of fumes from construction, traffic, waste burning, and firecrackers celebrating the Hindu Diwali festival.  

Grand promises by politicians last year to devise more sustainable alternatives for farmers – such as composting or machine threshing of crop stubble – to have so far failed to materialize.   

‘Massive credibility gap’, absence of clear targets for fossil fuel phase-out

In Glasgow, politicians seemed anxious to avoid making the potent linkages between climate change and millions of deaths a year from air pollution.

Language in the draft agreement remained general and non-specific around critical points, such as setting a target or timeline for actually phasing out fossil fuels. 

The draft agreement merely “invites parties to consider further opportunities to reduce non-carbon dioxide greenhouse gas emissions”.

The statement does, however, go further than previous COP declarations in suggesting that a more holistic approach to the climate crisis is needed, emphasising the “critical importance of nature-based solutions and ecosystem-based approaches, including protecting and restoring forests, in reducing emissions, enhancing removals and protecting biodiversity”.

Even so,  “at the midpoint of Glasgow, it is clear there is a massive credibility, action and commitment gap that casts a long and dark shadow of doubt over the net zero goals put forward by more than 140 countries, covering 90% of global emissions”, Climate Action Tracker’s briefing document observed.

The country targets for 2030 remain “totally inadequate”, added the report, estimating that they “put us on track for a 2.4°C temperature increase by the end of the century”. 

Another significant unresolved issue: LMIC financing  

COP26 President Alok Sharma confirmed at a plenary on Wednesday that while “some significant issues remain unresolved”, he expected “near-final” texts from the various negotiating groups by Thursday morning and a consensus document for adoption by the close of the summit on Friday.

Aside from the inadequate emission targets, other sticking points concern financing, including agreement on finance for countries’ claims of climate change-related loss and damage – most of which are likely to be filed by low- and middle income countries. 

UK lead climate negotiator Archie Young told the plenary that more work also needs to be done on the “significant finance agenda and the $100-billion goal” – the annual finance target set by the Paris Agreement to be available by the end of 2021 to assist LMIC countries to mitigate and adapt to climate change.

The draft appeals to “the private sector, multilateral development banks and other financial institutions to enhance finance mobilization in order to deliver the scale of resources needed to achieve climate plans, particularly for adaptation”.

Glasgow flooded with fossil fuel lobbyists

While the global business and finance community is said to have an unprecedented presence at COP26 – the largest contingent at the entire conference – is in fact the fossil fuel industry, an analysis of participants found.  

Some 503 fossil fuel lobbyists are registered at Glasgow, according to the analysis by the civil society groups, Corporate Europe Observatory (CEO) and GlobalWitness.org. 

The report “Glasgow Calls Out Polluters” found that if the fossil fuel lobby were a country delegation at COP it would be the largest with 503 delegates – two dozen more than the largest country delegation. In addition, the report found that: 

  • Over 100 fossil fuel companies are represented at COP with 30 trade associations and membership organisations also present;
  • Fossil fuel lobbyiests are members of 27 official country delegations, including Canada, Russia and Brazil.
  • Fossil fuel lobbyists dwarf the UNFCCC’s official indigenous constituency by around two to one.
  • The fossil fuel lobby at COP is larger than the combined total of the eight delegations from the countries worst affected by climate change in the last two decades – Puerto Rico, Myanmar, Haiti, Philippines, Mozambique, Bahamas, Bangladesh, Pakistan.

Image Credits: Climate Action Tracker., Climate Action Tracker.

Solar panels provide electricity to Mulalika Health Clinic in Zambia.

Fifty countries have committed to building sustainable, low-carbon and climate-resilient healthcare systems, and 14 of these have set net-zero carbon emission target dates from as early as 2030. 

This emerged from a health and climate change session at COP26, the United Nations climate conference in Glasgow, that was co-hosted by the World Health Organization (WHO).

“As part of a green and resilient recovery from COVID-19, we need to recognise the role of health systems as emitters accounting for 4% to 5% of global emissions,” said Dr Rachel Levine, US Assistant Secretary in the Department of Health and Human Services.

If the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, according to Health care’s climate footprint, a report produced by Health Care Without Harm.

“These emissions are predicted to increase as health systems develop, and demographic changes lead to increasing healthcare demand,” said Levine, adding that the countries that had committed to building low carbon health systems were responsible for about one-third of all health sector emissions globally.

The US has committed to decarbonizing the nation’s health systems by reducing  greenhouse gas emissions in the federal health system, as well as the private sector via  “incentives, guidance, technical assistance and regulatory approaches and partnerships”, Levine added. 

