US regulatory agencies established the populations eligible for the Pfizer/BioNTech booster shot this week, paving the way for the rollout of boosters nationwide.

The Director of the US Centers for Disease Control and Prevention (CDC), Dr Rochelle Walensky, has authorized millions of frontline workers in health care and school settings to receive a third COVD-19 vaccine booster dose-  opening the gates for a much wider wide swathe of Americans, ages 18-64, to receive the controversial booster shots. 

Her ruling late Thursday overruled that of a CDC’s Advisory Committee on Immunization Practices, which had endorsed Pfizer/BioNTech booster shots only for millions of older individuals and others at high risk of contracting the disease after a meeting on Thursday.

However, the panel voted against allowing frontline workers aged 18 to 64 years from getting another jab. This had put the recommendations at odds with the Food and Drug Administration’s (FDA) decision to authorize Pfizer booster shots for workers at risk, on Wednesday. 

The FDA authorized the use of boosters at least six months after the completion of the primary vaccination series in individuals over the age of 65; those aged 18 to 64 at a high risk of severe COVID-19; and those aged 18 to 64 whose occupation puts them at a high risk of serious complications of COVID-19.

Walensky’s decision to include adults working in high-risk settings, such as health care and school systems, aligned the CDC’s policy with the FDA. 

“As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said at a meeting on Thursday. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.”

Dr Rochelle Walensky, Director of the US Centers for Disease Control and Prevention (CDC).

She said that providing boosters to healthcare workers would “best serve the nation’s public health needs.”

Walensky’s decision will cover healthcare workers, teachers, and people living or working in institutional settings, such as prisons or homeless shelters. 

The panel attempted to limit those eligible for boosters, refusing to open jabs to healthy adults who aren’t at risk of severe illness. Members of the advisory committee wanted to avoid an all-adult booster campaign. 

Walensky’s decision was announced late on Thursday, demonstrating the complex decision making around the issue of boosters. 

The recommendations from the CDC and FDA still represent a considerable scale back on US President Joe Biden’s far reaching booster plan, which was designed to rollout the week of September 20. 

Some 20 million people are now eligible for a booster and in the coming months 40 million more people will become eligible, said Biden at a White House press briefing on Friday. 

Only Americans who already received two doses of the Pfizer/BioNTech vaccine will qualify for booster shots.  FDA authorization of boosters for Moderna or Johnson & Johnson vaccines and the safety of allowing mixing-and-matching with boosters, has yet to be addressed. 

‘Pandemic of the unvaccinated’ needs to be urgently addressed

Despite the current focus on boosters, the priority of vaccinations should be on getting the unvaccinated their first shots, which is the leading cause of rising COVID cases and hospitalizations, American experts have stated, echoing the position of the World Health Organization and many other global health officials.

“We can give boosters to people, but that’s not really the answer to this pandemic,” Dr. Helen Keipp Talbot, Professor of Medicine at Vanderbilt University, told NPR. “Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients.”

According to Walensky, the top goal “here in America and around the world” is to vaccinate the unvaccinated. 

Over 70 million have yet to get a single shot, said Biden. 

US President Joe Biden at a press conference on the COVID-19 Response and the Vaccination Program on Friday.

“Listen to the voices of the unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying…’If only I got vaccinated,'” Biden said. “People are dying and will die who don’t have to die.” 

Biden urged people to get vaccinated and announced his commitment to implement vaccination requirements wherever possible. Currently the vaccination mandates cover two thirds of all workers in the US. 

“We made so much progress during the past eight months of this pandemic, now we face a critical moment,” said Biden. “We have the tools, we have the plan, we just have to finish the job together as one nation. And I know we can…Please look out for your own self interest and health here. Get vaccinated.”

Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Centers for Disease Control and Prevention, White House.

regen-cov
Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida.

REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020,  was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. 

At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. 

“WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. 

“It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF.

He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year.  

Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail

Regeneron has so far ignored pressures by access groups for such concessions. 

It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US.  The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives.  

The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but  at high risk of more severe disease progression.  It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. 

