Countries will have a full agenda at the upcoming climate conference in Glasgow, facing pressure to take drastic action before the ravages of global warming become irreversible.

This year’s 26th UN Climate Change Conference of the Parties (COP26), will be a critical moment of decision on climate policies, as the clock runs down before the more severe ravages of global warming become irreversible.

Against the panoply of issues under debate, health is getting more attention from this year’s COP26 organisers as a potentially powerful motivating factor for action – although it remains to be seen if that can also translate into more concrete climate commitments from countries. 

“The COP26 presidency has for the first time ever in the history of climate negotiations put a special emphasis on health – and developed a dedicated Climate Health Programme specifically for COP,” Marina Maiero, a Technical Officer in Partnership and Advocacy as part of WHO’s Climate Change and Health team, told Health Policy Watch.  

“Health and the health sector will be more powerfully represented at this COP than ever before,” adds Josh Karliner, International Strategic Director of the global NGO Health Care Without Harm – which promotes greening the healthcare sector.

“While health has never been, and may never be, at the center of the climate negotiations, per se, due to the very technical nature of these talks, protecting people’s health from climate change is increasingly central to the climate conversation in and around the COP,” said Karliner in an interview with Health Policy Watch. 

“In the lead up to COP 26, COVID-19 has heightened awareness of the intimate connections between climate change and health for climate negotiators and health policy makers alike. Indeed, the UK COP Presidency has made health a scientific priority,” he said.

‘Belated recognition’ – but still not a central theme  

Health advocates have long maintained that placing human health at the heart of climate negotiations is critical to mobilising the political will required to meet the 2015 Paris Agreement target of keeping global warming under 1.5°C.

Even so, the health and climate nexus still remains on the sidelines of the formal  conference proceedings – with nary a mention on the COP26 programme to date.  

That reflects the long road yet ahead to convince most countries to take up health-related climate commitments, says Sir Andrew Haines, professor of environmental change and public health at the London School of Hygiene and Tropical Medicine. 

“There is a belated recognition of the importance of health in the climate change agenda – although it’s not one of the official themes,” Haines told Health Policy Watch. 

“The UK Government is becoming more interested, although its main focus is on decarbonisation of the health care sector, building on the NHS Commitment to achieve net zero emissions by 2040 for direct and 2045 for indirect emissions,” he points out. 

“Though the UK government, which serves as the incoming president of the COP, has a number of initiatives focused on health, health does not yet have a strong role in the negotiations,” Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance, told Health Policy Watch.

Already in November 2020, just before the Glasgow COP26 conference was postponed due to the COVID pandemic, the UK Government produced a series of key messages, case studies and essays on climate change and health – drawing on contributions from WHO, Wellcome Trust, LSTHM, and the Global Climate and Health Alliance (GCHA).   

Health and climate change COP26 campaign aims of the UK COP26 Presidency.

Promoting Health & Climate Nexus  

In fact, environmental health experts in WHO, academia and the NGO world, have spent years promoting the health and climate nexus as integral to the climate narrative. 

The fruits of those efforts are evident in the recent Intergovernmental Panel on Climate Change (IPCC) report, which refer in more detail than ever to the impacts of climate change on human health and well-being. See related story:

Climate Scientists Issue ‘Red Alert’ for Humanity – and Health 

The findings of the report are a “big red neon sign” alerting those in the traditional “climate camp” that health is becoming a more salient climate issue, says Dr Kim Knowlton and Dr Vijay Limaye, of the Natural Resources Defense Council (NRDC).  

“Hopefully there will be a lot of energy around climate-health adaptation, given the findings of the Working Group I report that’s just come out,” they told Health Policy Watch. 

“It finds that many climate impacts are already ‘locked in’ and that makes adaptation – finding ways to limit the health-harming effects of climate change that are already occurring and hammering frontline communities – even more critical,” said Knowlton and Limaye. 

The authors of the IPCC report project an increase in extreme heat exposure, heavy rainfall, drought, fire weather, and warming oceans.

Strong country responses to climate & health threats still lacking 

Cycling in Fortaleza, Brazil – the city strengthened its active transport plans as part of a WHO co-sponsored Healthy Cities Partnership. Cycling also reduces carbon emissions from transport.

However, so far, responses fall far short of the mark in most countries –  which continue to develop and subsidize polluting fossil fuel-based energy sources that create air pollution as well as climate emissions, and build unhealthy cities that lack access to green spaces, healthy mobility, housing, and foods. 

“There are major gaps in considering the health effects of climate change and health in adaptation policies or the co-benefits of GHG mitigation [in countries’ NDCs],” said Haines.  

He points to a recent analysis of the Nationally Determined Commitments (NDCs) of 40 nations – that looked at how governments’ national climate commitments recognise and respond to the linkages between climate change and health.

The “climate and health scorecards” point to gaps in all three policy domains: assessing the health effects of climate change; integrating plans for more climate resilient health systems into climate adaptation strategies, and choosing climate mitigation strategies that also optimise “health co-benefits.” 

Such co-benefits are huge, ranging from healthier plant-based diets to shifting urban transport systems to walking and cycling to stimulate physical activity, reduce climate emissions and air pollution – which kills over 7 million people a year. 

In the 15 countries with the highest greenhouse gas emissions, the health impacts of air pollution alone are estimated to cost over 4% of GDP. And yet most countries have yet to recognise in their NDCs how the health gains from investments in clean energy will reduce air pollution deaths.  

Health care services – 4.4% climate footprint, pollution & waste 

Essential health care procedures generate huge amounts of disposable waste.  Portrayed here are preparations for COVID vaccine administration in Argentina.

Along with that, there is enormous pollution and waste produced by health care services as such – from plastic disposables to energy intensive building operations.  All of that leaves a climate footprint – responsible for some 4.4 % of global climate emissions. And yet Argentina is the only country so far to explicitly include health care emissions reductions in its revised 2021 NDC strategy. 

“We can conclude that national governments’ understanding of climate change as a threat to health is quite limited but probably greater amongst low-income nations,” said Haines.

“Some countries have shown some progress [on achieving their climate targets] and some have integrated health, which is positive news,” agrees Maiero. “But it’s not enough.”

At the broader level, even the most updated commitments made so far by countries are insufficient “to really have global action that will allow the world to keep global temperature rises below 1.5 degrees Celsius”, WHO and other experts point out.

“The overall concern is that none of [the NDCs] are ambitious enough,” Maiero observed. 

The projected changes in extremes are larger in frequency and intensity with every additional increment of global warming, finds the IPCC Working Group I report.