“The United States action on health system decarbonization is influential and critical. The US accounts for approximately 25% of the world’s health sector greenhouse gas emissions. This commitment to reducing greenhouse gases will also result in decreasing the negative health impacts of air pollution, such as premature death, heart disease, stroke, and more,” said Levine.

Josh Karliner, International Director of Program and Strategy at Health Care Without Harm, said that “there is a growing global movement of hospitals and health systems” that were already reducing their carbon emissions.

“There are more than 54 institutions in 21 countries representing more than 14,000 hospitals and health centres committed to race to zero,” said Karliner. “This is from Newcastle to New York. It’s from Sao Paulo to South Africa. It’s from Kerala to California.” 

Karliner explained: “We’re seeing hospitals and health systems taking action by investing in renewable energy by investing in zero-emission buildings and transport; by substituting anaesthetic gases with more sustainable alternatives; by implementing sustainable procurement programmes to purchase sustainably produced food, energy-efficient medical devices and lower carbon pharmaceuticals.” 

However, ‘greening’ health systems is a massive, expensive undertaking that requires many fundamental changes covering architecture, waste disposal, energy, and water.

 

A flash flood in Fiji in 2018

Small island states struggle to make health services climate-resilient

Dr Satyendra Prasad, Fiji’s permanent representative to the UN, told the meeting that his country struggled to keep health services running when faced with superstorms and other adverse weather events.

“It is quite tragic when your doctors and nurses are being evacuated when they should be providing frontline services to people who have been injured and who need care,” said Prasad. 

“This conundrum is very tough, and it is a conundrum that exists for so many countries,” said Prasad, adding that Fiji is in the process of relocating health services to higher ground and equipping facilities with renewable energy to enable them to remain operational after major cyclones of flooding.

“We losing fewer lives to extreme weather catastrophes. We are losing more lives to waterborne diseases and all the diseases that come following a major catastrophe such as flooding, and cyclone,” he added.

Similarly, the Maldives has seen the emergence of vector-borne tropical diseases such as Dengue, which it didn’t use to have, said Aminath Shauna, Minister of Environment, Climate Change and Technology in the Maldives.

“The Maldives is one of the most vulnerable island nations to climate change. We are experiencing things that we thought would happen towards the end of the century,” said Shauna.

“Our coral reefs are dying. We are running out of fresh water. Our islands are eroding, and our islands are getting more frequently flooded, which poses a significant challenge to our public health system,” she added.

To mitigate these risks, the Maldives has integrated climate risks into health policy, developed climate-sensitive disease programmes and is promoting climate-resilient healthcare facilities that are able to withstand climate events. It is also working to ensure that its essential services such as water, sanitation, waste management and electricity can still function during extreme weather events. 

“The Maldives health sector is also committed to initiating the greening of the health sector by adopting environment-friendly technologies and using energy-efficient services,” said Shauna.

Finances for adaptation

However, finances to make these changes are a challenge for countries like Fiji and the Maldives. Lack of finance has been a recurrent theme at COP26, with smaller countries with small carbon footprints appealing for reparations from large polluting countries to assist them to mitigate climate change.

Former UK prime minister Gordon Brown and WHO Ambassador for Global Health Financing told the meeting that “you cannot cut investment in health at the expense of climate change – and you cannot cut investment in climate finance at the expense of health”.

“We really have to recognise that we’re dealing with global public goods – the control of infectious diseases, a clean environment, clean air and a clean environment,” said Brown.

“And we need to have a system of global burden-sharing where the richest countries that are responsible for the historic emissions and have the wealth and the capacity to pay, make good the funding that is necessary for mitigation and adaptation, and that includes the adaptation of healthcare systems, particularly in the poorest parts of the world,” said Brown.

Despite the global commitment made at Paris COP to ensure $100 billion a year in financing to mitigate climate change by the end of this year, it looks like this target will only be reached in 2023.

However, Brown stressed that if this target was not reached, it would deprive developing countries “of the opportunity not only to build coastal defences and renewable industries, but to build the healthcare systems that are necessary for resistance to droughts and famine, and also to pollution in the air”.

Addressing the meeting via a recorded message, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the changes the world needed to make to energy, transport and food systems to meet the Paris climate goals “would bring massive health gains”.

He added that the WHO is committed to working with the countries that had committed to building greener health systems “for a healthier and more sustainable future”.