The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease.  The drug has also been shown to  decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies.  

It was authorized for emergency use by the US  Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September.

“Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni.

MSF: ‘Price Should Reflect Cost of Production’

REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs.

The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients.

Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. 

One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. 

Accordingly,  Regeneron should “drop the price to reflect the cost of production”,  MSF said. 

“Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” 

Scarcity of COVID-19 treatment ‘Unacceptable’

Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” 

In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. 

“Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau.

That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said.  

“And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.”

Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates.  And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales.  

“In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” 

Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter.

 

New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York.

These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said.

“We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing.

Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. 

“This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern.

War against nature

The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday.

“We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.”

“Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres.

“We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added.

UN Secretary General Antonio Guterres

Boost ‘nature-based’ solutions

Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations.

The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. 

“Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added.

“Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added.

The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers.

“The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added.

Climate-smart investments

Samantha Power

Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US.

“The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative.

“We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power.

“That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.”

“With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power.

School meals coalition

Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems.

“The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO.

“Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. 

The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally.

The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the  WHO reported on Thursday.

WH0 Director General Dr Tedros Adhanom Ghebreyesus

WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. 

And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. 

On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” 

According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. 

“Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. 

No African country sponsors so far

Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. 

That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. 

Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” 

Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. 

That left him without an obvious ”home” country to sponsor his re-election bid. 

Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed.

Speaking at a press conference on Wednesday, he declined again to comment on his plans.

Sino-American tensions make for rough political waters   

President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020.

Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership.

That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“.  

Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. 

The unresolved mysteries of the SARS virus origins, and its woefully  incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west.  

New alliances with European partners

German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’.

But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom.  

In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez.  Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu.  And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“.  The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. 

This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. 

In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states.  For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO.

Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. 

However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now.  I am puzzled.  If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.”  

  • Updated 24 September 

Image Credits: WHO, C-Span.

Home-cooked food is a serious matter in the Middle East and family mealtimes are sacrosanct. We are known for our hospitality. We go all out for our guests. People have strong and definite opinions about food, and family recipes are secrets handed down from generation to generation.

 As a child, I took our cuisine for granted, and it was not until I studied abroad that I realized how lucky I was to have been brought up on such healthy and varied cuisine – fresh seasonal vegetables and fruits, and grains, all locally produced. 

As kids, vegetables and fruits were our only go-to snacks. I grew up with a love and passion for healthy satisfying food and have tried to pass the essentials for healthy eating on to my own children.

 Not everyone has access to such healthy food from a young age. Right now, there are more than 800 million people around the world who are affected by hunger each day. And three billion people in mostly low-and middle-income countries do not have access to healthy diets. The COVID-19 pandemic has regrettably increased food insecurity.  Malnutrition in children in 2020 climbed to over 149 million in under five-year old’s affected by a lack of healthy, consistent meals. A tragedy.

Transnational food corporations exploit pandemic

COVID-19 has brought new urgency to the need to reform our food system and our food environments. Nonetheless, transnational food and beverage corporations are taking advantage of the pandemic to further their own commercial interests. They are also using their marketing power to drive us towards unhealthy ultra-processed products like sugar-laden candy and salty chips.

Unlike eggs, vegetables, or fish, ultra-processed products have at least five added ingredients, including additives, colours, or preservatives, and go through multiple manufacturing processes. 

Familiar examples include sugary drinks, potato chips, ice cream and cookies. Some not-so-obvious examples include breakfast cereals, energy bars, infant milk formulas, and fruit yogurts – food that is high in sodium or sugar.

The deck is stacked against parents wanting to encourage their children to adopt healthier eating habits. Ultra-processed products are intensely marketed directly to children on TV and online. Even the packaging is designed to attract children. When parents are shopping with children in tow, they often find themselves pestered to buy unhealthy products.

Packaged food is replacing traditional food

Ultra-processed food consumption is on the rise, particularly in countries where many people are burdened by decades of malnutrition. Packaged foods are replacing locally produced foods and small enterprises, while large private companies have pushed for more investments in the production of sugary beverages and industrialized foods. These initiatives have resulted in undernutrition, stunted growth, and obesity, and can contribute to noncommunicable diseases like cancer, heart disease and diabetes.