Climate change leading to more & more deaths 

Against the political indifference, however, a growing body of evidence has sharpened our appreciation of how climate change is directly increasing mortality – from factors like extreme heat and extreme weather – not to mention more indirect issues like food insecurity.  

“Recent findings [show] that between 1991-2018, over a third of global heat-related deaths could be attributed to climate change,” said Knowlton and Limaye. “The [IPCC] report [demonstrates that] avoiding half a degree Celsius (0.9°F) of average warming could mean avoiding those deaths – that is, we could see far fewer heat-related health harms globally, plus fewer illnesses and deaths from more severe wildfires, hurricanes, floods, and other climate change-fueled extremes.”

“That’s a safer, healthier world that we need to fight for and demand from our global leaders,” said Knowlton and Limaye. 

“It’s also a world in which people, families, businesses and governments are less burdened by healthcare-related expenses tied to hospital care and emergency room treatment of health problems triggered by these climate-fueled hazards,” they said. 

Hopes from COP26 – health more prominent in NDCs and carbon markets 

The 26th UN Climate Change Conference of the Parties, will be a critical moment of decision on climate policies.

This year, once more, WHO will be asking UN member states at COP to include explicit references to health and equity in their NDC climate commitments – in line with WHO’s guidelines for a green and healthy recovery from COVID-19. 

“Our straightforward hope is that…everything negotiators and policy makers will do, they will do it in the name of health, because they recognise that taking action on the climate means improving the wellbeing and health of their population,” said Maiero.  

“We want to make sure that going forward, health and equity are the guiding compass of the Paris regime,” she adds. “We want to convey the clear message that health benefits from climate action…[and] investing in climate will improve health and actually compensate [countries].”  

COP26 also is a key moment to finalise the Paris Rulebook, the guidelines for  implementation of the Paris Agreement. Clear guidance to countries regarding the strengthening of national climate plans, and their implementation, will help transform the landmark agreement into a functioning system. 

And health needs to be central to the discussions surrounding the Rulebook – to ensure that rules governing carbon prices and markets yield co-benefits to health, and not more harmful impacts.  

Climate commitments also lack mechanisms for monitoring, tracking – and most of all – funding 

Another key area of concern  is the current lack of monitoring and tracking of countries’ NDC commitments, once they are made. 

At present, NDCs are largely a “wish list” of countries’ planned climate actions, however, there is no mechanism to enforce implementation, or even to monitor progress, Maiero and others say.  

“My personal concern is how we are really going to monitor data,” said another member of WHO’s climate team. “There is no system in place that can force the country to implement [its NDC].”

The climate system is also falling behind in terms of financing climate action in developing countries. 

“It’s great to have these plans and commitments to potentially do something, but we have noticed that…there is a massive gap for developed countries to commit finance and there’s a massive gap for developing countries to receive it,” say the WHO sources. 

Gaps in climate finance need to be filled to enable low- and middle-income countries to take vital action to both reduce and adapt to climate change – in line with their NDC/ climate commitments. 

Low- and middle-income countries heavily depend on climate finance to achieve their climate plans. 

This massive discrepancy is “extremely worrying for WHO, knowing that even though a lot of vulnerable countries now have these climate plans in place, there are no funds for them to actually achieve these plans,” said a member of WHO’s climate team. 

Donors and rich industrialised countries committed to raise at least US$100 billion in climate finance annually at the COP15 in Copenhagen more than 10 years ago. 

In 2018, an estimated US$78.9 billion in climate financing was mobilised – coming close to the goal. In other years, the world has fallen dismally short. 

Only 2% of all climate finance goes to health-related climate adaptation plans, such as making health systems more climate-resilient. 

And none of the key financial institutions, such as the World Bank and Green Climate Fund, that contribute to climate financing have dedicated funds for the health sector. 

The climate system lacks an “agile institution that’s really looking at accelerating disbursement,” says Maiero. And ministries of health lack any intermediate institution that can help health ministers access financing.

“These are the obstacles at the moment, maybe COP26 will actually help sort out all of these problems finally.”

COP26 ‘Health Programme’ focuses on green & climate resilient health systems

“The COP26 Health Programme is one of the three COP26 flagship science projects, alongside work on the Climate Risk Assessment and Vision for Net Zero,” said Maiero. “It is not yet visible on the COP26 agenda, but there will be special health events within the science and innovation day.”

In terms of the COP26 Health Programme, which bears the logo of the COP26 Presidency, the key priorities are focused more narrowly on health systems, including calling upon countries to invest in building greener and climate resilient health systems.  

Right now, only 50% of countries have a national health and climate change strategy, and half of those enforce its implementation, WHO’s climate team members note.

“[The Health Programme] is an important complement to the IPCC report, because it points to the urgency of taking swift action,” point out Knowlton and Limaye. 

“The health sector is increasingly participating in UN climate action, stepping up to do its part to implement the ambition of the Paris Agreement,” asserts Karliner.  

“Not only are health sector non-state actors representing thousands of hospitals from every continent taking concrete actions and committing to net zero health care through their participation in the UNFCCC Climate Champions’ Race to Zero, we are also expecting significant commitments to health care climate resilience and decarbonization from several national governments over the next couple of months as part of the COP 26 Health Programme. 

“This brand new initiative, a collaboration between the UK COP Presidency, WHO and Health Care Without Harm, is engaging with ministries of health from around the world to secure agreement for aligned action,” said Karliner. 

Health sector responsible for 4.4% of global greenhouse emissions

With responsibility for 4.4% of climate emissions, reducing the carbon footprint of health-care services is critical, Karliner and other backers of the COP26 Health Programme underline.

Countries are urged to create a roadmap to developing more sustainable and low carbon health systems – with the goal of achieving net zero emissions for health by 2050. 

Embedding sustainability involves everything from the planning and development of more efficient building energy systems, better waste management and medicines procurement – strategies that Health Care Without Harm is promoting around the world.   

“The sooner sustainable, low carbon health services are developed, the more cost effective they can be: reducing air pollution and therefore the ensuing demand for healthcare, by avoiding becoming locked into high carbon service delivery; and by not having to retro-fit sustainable solutions later,” states the concept note for the Health Programme. 

However, the ‘commitments’ will be made as non-binding declarations by health ministries – leaving questions about how much follow-up will really occur. 

Health side events at COP26

The 2021 Global Conference on Health & Climate Change will convene at the margin of the COP26 UN climate change conference.

Alongside the formal events, WHO and a number of partners are also hosting a Global Conference on Health and Climate Change to call on countries, businesses, and institutions to drive a “green, healthy and resilient recovery from COVID-19.”