Image Credits: UNDP/Karin Schermbrucker for Slingshot , World Meterological Organisation.

WHO Director-General Dr Tedros receiving an open letter about climate change, signed by health professionals from around the world and organized by Doctors for XR.

GLASGOW – Conversations on the health impacts of the climate crisis have grown this year at COP26 – the United Nation’s annual climate conference, now in its 26th year. Experts hope that this increase in conversation will lead to greater awareness about the health crisis exacerbated by the climate crisis and lead to concrete action in the months and years ahead. 

Around 85% of countries now have a designated focal point for health and climate change in their ministries of health, according to the 2021 World Health Organization (WHO) health and climate change global survey report released on Monday. 

But countries report that a lack of funding, impact of COVID-19, and insufficient resource capacity are major barriers to progress.

Many countries are unsupported and unprepared to deal with the health impacts of climate change, according to the survey. 

“We are here at COP26 to urge the world to better support countries in need, and to ensure that together we do a better job of protecting people from the biggest threat to human health we face today,” said Dr Maria Neira, WHO Director of Environment, Climate Change and Health.

At the sidelines of the climate negotiations, the WHO held a day-long conference over the weekend focussed on the climate and health that was attended by high-level delegates. 

“We are used to talking about climate as an environmental challenge, an economic challenge, an equity challenge. But it is also one of the most urgent health challenges facing us all today,” said Julia Gillard, former Prime Minister of Australia and Chair of Wellcome Trust.

The conference sought to highlight that while climate change affects health, the mitigation strategies will also automatically translate into health gains. 

“Health must become the beating heart of climate action”, said Jeni Miller, executive director of the Global Climate and Health Alliance. “Political leaders must prioritise health and social equity, emission reduction and impact mitigation over politics, profit and unproven technological fixes. The decisions made during COP26 will define the health and wellbeing of people all over the world for decades to come”.

Dr. Maria Neira, Director of WHO Environment, Climate Change and Health

Highlighting the health gains of clean air

In the first week of the COP26 negotiations, WHO also co-hosted a panel discussion on both the health and climate gains of clean air that this reporter helped moderate. Given that air pollution alone kills around seven million people worldwide every year, any progress on this would save millions of lives annually.  

The event also came at a time when air pollution in India’s capital, Delhi, had reached lethal levels following last week’s celebration of the festival Diwali, during which people set off fire crackers. 

The densely populated Indo-Gangetic plain where Delhi is, is one of the world’s most polluted regions, and emerging research suggests the source of air pollution is local. 

Dr Neira said that the time for conversations was over, the evidence on air pollution is clear and it is time now to act. 

As many of the pollutants that cause air pollution also lead to a greenhouse effect, the WHO has made efforts to highlight the dual climate and health gains of improving air quality that disproportionately affects vulnerable groups like children and the elderly. 

Developing countries are pushing for climate finance and technology transfer at COP so that they have the support they need to clean their air but much of this also needs to happen at sub-national levels, especially at city-level, that will also require local action, highlighted Ani Dasgupta, President and CEO of World Resources Institute (WRI).

Health not a part of text of negotiations

It was clear although that while health is a part of the growing conversation, it is far from figuring in the main climate negotiations. A former negotiator elaborated that, given how bitter and exhausting climate negotiations are, adding health to the text might not be practical and that any reduction in global carbon emissions will automatically translate into health gains.

At this year’s COP there is also a push to hold the rich countries accountable for the loss and damage being caused by the climate crisis in vulnerable nations. Public health crisis, even though directly caused or exacerbated by extreme climate events, aren’t part of these negotiations either.

“I don’t see it coming up very directly into the loss and damage negotiations here because the negotiations are more about the overarching structures, not necessarily on a very particular theme,” said Sven Harmeling, the International Climate Policy Lead, from CARE and CAN Europe. He did add that it does factor in how many of the developing countries think about the damages being caused. 

WHO’s latest survey backs his view. It found that virtually all (94%) countries have incorporated health considerations in their nationally determined contributions (NDCs) to the Paris Agreement, voluntary pledges by the government to reduce their carbon emissions.

Emissions from coal-burning power stations are causing air pollution that is affecting millions of people worldwide.

Highlighting emissions from healthcare and silos

Among the conversations at COP26 that centred on healthcare was also how to get the healthcare sector to reduce its own emissions. A 2019 report from Healthcare Without Harm based on 2014 data on carbon emissions suggests that globally 4.4% of carbon emissions are from the healthcare sector itself. The US health sector had the largest greenhouse gas emissions.
Andrea Epstein, climate programme manager for Latin America at Healthcare Without Harm said that number is probably higher now that despite the region being a part of the developing world, there is a growing interest in decarbonizing the health systems. “The problem is of course the means of implementation. Not just the financing and the technology but also having the capacity for that. So while it is a challenge, the interest is there.” 