Brazil is a country with a wealth of diverse fruits and vegetables but over 60% of adults are overweight. To begin to counter this, Vital Strategies’ Food Policy program and its partners have launched a new dietary guidelines campaign in Brazil to encourage families to download and use the guidelines.

In a world where unhealthy diets are estimated to be responsible for 11 million preventable deaths each year, we need effective global regulatory action. The good news: After a decade of lessons learned and global best practices, Vital Strategies has focused on four policy areas that are key to making diets healthier:

  • Increasing taxes on sugary drinks and junks food
  • Championing clear, simple front-of-package labelling on food and beverage products;
  • Improving nutrition in schools and other public institutions
  • Supporting marketing restrictions on unhealthy foods, especially to children.

Taxation works

The single most effective of these policies is taxing sugary beverages. Taxes not only discourage consumers from buying sugary drinks but can also provide governments with much-needed revenue.

 In 2018, South Africa implemented a roughly 10% tax on sugary drinks, which is expected to generate $400 million each year while also saving the government $130 million per year in health care costs, averting an estimated 8,000 premature deaths over 20 years. Moreover, the health-related benefits are estimated to be greater among lower-income South Africans. 

This week’s UN Food Systems Summit will try to address some of these issues, and advance an agenda for UN Sustainable Development Goal Two that focuses on an approach to food that is more equitable, inclusive, and respectful of the rights of local farmers and indigenous people. 

Ideally, the summit will bring some attention to the difficult work of wresting control of our food systems away from profit-driven corporations and return it to local food producers and communities. But many have criticised summit organisers for falling short on these essential issues while cosying up to private interests.

Our approach to food policy, and especially ultra-processed products must enable governments to empower people, especially women, with access to healthy foods at lower costs, and nutrition education. The science is clear, the tools are available, and the benefits are obvious. It’s high time for governments to put people before profits. Let’s not hesitate.

Her Royal Highness Princess Dina Mired of Jordan serves as Special Envoy for Noncommunicable Diseases at Vital Strategies. She was a recipient of this year’s World Health Organization (WHO) World No Tobacco Day award for her work to fight tobacco and NCDs across the globe.

Princess Dina Mired

 

Image Credits: Ashley Green / Unsplash.

Pedestrians in Dhakka cover their faces to keep from breathing in air pollution, which takes 22 months off the average life expectancy in Bangladesh, according to recent data. (Photo: Rashed Shumon)

In a milestone moment, WHO today issued new guidelines for a range of health-harmful air pollutants – recommending a reduction by one-half in safe levels of fine particulates (PM2.5) – considered to be the benchmark indicator of health impacts that lead to some 7 million deaths a year. 

The new standards put most cities of the world – including in high income countries – in excess of WHO clean air standards once again – after a decade in which many cities and countries enacted strict new policies to clean up their air in line with the last set of WHO recommendations, issued in 2005.  

But reducing ambient concentrations of PM2.5 pollution, both outdoors and inside homes, even further to the new guideline limit of 5 micrograms per cubic meter (5 µg/m3) would save some 5-6 million lives a year, said WHO expert Michel Kryzanowski at a WHO press launch of the new guidelines on Wednesday. And that justifies the strict new WHO recommendations. 

New WHO Air Quality Guidelines – safe levels of key pollutants reduced by one-half or more.

“Some 80% of health impacts could be avoided if we get to these WHO levels globally,” Kyrzanowski said. “It’s not because the pollutants became more dangerous, but we know much more about how those pollutants affect human populations.” 

Altogether, the new WHO guidelines impose stricter limits on five key pollutants overall – including nitrogen dioxide, ozone and carbon monoxide, as well as small (PM10) and fine (PM2.5) particulates.

The new limits reflect new scientific evidence that has documented the even greater impacts of air pollution from respiratory and cardiovascular diseases, stroke and cancers, and the risk of severe COVID-19, said WHO Director General Dr Tedros Adhanom Ghebreyesus in his remarks. 