The conference, scheduled for 6-7 November will feature thematic sessions on health related aspects of: biodiversity, food systems, sustainable infrastructure, clean energy, cities – and health as part of NDC commitments.  

“Weighing in both the impacts of health-damaging business-as-usual policies and the massive health co-benefits of ambitious climate policy, drives climate policies that are more ambitious and health-promoting,” states a press release for the conference, being held in collaboration with the Global Climate and Health Alliance (GCHA) and the UK Health Alliance on Climate Change.

WHO Special COP26 Report – Health Argument for Climate Action

For COP26, WHO also is developing a special report on health and climate change, ‘The Health Argument for Climate Action,’ that will be submitted to the COP26 presidency at the beginning of the summit.   This follows on from a series of high-level statements made by WHO Director General Dr Tedros Adhanom Ghebreyesus  during May’s World Health Assembly and last year, on the importance of climate action and a “green recovery” from COVID-19.

“The risks posed by climate could dwarf that of any single disease. … there’s no vaccine for climate change,” Tedros has repeatedly pointed out. 

The WHO Special Report will present the latest evidence on the health impacts of climate change, provide scientific findings on the health co-benefits of taking climate action, and offer ten high-level recommendations to climate change policy makers at COP26.

A public consultation of a draft version of the report is underway to receive action-oriented comments on the health recommendations. The report “hope[s] to represent the unified voice of the global health community at the COP26 UN climate conference in Glasgow,” said WHO. 

“This year is crucial for international climate action, with far-reaching consequences for the long-term health and resilience of communities and societies,” WHO said in announcing the consultation earlier this month. 

“The COP26 Special Report hopes to place health and equity front and center at COP26.

“WHO and the global health community are calling on governments to commit to more ambitious climate action, to place health and social justice central, and to commit to a healthy recovery from COVID-19.”

“While there is still much to be done to integrate health into the various areas under negotiation at the UNFCCC [UN Framework Convention on Climate Change],…this year marks a turning point for health sector engagement in the intergovernmental process from which there will be no turning back,” said Karliner. 

“Health care climate action in these global negotiations, national policy and local government will only grow. And it is none too soon,” he added.

Image Credits: IPCC, Commons Wikimedia, UK COP26 Presidency, City of Fortaleza, Gobierno de Provincia de Neuquen, Argentina, IPCC, COP26, WHO.

Experts address WHO’s meeting on vaccines, 13 August 2021.

As wealthy countries opt to give third COVID-19 vaccine booster doses to vulnerable citizens, some researchers have called instead for “fractional doses” to stretch the scarce resources.

“If you have two million doses of vaccine, you can give that as two doses to one million people. But what about if you gave fractional doses?” asked Dr Ben Cowling of Hong Kong University’s School of Public Health.

“If you gave half doses, you could spread the same amount of vaccines to two million people, and if half a dose gives you more than half the level of protection compared to a full dose, then you end up with better outcomes at the population level,” Cowling told Friday’s World Health Organization (WHO) meeting on vaccine research.

“Fractionation was used very successfully for the yellow fever vaccine five or six years ago in West Africa when antigens were in short supply,” added Cowling. 

His comments came hours after the US Food and Drug Administration (FDA) announced that “immuno-compromised people” should receive third vaccine booster shots, joining the Israel and Germany.

 

‘Herd immunity’ seems unachievable

Professor Alejandro Cravioto, chairperson of the WHO Special Advisory Group of Experts (SAGE) on immunisation, said it had advised the global body to seek more evidence from a wider group of experts on the need for boosters.

“While countries have hoarded a huge amount of the available vaccines developed for the control of SARS-Co-V2 virus, other parts of the world are still waiting to receive a small share of these products to protect at least their health force and the most vulnerable groups of their population,” said Cravioto.

“This inequity is what hinders the possibility of a worldwide control of infection… The idea that we’ll achieve a level of herd immunity by immunising a defined percentage of the population seems to be a moving target towards an unachievable goal.”

As a result, said Cravioto, SAGE had advised WHO Director-General Dr Tedros Adhanom Ghebreyusus to “consult a larger group of experts and come up with new science-based actions that can make sure that there are sufficient vaccines available to help defeat the pandemic virus”. 

“One of these actions is to determine whether there is a need for booster doses and to assess whether it is more sound to use these products to immunise the same population again, or to use them more reasonably to help protect those that remain to receive their first doses of the available vaccines.” 

All but one vaccine manufacturer that addressed the meeting made the case for boosters. Only the Janssen/ Johnson and Johnson representative said the company did not yet have evidence that its vaccine needed a booster.

The manufacturers of Moderna, Pfizer, Sinovax, Novavax, Covaxin (Bharat) all presented studies to show how immunity against COVID-19 waned over time and how a third booster increased immunity.

Moderna’s booster agenda
Sinovac presents its evidence for boosters.

But Larry Brilliant of Ending Pandemics in the USA called for a move away from “mass vaccinations” to targeted vaccinations based on epidemiological research.

Professor Helen Rees, chairperson of South Africa’s medicines regulatory authority, noted that a “two-tier research agenda” appeared to be developing, one for wealthy countries and another for poorer countries. She also questioned the basis on which countries were opting for boosters, saying the decisions appeared to be based on “immunogenicity data” rather than clinical data.

Larry Brilliant proposes a research agenda not based on mass vaccination.

Meanwhile, Peter Figuero, from the WHO’s Americas office, the Pan American Health Organisation (PAHO) called on governments to share in the profits of pharmaceutical companies.

“Governments should preserve a share in the patents of pharmaceutical companies when their support has made a tangible contribution to the development of the product being patented,” said Figuero.

Moderna had received $957million in public funds and Pfizer had received $445million, and gone on to make billions in profits, said Figuero. If governments that had invested in the R&D of these vaccines also received a share of their profits, this could be re-invested in global vaccine acquisition, he added.

Image Credits: Sky News.

wildfire
Wildfires in western US may be linked to increased COVID-19 cases and deaths in 2020

While the US was contending with the COVID-19 pandemic, huge wildfires that swept across the country in 2020 may have contributed to thousands of COVID cases and deaths, according to a US study on fine particulate matter (PM 2.5) air pollution from wildfires and COVID-19. 

The study, conducted by researchers at the Harvard Chan School of Public Health, found that the cumulative total of COVID-19 cases and deaths attributable to daily increases in PM 2.5 from wildfires was 19,700 and 750, respectively.

Wildfires produce high levels of fine particulate matter, which has been linked to several negative health outcomes, including premature death, asthma, chronic obstructive pulmonary disease, and other respiratory illnesses.