Members of the civil society organisations present at COP highlighted the silos that continued to exist in conversations around health, climate and food – all of which affect each other but are handled by different organisations. 

Disha Shetty is 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

 

Image Credits: WHO/Chris Black, Planetary Health Eastern Africa Hub.

A nurse takes the temperature of a child suspected of COVID-19 symptoms in a Lebanese public health centre.

An international pandemic treaty based on equity could be the antidote to current weaknesses and imbalances in the global response to COVID-19, according to a group of influential authors in a Lancet paper published on Tuesday.

A number of the authors are associated with The Independent Panel for Pandemic Preparedness and Response chaired by Helen Clark and Ellen Sirleaf Johnson, which was set up to assess the World Health Organization’s (WHO) response to COVID-19.

Based on a timeline developed by the panel that lays out the global COVID-19 response, the authors conclude that the International Health Regulations (IHR) are too weak, and the required country actions are too slow, to protect the world against pandemics.

Revised after the 2005 Severe Acute Respiratory Syndrome (SARS) outbreak, the IHR focus on balancing disease notification and health risks with international trade and travel considerations. They specify when and how Member States should notify WHO of a local disease outbreak, and what actions WHO and States should take after that notification. 

The IHR are currently the only legally binding international instrument governing countries’ obligations to report and respond to pathogens that could result in cross-border disease outbreaks and potential public health emergencies.  

In their review, the authors identified a number of significant IHR weaknesses, including: constraints on WHO reporting publicly about national events with pandemic potential; the need for greater specificity on the information that countries need to share with WHO; and a streamlined process to facilitate WHO verification of events within 24 hours of the first signals of an outbreak being received.

Special World Health Assembly

The article comes a few weeks before global leaders meet at a World Health Assembly special session (29 November – 1 December) to consider adopting an “instrument or treaty” to address pandemic preparedness and response. 

“It’s clear: if a new, fast-spreading pathogen were to emerge next month, the current IHR regime would not protect people and trade as intended,” said Dr Sudhvir Singh, lead author on the paper and an advisor to the Independent Panel.

“We suggest change to the IHR and a new treaty or another instrument that would result in more information shared faster, WHO able to investigate rapidly, all countries moving immediately to assess risk;  and tools, like tests and vaccines, available to all who need them.”

Georgetown University’s Dr Alexandra Phelan added that “COVID-19 has shown that the existing obligations under the IHR are insufficient for our interdependent and digital world.” 

 “Our analysis demonstrates that collectively, countries urgently need to update our international system to respond to the potential rapid spread of a high impact respiratory pathogen,” said Phelan.

“We have concrete suggestions for ways in which the IHR may be revised or amended, as well as the approach and issues that must be covered in any new legal framework, like a pandemic treaty.”  

Four reasons for a pandemic treaty

The authors advance four reasons why a pandemic treaty “presents the opportunity to enact comprehensive reform in pandemic preparedness and response”. 

“First, a pandemic treaty centred on the principle of equity would be an important signal of international commitment to guard against the entrenchment of global division and injustice.”

A pandemic treaty offers an opportunity to “develop and instil norms of equity, justice, and global public goods of pandemic preparedness and response”, they argue.

“Second, a pandemic treaty could provide high-level complementarity to the IHR and any potential post-pandemic reforms and proactive multidisciplinary approaches to zoonotic risk,” they argue.

Their third argument is that a treaty establishes greater accountability, outbreak support, and global access to vital public health information. 

Finally, a pandemic treaty could provide the opportunity to develop “a solid evidence base for non-pharmaceutical interventions” that might prevent the next outbreak from becoming a pandemic.

“The upcoming Special Session of the World Health Assembly is a critical opportunity for Member States to move ahead with strengthening the IHR and to agree on a process for negotiating a pandemic treaty. We must not lose this opportunity to protect global public health and future generations,”  said Phelan.

At a recent event hosted by G2H2, civil society organisations expressed fear that a pandemic treaty was a distraction from the TRIPS waiver.

But Björn Kümmel, deputy head of the global health unit in the German Federal Ministry of Health, disputed that there is any direct political link between the treaty and the TRIPS waiver.