“Right now, the simple act of breathing contributes to more than 7 million deaths a year,” Dr Tedros said. Those health impacts extend from “the brain to a growing baby in a mother’s womb, at even lower concentrations than previously observed”.”  

And air pollution is a particular health threat in low-income countries – where millions of people routinely breathe air choked with pollutants that are many times over WHO guideline levels “due to urbanization and rapid economic development, and household air pollution in the home caused by cooking, heating and lighting.” 

WH0 Director General Dr Tedros Adhanom Ghebreyesus

Less Climate Change – More Economic Growth &  Benefits for Developing Countries  

Along with saving lives, stricter limits on air pollution emissions will translate immediately into less climate change as well as generating trillions of dollars of economic benefits, stressed Tedros, in his appearance alongside WHO European Regional officials, who oversaw the new guidelines development, and WHO’s director of Climate,, Health and Environment, Maria Neira. 

“These guidelines come at an important time ahead of the COP26 climate change conference in November. .. I urge all countries to put these guidelines to use to save lives, support healthy communities and help address the climate crisis,” Tedros said. 

Added Hans Kluge, WHO Europe Regional Director, “almost all efforts to improve air quality can enhance climate action: almost all climate change mitigation efforts improve air quality, with immediate health benefits… “This enhances return of investments into measures that simultaneously address both.”

Not only would millions of lives be saved, but some US$ 3.5 trillion a year in lost worker productivity and healthcare costs could be avoided if the new WHO guidelines were met, added Neira.  Other benefits would extend to agricultural production, whose yields are reduced by pollutants like ozone, which develops over cities and then drifts across the countryside. 

Key sources of pollution that could readily be identified and reduced range from energy and transport systems to industrial pollution, waste burning and household pollution from wood and coal fire use, she noted.  All require a “holistic approach” by policymakers to tackle and reduce.

New limits – a high bar to reach 

Hans Kluge, WHO Regional Director for Europe

But even in developed countries, with comparatively good air quality, the stricter limits will be a high bar to reach.   Many cities in Europe and North America have average annual air pollution concentrations that meet the current WHO guideline limits for the benchmark pollutant of PM2.5, or come close.  

Those cities and towns will now find themselves far out of compliance with the new WHO standards – not to mention low- and middle-income cities in regions such as South East Asia, which suffer from chronic air pollution levels that may be 10-20 times higher than WHO guidelines. 

“Almost all guideline levels are now lower than 15 years ago. We know that for many countries, this places the bar even higher than ever before,” Kluge said. “But these guidelines also provide interim targets, to support stepwise progress towards that achievement.”

Nitrogen dioxide pollution, associated with diesel vehicles, reduced four-fold 

Countries and regions with the highest levels of health-harmful air pollution.

Along with the tighter limits on PM2.5 – most closely associated with fatal health impacts – the new WHO guidelines also recommend a fourfold reduction in average annual concentrations of nitrogen dioxide – from 40 µg/m3 to just 10 µg/m3. 

Recent evidence has underlined the long-term damage that NO2 exposures can wreak on respiratory systems – from a very young to older ages. NO2 also contributes to the production of urban ozone (O3) – which is a short-lived climate pollutant (SLCP). Reducing short-lived climate pollutants, including black carbon particulates and methane, as well as ozone, would be one of the fastest ways to slow down the pace of global warming, say advocates with the Climate and Clean Air Coalition, sponsored by the United Nations Environment Programme and supported by WHO.  

But the strict new NO2 limits also strike at the heart of the diesel car industry, which had built a generation of vehicles with progressively lower emissions of PM2.5 – but still high emissions from nitrogen dioxide – which particulate filters cannot trap.  

Closer adherence by cities to the new WHO NO2 guidelines would thus almost certainly hasten the transition to hybrid gasoline and  electric vehicles – as well as other public transit, walking and cycling alternatives.    