The study used monitoring data on PM 2.5 air concentrations at a county- and daily-levels, wildfire satellite data, and the number of COVID-19 cases and deaths in 92 countries, representing 95% of the population across California, Oregon, and Washington – three states that bore the brunt of the 2020 wildfires.  

“The convergence of the pandemic and wildfires across the western US,” noted Francesca Dominici, senior author of the study at the Harvard Chan School, has brought “unimaginable challenges in public health.” 

“In this study, we are providing evidence that climate change – which increases the frequency and the intensity of wildfires – and the pandemic are a disastrous combination,” added Dominici. 

‘Hazardous’ levels of fine particulate matter attribute to increased cases and death 

Several counties in the three states experienced levels of PM 2.5 deemed “hazardous” by the US Environmental Protection Agency. High levels of PM 2.5 were attributable to a substantial percentage of total COVID-19 cases and deaths in these areas.

Researchers found that wildfires amplified the effect of exposure to fine particulate air pollution on COVID-19 cases and deaths, up to four weeks after the exposure. On average, a daily increase of PM 2.5 was associated with an 11.7% increase in COVID-19 cases and an 8.4% increase in COVID-19 deaths.

Looking at individual wildfire days and at individual counties, they found that Butte, California and Whitman, Washington, had the highest percentage of total COVID-19 cases attributable to high levels of PM 2.5, 17.3% and 18.2% respectively. 

Two counties in California, Butte and Calaveras, also had the highest percentage of COVID-19 deaths attributed to high levels of PM 2.5 during wildfires – 41% and 137.4% respectively.

Cascading effect of climate change on health 

The link between COVID-19 and the PM 2.5 released from wildfires is further supported by a recent major report by the Intergovernmental Panel on Climate Change (IPPC) that confirms climate change as an existential health problem that overshadows all others. 

Dominici hopes that this study will prompt policymakers to take urgently needed action. 

“Climate change will likely bring warmer and drier conditions to the West, providing more fuel for fires to consume and further enhancing fire activity. This study provides policymakers with key information regarding how the effects of one global crisis—climate change—can have cascading effects on concurrent global crises—in this case, the COVID-19 pandemic,” she said.   

Image Credits: Daria Devyatkina/Flickr.

Teachers aged 50 years and above were the first to get the COVID-19 vaccine in Kenya, but now all civil servants are compelled to get vaccinated.

The Kenyan government’s decision to compel its workers to be vaccinated against COVID-19 has received the support of Dr John Nkengasong, Director of the Africa Centre for Disease Control (CDC).

“I support policies that get citizens of Africa to go out there and get vaccinated whenever they have an opportunity to have access to vaccines. They’re saving themselves, their loved ones and protecting their community and country,” Nkengasong told a media briefing this week. 

Kenya’s Head of Public Service, Joseph Kinyua, told the briefing that COVID-19 vaccination has become mandatory for civil servants in the country. They have until 23 August to get vaccinated and may face disciplinary action if they fail to do so.

“It was observed that some public servants have deliberately avoided being vaccinated so that they can stay from work under the disguise of working from home. This has negatively affected service delivery to the public,” Kinyua said.

Nkengasong described COVID-19 vaccination as a best shot at ending the pandemic on the continent. He noted that vaccines have been instrumental in eradicating smallpox and in tackling other diseases too.

“The right behavior is to go out there, get the vaccine whenever you have access to vaccines. We don’t even want to get to a point where the government is requiring that you get vaccinated,” he added.

Huge increase in COVID cases in Ethiopia 

Africa is still on the crest of its third COVID-19 wave, according to the World Health Organisation (WHO). This week, the continent surpassed seven million confirmed cases with numbers still rising.

“Weekly COVID-related deaths also reached another record peak this week, with nearly 6,600 deaths reported. Vigilance remains crucial,” WHO stated.

In the past week, cases have increased in several African countries including Ethiopia where there has been a 62% average increase in new cases, Nigeria (56% increase), Kenya (30% ) and the Democratic Republic of Congo (6%).

New deaths also increased by an average of 108% in Nigeria, 56% 30% in Kenya and 6% in DRC.

Tanzanian and US officials celebrate the arrival of the first COVID-19 vaccines in the country last month as, part of a donation from the US.

Africa CDC and the WHO have described COVID-19 vaccination roll-out as the largest vaccination exercise ever conducted on the continent. 

After a long pause owing to delays in shipments of Covishield from the Serum Institute of India, African countries are starting to receive Johnson and Johnson (J&J) vaccines, which are being filled and finished by Aspen, the South African pharmaceutical company. 

The African Vaccine Acquisition Trust (AVAT) is facilitating these vaccines, and 10 African countries have received their first J&J vaccine deliveries although only 1.5 million doses have been delivered. 

Egypt received the largest shipment (261,000 doses), while Angola (165,000 doses), Ghana (177,600), Tunisia (108,000), Cameroon (158,000), Mauritius (108,000), Togo (117,600), Lesotho (108,000), Botswana (108,000) and Nigeria (177,000) also received deliveries. 

The doses are part of a total of 400 million doses agreed to by the African Union, AVAT and Johnson & Johnson.

A total of 23 African countries have also received their US government dose donations which totals 9,244,000 doses. Ethiopia got the largest shipment of J&J vaccine doses, receiving 1.6 million doses followed by Tanzania (one million). 

Three African countries received US-donated Pfizer doses: South Africa (9.2 million doses), Rwanda (300,000 doses) and Botswana (81,000 doses). 

WHO recently announced that, in spite of the delays, COVAX still aims to deliver 520 million doses to Africa by the end of 2021. 

“Almost 90 million of these doses have now been allocated to African countries and will be delivered by the end of September,” WHO stated.

However, the facility still relies on vaccine donations from countries with abundant doses. Canada announced on Thursday that it would be donating 10 million doses of J&J vaccine to COVAX.

Addressing a joint press event, Canada’s minister for international development, Karina Gould, and the country’s procurement minister, Anita Anand, disclosed the donation is from Canada’s advance purchase agreement with the vaccine manufacturer. However, Canada has yet to deliver on previous promises to donate doses  .

COVAX has also had to expand its bouquet of vaccines. On Wednesday, it delivered the first tranche of six million doses of Sinopharm vaccines to Pakistan.

In late March, Health Policy Watch reported that the Nigerian government was pivoting to J&J vaccine for its COVID vaccination plans. Although the country’s health authorities still maintain additional doses of Covishield will soon be available in the country for citizens that got the first dose but are yet to receive the second dose, Nkengasong revealed that Covishield doses are not expected anytime soon in Africa.