Kümmel added that amending the IHR also would take time to negotiate.  And a key question here is: “would they be a game-changer for the next pandemic to come? Certainly not,” he added, noting that there is “no compliance mechanism that currently is foreseen in the IHR.”

Image Credits: UNICEF .

obama
Former US President Barack Obama speaking at COP26

Former US President Barack Obama openly criticized two of the world’s largest CO2 emitting countries – Russia and China, for their “dangerous lack of urgency” in discussing the pressing matters of climate change this past week during COP26.

Both Chinese President Xi Jinping and Russian President Vladimir Putin failed to make an appearance with other global leaders at the 26th United Nations Climate Change Conference in Glasgow, which Obama found to be “particularly discouraging,” as he addressed a room of climate experts at the event on Monday. 

“We need advanced economies like the US and Europe leading on [the issue of climate change]. But we also need China and India, we need Russia, just as we need Indonesia and South Africa and Brazil leading on this issue. We can’t afford anybody to be on the sidelines.” 

Obama noted that while there has been some progress made in the six years since the Paris Agreement, the legally binding international treaty on climate change, the world still falls short of their commitment to limit global warming to well below 1.5 C. 

“Here in Glasgow we see the promise of further progress. What is also true is that collectively and individually, we are still falling short. We have not done nearly enough to address this crisis.” 

“We are going to have to do more and whether that happens or not to a large degree is going to depend on you,” said Obama, calling for collective action from young people and politicians alike to take climate change seriously. 

Twenty countries pledge to end public finance of international fossil fuel development

Although most nations have failed to be ambitious in their climate goals in the past week of COP26, said Obama, significant accomplishments and hard-won commitments have been made during the climate conference.  

One such commitment was for high-income countries to help low- and middle-income countries move away from fossil fuels. 

Back in September, US President Joe Biden told the UN General Assembly that the US would provide more than $11 billion in climate aid annually by 2024 to developing nations vulnerable to extreme weather and rising temperatures. 

In addition, the US and 20 other countries have pledged to stop publicly financing international fossil fuel development, with limited exceptions.  

“We will end new public direct support for the international unabated fossil fuel energy sector by the end of 2022,” the declaration read. 

The 20 countries that signed the pledge include Denmark, Italy, Finland, Costa Rica, Ethiopia, Gambia, New Zealand and the Marshall Islands, plus five development institutions including the European Investment Bank and the East African Development Bank. 

This deal does go further than a pledge made earlier in the year by the G20 to end international financing of coal-based power generation outside their own countries. 

However, this declaration does not include major Asian countries responsible for financing a majority of overseas fossil fuel projects. 

Climate change cannot be a partisan issue 

While collective action in fighting climate change requires international cooperation, Obama noted the geopolitical tensions that have arisen as a result of the pandemic, but called for the world to step up despite these tensions. 

“Climate change can’t be seen anywhere in the world as just an opportunity to score political points.”

“Saving the planet isn’t a partisan issue. Nature, physics, science, do not care about party affiliation,” he added.  

Climate change, in the US particularly, has become a partisan issue, causing what Obama referred to as a “lack of leadership on America’s part” and the “open hostility towards climate science at the very top of the [US] federal government” that resulted from former President Donald Trump’s four years in office.  

Obama also pointed out that the lack of a stable congressional majority has prevented him and current President Joe Biden from taking an even stronger stance on climate change. 

However, Obama remain sconfident that Biden’s Build Back Better Framework, which would set the US on course to meet its climate goals, would be passed in coming weeks.   

The legislation, once approved by the US Congress, would devote at least US $1.7 trillion dollars to reduce greenhouse gas emissions by over a billion metric tons by the end of 2030.

Young people have more at stake in the fight against climate change  

Greta Thunberg addresses climate strikers at Civic Center Park in Denver, Colorado. Thunberg is one climate activist Obama praised for inspiring millions in the fight against climate change.

Though Obama noted that at times, he was “doubtful that humanity can get its act together before it’s too late”, this cynicism was countered by the prevailing efforts of young climate activists around the world. 

Addressing all the young people, who Obama said, had “more stake in this fight than anybody else,” he said: 

“I want you to stay angry. I want you to stay frustrated. Channel that anger, harness that frustration.”

“Because that’s what’s required to meet this challenge. Solving a problem this big and this important has never happened all at once.”

Image Credits: COP26, Andy Bosselman, Streetsblog Denver/Flickr.

Most countries’ drug policies are misaligned with governments’ obligations to promote health, human rights and development, according to the first-ever Global Drug Policy Index, which was launched on Monday.