At the same time, the new WHO guidelines also establish, for the first time ever, a limit for “peak season” concentrations of ozone, as such. Ozone contributes to chronic respiratory disease, including the prevalence of asthma, as well as inflicting considerable damage on crop production when ozone drifts from cities into surrounding rural areas.  

South East Asian cities suffer from some of the worst pollution in the world.  Pollution in Delhi (portrayed here) typically peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources.

SO2 guideline value loosened – but that was due to methods change 

Conversely, however, WHO actually raised its safe guideline for 24-hour concentrations of sulphur dioxide, SO2 – from 20 to 40 µg/m3. A key source of SO2 emissions is industry smokestacks which were among the first targets for air quality campaigns by environmental groups in the 1960s and 1970s. . 

In fact, there is “vast new evidence which was produced in the last 15 years, which confirms what we knew before about sulfur dioxide exposure -that it is producing health effects, up to the very low levels,” said Kryzanowski. 

However, he said methods changes in attributing health impacts to various pollutants still led to a higher baseline indicator for SO2 – in comparison 2005 value, as well as in comparison to the other pollutants now being measured. 

“There was a methodology of setting guidance, which was different back in 2005,” Kryzanowski said. “We tried to make the guidelines comparable between various pollutants. 

“And using the same methodology, the same protocol of defining the guideline values, this protocol ended up actually with a higher value than before. This value  is believed to count the health effects to the same extent as the guidelines for other pollutants, so we believe that it is fair to have it in this form as it is now.” 

Image Credits: Rashed Shumon, WHO, World Bank, Flickr.

US President Joe Biden addressing his COVID-19 summit.

The US is buying 500 million COVID-19 vaccines from Pfizer for low and middle-income countries, which will be shipped “by this time next year”, US President Joe Biden announced at his COVID-19 summit on Wednesday.

“For every one shot we’ve administered to date in America, we have now committed to doing three shots for the rest of the world,” said Biden, adding that the US had already shipped nearly 160 million doses to 100 countries – “more than every other country has donated combined”.

The US committed an additional $370 million to buy and deliver these shots and more than $380 million to assist in the global vaccine alliance, Gavi, to further facilitate vaccine distribution in regions of the greatest with the greatest need, said Biden.

Meanwhile, Pfizer announced on Wednesday that it would provide the 500 million vaccines “at a not-for-profit price for donation to low- and lower-middle-income countries and the organisations that support them” – but did not specify a price.

“This expanded agreement brings the total number of doses to be supplied to the US government for donation to these countries to one billion,” said Pfizer, adding that they would be shipped to  92 low- and lower-middle-income countries as defined by Gavi’s COVAX Advanced Market Commitment (AMC) and the 55 member states of the African Union.

“Deliveries of the initial 500 million doses began in August 2021, and the total one billion doses under the expanded agreement are expected to be delivered by the end of September 2022. The current plan is to produce these doses in Pfizer’s US facilities,” the company added.

Earlier in the week, Knowledge Ecology International reported that the $10 billion contract between the US government and Pfizer to purchase the initial 500 million doses “contains a clause indicating that the $20 per dose price may be a floor and not a ceiling going forward”.

Acknowledging that over 4.5 million people had already died of COVID-19, Biden said that the summit is about “supercharging” global efforts in “vaccinating the world by dramatically ramping up vaccine production, donations delivery and administering the vaccine, which is a logistical challenge”. 

New US-EU fund

The US and the European Union also announced a COVID-19 vaccine partnership to donate – not sell – vaccines to LMIC, added Biden.

Ursula von den Leyen, President of the European Commission told the summit that the EU would “work with the US and within the G20 to set up a new global health financial intermediary fund” to help pay for the donations.

US Vice-President Kamala Harris elaborated that her country wanted the fund to be based at the World Bank, and at address pandemic preparedness – not just  the current pandemic

“The United States is prepared to contribute at least $250 million to help get this fund started. We have also requested an additional $850 million from the US Congress,” Harris told the summit.