“Doses of Covishield are not expected anytime soon. What we are having now are J&J vaccine doses,” Nkengasong said.

John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC).

Test for vaccine hesitancy

As more vaccine doses become available, this is expected to uncover the level of vaccine hesitancy in Africa. 

However, Nkengasong expressed confidence COVID vaccine uptake improving in Africa as more doses become available on the continent. 

“Vaccine hesitancy is not static at all,” he said. “We have seen countries where initially there was a lot of resistance, and then, as campaigns were made and information sessions were organized, the situation changed.”

He noted that in Ivory Coast, during the early days of the vaccination exercise, few people turned up for vaccination. But with the government and the Ministry of Health conducting awareness campaigns, the vaccines were gone in no time. Initially, uptake in Senegal was slow but the country is now they are doing about 50,000 vaccinations a day. 

Image Credits: Wish FM Radio, Africa CDC.

The WHO visiting Wuhan’s Huanan seafood market on January 31, 2021, as part of their investigations into the origins of COVID-19.

The World Health Organization (WHO) has called on China to provide it with access to raw data so that the global search for the origins of SARS-CoV2 can move forward.

The WHO made the call on Thursday while asking member countries for nominations to the Scientific Advisory Group for Origins of Novel Pathogens (SAGO).

While countries such as Italy, where the virus had hit hard and early, had been cooperating with the WHO, China needed to do the same by “sharing raw data and giving permission for the retesting of samples”, said the WHO.

Doing this would be a reflection of “scientific solidarity” to “ advance the studies of the origins quickly and effectively,” the WHO added.

But last month, China said that it would be “impossible” for it to cooperate with the next phase of the origins research.

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

In January, after months of stalling, China finally allowed an international scientific team into the country – but it refused to give the team access to certain key raw data, including the hospital records of patients in the greater Wuhan area, where SARS-CoV-2 was first identified.

The team finally produced a phase one report which considered four key hypotheses about the origins of the virus, including that it could have escaped from the laboratory in Wuhan that is studying coronaviruses.

China questions ‘lab hypothesis’

“China and a number of other Member States have written to WHO regarding the basis for further studies of the SARS-CoV-2 ‘lab hypothesis,” said the WHO this week.

But, the WHO added, it could only address the ‘lab hypothesis’, if it had “access to all data”.

A number of countries that “have reported detection of SARS-CoV-2 in samples from stored biological specimens from 2019” had been working with the WHO. In Italy, this had included “the blind retesting of pre-pandemic blood samples”. 

“Sharing raw data and giving permission for the retesting of samples in labs outside of Italy reflects scientific solidarity at its best and is no different from what we encourage all countries, including China, to support so that we can advance the studies of the origins quickly and effectively,” the WHO added.

Refuting claims from China that it had been put under political pressure to act, the WHO stressing that “there was insufficient scientific evidence to rule any of the hypotheses out”. 

“WHO’s priority is for scientists to build on the first phase of studies, implement the recommendations outlined in the March 2021 report and accelerate scientific efforts on all hypotheses,” said the body.

“Searching for the origins of any novel pathogen is a difficult process, which is based on science, and takes collaboration, dedication and time.” 

No blame or finger-pointing

It stressed that the search for the origins of SARS-CoV-2 “should not be an exercise in attributing blame, finger-pointing or political point-scoring” but that it was vital to understand how the pandemic started for “future animal-human spillover events”. 

“Countries have a collective responsibility to work together in the true spirit of partnership and to ensure scientists and experts have the space they need to find the origins of the worst pandemic in a century,” stressed the WHO.

“Building on what has already been learned, the next series of studies would include a further examination of the raw data from the earliest cases and sera from potential early cases in 2019. Access to data is critically important for evolving our understanding of science and should not be politicised in any way.”

SAGO is being set up to advise the global body on how to “study the emergence of future emerging pathogens with pandemic potential”, and its first task will be to “support the rapid undertaking of recommended studies” outlined phase one of the virus origins study.

By issuing an open call for nominations to SAGO, WHO hopes to provide “a transparent foundation for the new scientific advisory group that we expect all Member States will engage with”. 

WHO added that it hoped for continuity from “previous missions to China for SARS-CoV-2, as well as other missions studying the origins of, for example, SARS-CoV, MERS-CoV, avian influenza, Lassa and Ebola”.

“This open call aims to ensure that a broad range of scientific skills and expertise are identified to advise WHO on the studies needed to identify the origins of any future emerging or re-emerging pathogen of pandemic potential.”

Image Credits: South China Morning Post.

PAHO is supporting vaccinations of indigenous people

As the Delta variant continues to fuel COVID-19 cases and deaths across the Americas, the Pan American Health Organization (PAHO) is becoming more proactive in procuring vaccines for its members.

PAHO announced this week that its Revolving Fund, which provides access to vaccines at affordable prices, is now open for requests from member states for COVID-19 vaccines for the last three months of 2021 and for 2022. 

The new initiative aims to make available tens of millions of COVID-19 vaccine doses, “beyond the 20% that COVAX offers”, PAHO Director Carissa Etienne told a media briefing on Wednesday.

“It is an initiative that will benefit every country in the region, but especially those that lack the resources and the negotiating power to secure the doses that they need to protect their people,” she said.

More than 20 countries in the Americas have formally expressed interest in the Revolving Fund offer, which consolidates regional demand so that vaccines can be procured in bulk and also procures syringes, cold-chain equipment, and other supplies.

But the region is still short of doses needed to turn the tide of the pandemic, said Etienne, calling for “a significant influx of vaccines and a more equitable process of distribution”.

The Revolving Fund has been working in three key areas to increase access to COVID-19 doses: through purchase and delivery of vaccines on behalf of the COVAX facility; supporting bilateral donations; and providing complimentary access to vaccines in order to achieve high coverage to control the pandemic.

Cases increase in North America, decrease in Brazil

Over 1.3 million COVID-19 cases and 19,000 COVID-related deaths were reported in the Americas in the past week, PAHO announced at a press briefing on Wednesday. 

Canada, Mexico, and the United States are reporting increases in infections and deaths. 

Cases are falling in Panama and Costa Rica, but rising in Honduras and Belize, with a 30% increase reported in El Salvador. 

However, South America is reporting an overall decline in cases, including in the Andean region and Brazil, and substantial drops in Colombia, Paraguay, Uruguay, and Bolivia. 

Etienne noted that though there is a surge in cases, this also presented  “good evidence that wherever vaccines are available, they limit severe illness and save lives.’

“That is why increasing access to vaccines remains our top priority, not just for some countries, but for all countries.” 