Drug policies that rely on criminalisation, police intervention and forced eradication have a detrimental effect on the health and human rights of the affected community instead of helping them, according to the Index, which ranked 30 countries.

Brazil, Uganda, Indonesia, Kenya, and Mexico had the worst drug policies, according to the Index. However, it did not rank the Philippines, a country whose “war on drugs” has led to the death of over 12,000 citizens. 

At the other end of the spectrum, Norway, New Zealand, Portugal, the UK and Australia are the five leading countries on humane and health-driven drug policies.

Despite Norway topping the Index, it only managed a score of 74/100, while the average score for the 30 countries ranked was only 48/100.

“Forty-eight out of 100 is a drug policy fail in anyone’s book,’ said Ann Fordham, Executive Director of the International Drug Policy Consortium which led the development of the Index with the partners in the Harm Reduction Consortium.

“None of the countries assessed should feel good about their score on drug policy because no country has reached a perfect score, or anywhere near it. This Index highlights the huge room for improvement across the board,” she added.

For decades, tracking how governments are doing in drug policy has been an elusive endeavour, according to a press release from the Harm Reduction Consortium.

“In no small part, this is because data collection efforts by both governments and the United Nations have been driven by the outdated and harmful goal of achieving a ‘drug-free’ society,” it added.

Low-income groups worst affected

Countries’ ranking is based on 75 indicators across the fields of criminal justice and response, development, health and harm reduction, availability and access to controlled medicine, and the absence of extreme sentencing and response. 

Those countries that steered away from the health and safety aspects of drug policies generally impeded people’s access to harm reduction and controlled medicines, resulting in cases of abuse, violence and human rights violations, it said. 

In addition, drug policies disproportionately affected people women, LGBTIQ+, low-income and Black people. 

 

The ranking according to the Global Drug Policy Index 2021

Julita Lemgruber, the former Director of the Prison System of the State of Rio de Janeiro, said that in Brazil, the war on drugs has been an excuse by the police to kill black young people in the poor regions in big cities.

“In Brazil, the police regularly kills approximately 4,000 people every year…this [index] is needed, it is urgent. We need more funding to get more countries measured. This will be key for actors in different areas,” said Lemgruber, currently Coordinator of the Centre for Studies on Public Security and Citizenship in Rio, at an online launch.

“The Global Drug Policy Index is nothing short of a radical innovation,’ said Helen Clark, Chair of the Global Commission on Drug Policy and former Prime Minister of New Zealand.

“Good, accurate data is power, and it can help us end the `war on drugs´ sooner rather than later.”

However, Clark added that the findings “paint a bleak picture of the state of global drug policy”. 

“The success of drug policies has not been measured against health, development and human rights outcomes, but instead has tended to prioritise indicators such as the numbers of people arrested or imprisoned for drug offences, the amount of drugs seized, or the number of hectares of drug crops eradicated,” she added.

The index’s health and harm reduction showed that with the exception of Brazil, Indonesia, Jamaica, Mozambique and Russia, countries surveyed had explicit supportive references to harm reduction in national policy documents. 

Minorities Affected Disproportionately 

“If drug policies were not so punitive and were instead guided by consideration of health, we would see much lower rates of HIV in south-east Asia,” said Adeeba Kamarulzaman , President of the International AIDS Society. 

The index shows a “shocking” lack of availability and coverage of harm reduction interventions, with only five countries reporting widespread access to needle and syringe programmes, opioid agonist (methadone) treatment in four countries, and distribution of naloxone in three. None of the countries in the report has a wide coverage of drug checking services. 

There were major disparities in access to controlled medicines between countries in the  ‘Global North’ in comparison to those in ‘Global South’.

Access to harm reduction services is considered to be restricted in an overwhelming majority of countries for people discriminated against on the basis of ethnicity, gender identity and sexual orientation. Women and members of the LGBTQI+ community also face more obstacles to access to harm reduction in every surveyed country.

Inequality is deeply seated in global drug policies, according to the report.India, Indonesia and Thailand still have capital punishment for drug offences., while 24 of the countries surveyed impose mandatory minimum penalties for drug offences, most of which can be applied for first-time offences. 

“We must emphasize the importance of evidence and rights-based drugs policy and index like this based on those questions should guide policymaking priorities and reforms for years to come,” Clark said. 

Image Credits: Global Drug Policy Index, The Global Drug Policy Index 2021, The Global Drug Policy Index 2021.