“We are issuing a call to action to countries and corporations from around the world to join us in this effort. And we have a collective goal of reaching $10 billion at the outset,” said Harris, adding that the world was still not prepared for the next pandemic.

“Our world is not fully prepared to prevent to detect and to respond to future biological threats,” said Harris, reiterating US support for a global health threats council that would monitor progress and identify gaps.

Kamala Harris addresses the COVID-19 Summit.

South African President Cyril Ramaphosa welcomed the establishment of the fund, and also expressed support for a proposed global health threats council.

However, Ramaphosa asked the summit to go further and adopt UN Secretary-General Antonio Guterres’ proposal for a “global vaccination plan”. 

“Cooperation, collective action and, above all, consensus, is our greatest strength in the current crisis, and will continue to be so into the future,” stressed Ramaphosa.

Guterres has previously expressed fears that the tension between the US and China may undermine global efforts to end the pandemic. South Africa has close relations with both countries.

Ramaphosa also urged the summit to come up with a sustainable plan “on how developing countries can be supported through technology, through finance and through various of support, not only to meet targets around vaccines, diagnostics, personal protective equipment, but also for manufacturing”.

Ramaphosa also stressed that the world “must close the financing and supply gap for COVAX, the Africa Vaccine Acquisition Task Team, and other mechanisms”. 

WHO’s recent mission to Afghanistan

Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday.

Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. 

“This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said.

Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”.

It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. 

“Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.”

The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients.

“WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated.

“With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.”

Polio is still endemic in Afghanistan, while measles is on the increase.

  

 

Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012.

Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades.

Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends.

Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN.

But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance.

Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness.

Boycotts and controversy

“The issue of landlessness and land grabbing is not on the agenda of the UNFSS.  Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC).

Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday.

“After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. 

However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment.

Food policy activists protest against ultr-processed food in South Africa.

Desperate need for food policy change

Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. 

“In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program.

Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people.

“The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program.

Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”.

Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin.

Taxes, warning labels and marketing restrictions

Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats”

They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. 

Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. 

“We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds.

“There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.”

Most Mexican kids had sodas for breakfast

Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight.

Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. 

A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population.

South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year.

Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. 

Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food.

These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item.

“Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.”

Safe, nutritious food for all

UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks.

Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”.

“We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman.

She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. 

Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”.

Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling.

 

 

Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media.

Members of Physicians for Human Rights join other NGOs to call for vaccine equity.

Vaccine equity and booster debates are shadowing the lead-up to US President Joe Biden’s planned COVID-19 Summit on Wednesday, with the US reportedly poised to donate another half a billion Pfizer vaccines to the world. 

Israeli scientists reported that people over age 60 who received a third dose of the Pfizer vaccine were five times less likely to become severely ill if they had their first shots at least five months earlier. The findings were published last Friday in the New England Journal of Medicine.

The findings were the largest yet on the outcomes of Israel’s booster campaign, which has so far seen 30% of its population triple vaccinated as the country battles one of the highest COVID-19 infection rates in the world. 

The Israeli findings were regarded as a critical factor in the recommendation by the US Food and Drug Administration’s (FDA) independent advisory panel of experts to approve a third Pfizer booster shot for people 65 years and over or at severe risk of COVID-19 and who were vaccinated at least six months or earlier. 

Last Friday, the FDA expert panel voted by 16 to 2 against booster shots for those over the age of 16, and the FDA itself is expected to announce its decision on boosters this week.

A recent review in The Lancet authored by key scientists from the World Health Organization (WHO) and other institutions argued that there was insufficient evidence to justify booster campaigns in developed countries which had already vaccinated at-risk groups with two courses of the Pfizer or Moderna vaccine. 

However, the review made its case on the serious equity issues around the relative global health benefits of directing third shots to already vaccinated group, as compared to first and second jabs to never-vaccinated people. 

It also relied heavily on a series of smaller, observational trials and laboratory analyses, and did not fully incorporate the Israeli results, which had only just been published in a pre-print format.  

Protests against ‘vaccine apartheid’ at UN

Regardless of the medical arguments for boosters, a rising chorus of politicians and global health advocates have charged that gross inequities around vaccine distribution are creating a “perfect storm” for new variants to emerge among entirely unvaccinated groups – threatening rich and poor countries alike. 