PAHO concerned over anti-vax protests in Caribbean

Amid a number of vaccine related-protests in Antigua and Barbuda and other Carribean countries and territories, PAHO expressed concern over the rise in vaccine hesitancy and limited hospital capacity in the region. 

Police used teargas to break up a demonstration against a government decision that frontline workers in Antigua and Barbuda need to be vaccinated. 

Meanwhile, at a protest against mandatory vaccination in St. Vincent and the Grenadines, Prime Minister Dr Ralph Gonsalves was injured when a protester threw an object at his head.

Etienne expressed deep concern over these protests and urged caution in order to control the spread of the pandemic, making a special appeal to her fellow Caribbean residents.

“It is really foolhardy to not adhere to public health measures and not be vaccinated in a situation where [hospital] capacity is limited. We are playing with our lives. My appeal is to wake up from that slumber, wake up from that dream, because we know that vaccines are safe.”   

Supporting indigenous communities in vaccination campaigns 

PAHO is also involved in increasing vaccine access to remote and vulnerable communities, such as the indigenous communities of Central and South America.

More than 134,000 indigenous people have been fully vaccinated across Guatemala, and more than 312,000 have completed their vaccinations in Brazil. 

Seventeen countries in the Americas have listed indigenous peoples as a priority group for COVID vaccinations and vaccination campaigns are underway in those and  other countries.

But there is not enough data for every country on the vaccination rates of indigenous groups, leading PAHO to call for more data collection in order to resolve the challenges faced by this vulnerable minority. 

“We must ensure that our strategies are designed by, for, and with the communities they are intended to serve. Countries must engage indigenous groups as they design pandemic policies and adjust their COVID responses to ensure that they align with their needs and customs,” said Etienne recently.  

PAHO is working with groups that represent indigenous people in the region, such as the Fund for Development of Indigenous Peoples in Latin America and the Caribbean (FILAC), to issue culturally appropriate recommendations in countries across the region and supporting cross-border vaccination campaigns to reach indigenous communities in the Amazonian regions of Colombia and Ecuador.

‘Climate-smart’ health facilities needed to mitigate climate change 

PAHO Director Carissa Etienne

PAHO officials have called for more investment in prevention to mitigate the impact of climate change following a major report released by the Intergovernmental Panel on Climate Change (IPPC), that announced climate change as an existential health problem overshadowing all others.

Only 3% of health resources are invested in prevention and health promotion related to climate change, a number Etienne called ‘totally insufficient’. 

Etienne advocated for ‘climate-smart’ health facilities that can continue to be functional in the face of changing climate and extreme events.

“We need to build strong, resilient systems with the capacity to respond during emergencies, whether they are linked to climate change or pandemics. We need to prevent future pandemics that are linked to the disruption of our natural systems while maintaining the ability to keep us healthy and thrive as societies.” 

PAHO is now coordinating projects with partners to receive and implement funds from the Green Climate Fund, a platform built to limit or reduce greenhouse gas emissions in developing countries, and also other donors in order to increase the ability of health systems to better anticipate, prepare, respond, and recover from climate events. 

 

Image Credits: PAHO.

International Youth Day – Loneliness, depression, anxiety, substance abuse and job losses. These are some of the ways in which the COVID-19 pandemic is weighing on children and young adults who have been isolated from friends, leisure activity and job opportunities by lockdowns and social distancing.

Over 1.5 million children have also lost their parents and caregivers to COVID, giving rise to a “hidden pandemic of orphanhood”.

Over half of young people in the US (56%) aged 18 to 24 have reported feeling anxious or depressed during the pandemic, according to the Kaiser Family Foundation (KFF). A quarter of young adults also reported suicidal thoughts and substance abuse.

“During the pandemic, adults in households with job loss or lower incomes report higher rates of symptoms of mental illness than those without job or income loss (53% vs. 32%),” said the KFF, which drew its conclusions from the US Census Bureau’s Household Pulse Survey, a survey created to capture data on the  impact of the pandemic.

Heated debates in the US about how schools could open up safely this week in the face of Delta variant surges have heightened the stresses on school-going youth, particularly as more young people are becoming infected.

Recognising that “students benefit from in-person classes”, the US Centers for Disease Control and Prevention (CDC) recommends “universal indoor masking” by all students from the age of two, staff, teachers, and visitors “regardless of vaccination status”, and that schools maintain “at least three feet of physical distance between students in classrooms”.

However, at least nine US states – Arizona, Arkansas, Florida, Iowa, Montana, North Dakota, South Carolina, Tennessee and Texas – have banned or limited the CDC mask mandates.

Despite COVID-19 infections surging in Florida, Governor Ron DeSantis has threatened to withhold the salaries of teachers at schools that are enforcing the CDC mask mandate.

Law suits have been filed – both from parents opposed to their children wearing masks, such as in New Jersey, and from parents opposed to state governors’ refusing to implement mask-wearing, such as in Texas.

This has heightened anxiety for parents and children as US schools re-open after the summer break.

Rise in substance abuse

There has also been a marked increase in deaths from drug overdoses in the US, which jumped by 30% last year and account for roughly a quarter of the deaths caused by COVID, according to NPR. The majority of deaths were adults between the ages of 35 and 44, a number of whom are parents.  

Meanwhile, KFF reported that 25% of young adults in the US reported that they had started or increased substance use during the pandemic.

“Solitary substance use (as opposed to social use) has increased among adolescents during the pandemic, which is associated with poorer mental health,” added KFF.

Meanwhile, a recent systemic review of clinical research on the impact of social isolation and loneliness found that the subjects were “probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends”. 

The longer the isolation, the worse the feelings of depression were likely to be, according to the review, which drew on 61 studies – primarily in the US, China, Europe, and Australia. 

Soweto, South Africa. Poverty and crowded conditions make lockdowns doubly difficult.

Financial pressure drives stress in poorer countries

There is far less information about the impact of COVID-19 on young people in low and middle-income countries (LMIC) but the little research that does exist shows that economic stress is the most overwhelming burden for young people, and that this sparks other mental health conditions.

“The loss of employment opportunities, reduced pay, together with lockdowns and movement restrictions have influenced deterioration of the social and economic conditions of many,” according to a review on mental health and psychosocial support in sub-Saharan Africa during COVID-19.

“Many are at risk for a decline in their mental health thus highlighting the need to address the social and economic conditions that contribute to poor mental health during this time,” according to the researchers, who are from Botswana, South Africa, and the Netherlands.

“People need support to deal with fears, stress, anxieties and distress of poverty, job and income loss as well as challenges of working at home in mostly inappropriate environments,” said a Zimbabwean mental health professional who was interviewed for the research.

Research involving 957 adults living in Soweto in South Africa interviewed during the country’s hard lockdown in March 2020 “identified potent experiences of anxiety, financial insecurity, fear of infection, and rumination”. 

In October last year, the World Health Organization (WHO) Africa region identified that 37% of the 28 African countries surveyed reported that their mental health response plans had no funds 

This comes as the COVID-19 pandemic increases demand for mental health services.

Invest in mental health services, says WHO

“Isolation, loss of income, the deaths of loved ones and a barrage of information on the dangers of this new virus can stir up stress levels and trigger mental health conditions or exacerbate existing ones,” Dr Matshidiso Moeti, WHO Regional Director for Africa, told a media briefing. 

“The COVID-19 pandemic has shown, more than ever, how mental health is integral to health and well-being and must be an essential part of health services during outbreaks and emergencies.”

Even before the pandemic, the region had one of the lowest mental health public expenditure rates, at less than US$ 10 cents per capita, according to the WHO.

“COVID-19 is adding to a long-simmering mental health care crisis in Africa. Leaders must urgently invest in life-saving mental health care services,” said Dr Moeti.

 

Image Credits: Taylor Brandon/ Unsplash, Matt-80.

Hanna Sarkkinen, Finland’s Minister of Social Affairs and Health

Three medicines currently being used to treat malaria, cancer and immune deficiencies are being tested on hospitalised patients with COVID-19 to see whether they can be repurposed to address the virus, the World Health Organization (WHO) announced on Wednesday.

“These therapies – artesunate, imatinib and infliximab – were selected by an independent expert panel for their potential in reducing the risk of death in hospitalized COVID-19 patients,” said the WHO.

Artesunate is currently used to treat severe malaria, imatinib treats certain cancers, and infliximab is used against diseases of the immune system, including Crohn’s Disease and rheumatoid arthritis.

The medicines will be tested as part of the next phase of the WHO’s Solidarity trial platform, Solidarity PLUS, which “represents the largest global collaboration among WHO Member States”, according to the global body. 

“The trial involves thousands of researchers at more than 600 hospitals in 52 countries,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

Finland becomes the first to test the medicines

Hanna Sarkkinen, Finland’s Minister of Social Affairs and Health, told the briefing that two hospitals in her country had become the first in the world to start recruiting patients to test these medicines on 6 August.

“Even though there are approximately 3,000 clinical studies on COVID-19, most of them are too small to yield significant information,” said Sarkkinen, adding that only Solidarity and the United Kingdom’s Recovery trials were large enough to reliably assess multiple new treatments fast and at the same time.

Manufacturers of the drugs have donated stock to Solidarity Plus. 

Artesunate, produced by Ipca, will be administered intravenously for seven days using the standard dose recommended for the treatment of severe malaria.

Novartis’s Imatinib will be administered orally, once daily, for 14 days. Johnson and Johnson’s Infliximab will be administered intravenously as a single dose. 

Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit, said that two expert groups assisted the WHO to identify promising COVID-19 treatments. 

“We have an independent expert group that helps WHO to review the evidence of all the emerging drugs and treatments that are available. As they become promising based on the data, we consider them for the therapeutics trial, Solidarity Plus,” said Henao-Restrepo.

“In addition, WHO has another independent group of experts that routinely reviews the evidence on drugs for which there is information from Phase Three clinical trials and beyond. This independent committee also helps WHO to formulate the guidelines that will be used to improve or to adjust the current clinical management of patients with COVID,” she added.

“So any drug that has been tested or used through a clinical trial, or through an observational deployment in a country is of interest for us.”

Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit

Four targets to treat COVID infection

Dr Mike Ryan, WHO’s Executive Director of Health Emergencies, said that the WHO was looking at four targets to mitigate COVID-19 infections: developing more broad-spectrum antivirals; developing and deploying monoclonal and polyclonal antibodies; knowing how to use steroids and immunomodulators that modulate the immune response, and ensuring people have access to higher standards of care, basic oxygen and intensive care. Previously, Solidarity has tested remdesivir, hydroxychloroquine, lopinavir and interferon, but the trial results showed that they had little or no effect on hospitalized patients with COVID-19.

Meanwhile, the Drugs for Neglected Diseases initiative (DNDi) has warned that the few innovative COVID-19 therapeutics are mostly available in high-income countries, and that the world risks “replicating the vaccine inequality” if these are not shared with low and middle-income countries (LMIC).

To arrest the progress of COVID-19, there is a “clear rationale emerging” that strong antivirals combined with host-directed therapies (anti-inflammatories and immunomodulators) need to be given to patients during the first few days of infection, said DNDi in a new report.“Efforts are today rightly focused on identifying novel antivirals, additional repurposed therapeutics, and more affordable and adapted new approaches, such as second-generation monoclonal antibodies and other biologics,” it adds. 

But, says Rachel Cohen, DNDi’s North America Executive Director, “with more interest now in second-generation monoclonal antibodies and antivirals, the investment going into these areas needs to be directed to the right area, and it must ensure access.”

 

The new IPCC report predicts that extreme heat exposure and extreme weather events will increase in frequency and intensity as the world warms.

The 26th UN Climate Change Conference of the Parties (COP26) is expected to be a pivotal moment in the fight against climate change, bringing leaders together in Glasgow to accelerate progress on global climate action. 

The event is “the world’s best last chance to get runaway climate change under control,” said the COP26 organisers in the wake of the “Red Alert” report issued on Monday by the International Panel on Climate Change (IPCC). 

The report sounds the alarm on the state of the climate crisis, including changing weather patterns, intensifying water cycles, rising sea levels, ocean acidification, thawing permafrost, and increasing exposure to extreme heat. 

Addressing climate change is urgent and insufficient progress has been made, as “nations still haven’t implemented the Paris Agreement, they’re still far from its 1.5°C goal, and levels of greenhouse gases in the atmosphere continue to rise,” said Ovais Sarmad, UN Climate Change Deputy Executive Secretary, in late June at a Chatham House virtual conference ‘Climate Change 2021.’

Tough decisions will need to be made to advance the world towards the goal of limiting global temperature rise to 1.5°C above pre-industrial levels. 

“What we need are political decisions to be made. There are opportunities for these decisions and this leadership in the next few months leading up to COP26,” said Sarmad. 