 

On Monday, protestors from a range of health organisations, including HealthGAP and Physicians for Human Rights, grouped outside of the United Nations (UN) headquarters in New York to protest against “vaccine apartheid”.

 

Meanwhile, UN Secretary-General Antonio Guterres expressed concern that the global COVID-19 response might be hampered by the poor relationship between the US and China in a Sunday evening interview with CNN. 

Guterres said there were “two divides” related to the COVID-19 pandemic. The first relates to the “north-south divide where the North took care of its own population and forgot largely about the south”, which was driving mistrust from the south.

“Then there is the geostrategic divide now centred in the relationship between the US and China,” said Guterres, who called on the two superpowers to negotiate on issues of potential commonality, namely “trade and technology”, to make “co-operation on vaccines possible”.

China has emerged as the world’s greatest producer of vaccines.

Jeffrey Sachs, chair of the Lancet COVID-19 Commission, appealed for similar global co-operation in an article for Project Syndicate on Monday.

“Governments of countries where vaccines are being produced – the United States, European Union members, the United Kingdom, India, Russia, and China – need to cooperate under UN leadership to ensure that a sufficient supply of vaccine doses reaches the poorest countries,” said Sachs.

UN Secretary General Antonio Guterres

Hopes have been expressed that a proposed US COVID-19 Summit could encourage  sweeping commitments from other world leaders to change course. 

The White House publicly announced its plans for a virtual COVID-19 summit on Friday where it hopes to secure a firm global commitment to vaccinate 70% of the world’s population by September 2022. 

“This meeting is about expanding and enhancing our shared efforts to defeat COVID-19, building out from previous gatherings of world leaders and ministers in fora like the G7, G20, and Act Accelerator to rally civil society, NGOs, philanthropists, and industry along with world leaders and align on a common vision for defeating COVID-19 together,” White House press secretary Jen Psaki said in a statement.

US President Joe Biden plans to use Wednesday’s summit to call on global leaders to make new commitments to fight the coronavirus pandemic, including fully vaccinating 70 percent of the world’s population by next September and securing billions of additional doses for the developing world, among other targets, according to details obtained by the Washington Post.

Vaccine equity has morphed from being a primarily global health issue, to one with domestic political impacts in the US. Last Friday, Congressional Democrats sent a letter to Biden, urging him to change the current paradigm where rich countries enjoy unlimited access to vaccines while poor countries can hardly get first doses. 

“So far, 5.82 billion doses have been administered globally, but less than 2% of the population living in low-income countries received even one dose,” Senators Tina Smith (D-Minn), Elizabeth Warren (D-Mass) and six colleagues wrote to Biden, citing WHO data on vaccine inequity.  “Clearly, there is an inequitable distribution of COVID-19 vaccine doses, and it is getting worse,” the letter said, calling for “additional U.S. leadership”.

More Biden donations 

Meanwhile, the Washington Post reported that the Biden administration is buying hundreds of millions more doses of the Pfizer-BioNTech coronavirus vaccine, with an announcement slated for early next week, during the UNGA.  But the terms are not finalized, people with knowledge of the deal, told the Post. 

Jeff Zients, the White House coronavirus coordinator, declined to comment on the deal but said vaccine access “will be a big topic of conversation” at the UN General Assembly.

The purchase would bring the US donation of Pfizer vaccines to over one billion – following announcement of an 80 million dose emergency donation in May, followed by a 500 million dose donation in June. mark the second major effort by the United States to distribute vaccine to the world. 

The Biden administration has been adamant that the United States has enough vaccine supply for booster shots and global donations.

“We feel it’s a false choice to suggest it’s either give to the world or not,” Psaki said last Thursday. “We are continuing to increase the supply of vaccines we’re giving to the world. We will continue to have more announcements on that because we want to be the arsenal of vaccines to the world, and we are giving more than every other country in the world combined.

Image Credits: CNN.