The four main goals of the summit are to: 

  • Secure global net zero emissions by 2050 and keep global warming of no more than 1.5°C within reach; 
  • Enable and encourage countries affected by climate change to protect and restore ecosystems and build resilience infrastructure and agriculture to avoid the loss of livelihoods and lives; 
  • Follow through with the promise to mobilize US$100 billion in climate financing per year by 2020; 
  • Finalise the “Paris Rulebook” to make the 2015 Paris Agreement operational. 

“I feel there is a new enthusiasm and a new momentum around international climate action that we haven’t experienced since the adoption of the Paris Agreement. There is a renewed appetite for progress,” said Sarmad. 

Key emitters miss deadline to deliver climate pledges

This momentum, however, has not translated into action from countries so far, as 80 countries missed the deadline to submit new climate plans ahead of the Glasgow summit. 

Countries had until 31 July to submit enhanced Nationally Determined Contributions (NDCs), which represent efforts to reduce national emissions and adapt to the impacts of climate change. 

The NDCs will be included in a synthesis report on global climate progress, to be published prior to COP26.

Only 110 of the 191 signatories to the Paris Agreement submitted updated plans. Notably, key emitters, including China, India, South Africa, and Saudi Arabia, have failed to submit plans.

This is “far from satisfactory,” said Patricia Espinosa, Executive Secretary of the UN Framework Convention on Climate Change (UNFCCC), in a statement. 

“I call on those countries that were unable to meet this deadline to redouble their efforts and honour their commitment under the Paris Agreement to renew or update their NDCs,” said Espinosa. 

Since the deadline, an additional 13 countries have submitted their updated NDCs. 

The level of ambition in the submitted plans is lacking, according to Espinosa. An early analysis of the NDCs showed that collective efforts fell short of the scientific requirements to limit global temperature rise by 2°C by the end of the century.

To achieve the goal of 1.5°C, emissions must be reduced by at least 45% compared to 2010 levels by the end of this decade. 

“I encourage those who have submitted their NDCs to continue reviewing and enhancing their level of ambition,” said Espinosa. “I truly hope that the revised estimate of collective efforts will reveal a more positive picture.”

“Recent extreme heatwaves, droughts and floods across the globe are a dire warning that much more needs to be done, and much more quickly, to change our current pathway. This can only be achieved through more ambitious NDCs,” Espinosa stressed.

IPCC report shows that climate change ‘endangers our health and future’ 

The major report by the IPCC has made waves, receiving widespread media attention and responses from world leaders and the global health community.

“The new IPCC report shows that every fraction of a degree hotter endangers our health and future. Similarly, every action taken to limit emissions and warming brings us closer to a healthier and safer future,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, on Twitter. 

“The risks posed by climate change could dwarf those of any single disease. The COVID-19 pandemic will end, but there is no vaccine for the climate crisis,” Tedros added.

The health impacts of climate change range from exacerbated respiratory and cardiovascular diseases from heatwaves to injuries and diarrhoeal disease from variable rainfall patterns and floods to malnutrition from loss of food security due to changing weather patterns and droughts.

Dead and dying animals at the Dambas, Arbajahan, Kenya, which has dried up due to successive years of very little rain. Changing weather patterns and droughts are expected to have a large impact on crops and livestock, which influences food security.

“Urbanization and climate change are intensifying contact between animals and humans, increasing the likelihood of zoonotic transmission. It’s also set to increase the burden of mosquito-borne diseases such as dengue and malaria,” said Dr Seth Berkley, CEO of Gavi, The Vaccine Alliance, on Twitter. 

“We are all too aware how quickly outbreaks can wreak havoc and claim lives. It is one of many reasons the world must heed IPCC’s dire warnings about the devastating impact of climate change,” said Berkley.

“We live in an era of more frequent and more complex epidemics/pandemics with the key drivers all [as] features of the 21st century – ecology and climate change, animal/human interface, urbanisation, trade/travel,” said Dr Jeremy Farrar, Director of Wellcome Trust, on Twitter.

Leaders call for action and consensus at COP26

World leaders and government officials joined calls for immediate and large-scale measures against climate change on Monday.

“As countries prepare for the 26th UN Climate Change Conference (COP26) in Glasgow, this report is a stark reminder that we must let science drive us to action,” said Anthony Blinken, US Secretary of State, in a statement released on Monday. “This moment requires world leaders, the private sector, and individuals to act together with urgency and do everything it takes to protect our planet and our future in this decade and beyond.”

The report found that unless there are immediate, rapid, and large-scale reductions in greenhouse gas emissions, the world will not be able to limit global warming to 1.5°C or 2°C above pre-industrial levels. 

Significant reductions in greenhouse gas emissions and reaching global net-zero CO2 emissions could gradually reverse the global CO2-induce surface temperature increase, said the authors of the report

“The new IPCC report puts Pacific Island nations 0.4 degrees Celsius away from existential catastrophe,” said Frank Bainimarama, former President of Fiji and President of COP23, on Twitter. “We know what’s coming. More importantly, we know how to stop it.”

“By COP26, we need: dramatic cuts in emissions by 2030; net-zero emissions by 2050; [and] no excuses,” said Bainimarama.

“It is clear that the next decade is going to be pivotal to securing the future of our planet. We know what must be done to limit global warming – consign coal to history and shift to clean energy sources, protect nature and provide climate finance for countries on the frontline,” Boris Johnson, the UK’s Prime Minister, said in a statement.

“We have a full 84 days to secure…consensus [on the 1.5 degree target] – for the Blue Pacific and for the planet,” said Satyendra Prasad, Fiji’s Ambassador and Permanent Representative to the UN, on Twitter. 

Fossil fuel from rich countries hurting lives in developing world

“We should never forget the fundamental injustice at the heart of the climate emergency: our people are dying in vulnerable developing countries because of the fossil fuel burning for consumption and economic growth in rich countries,” Mohamed Nasheed, Former President of the Maldives and ambassador for the Climate Vulnerable Forum, representing 48 countries most at-risk to the effects of climate change, said in a statement.

“We are paying with our lives for the carbon someone else emitted. We will take measures soon to begin to address this injustice, which we cannot merely accept,” said Nasheed. 

“The report reaffirms India’s position that historical cumulative emissions are the source of the current climate crisis,” said India’s Environment Minister Bhupender Yadav on Twitter. “The report is a clarion call for the developed countries to undertake immediate, deep emission cuts and decarbonisation of their economies.”

Image Credits: Commons Wikimedia, Brendan Cox / Oxfam.

Midwives around the world adapted their practices to help pregnant women affected by COVID-19 restrictions, showing how important flexible, community-based care is in crises.

More than a year after the start of the global coronavirus pandemic, and the release of openDemocracy’s investigation into childbirth during COVID-19, we know that there have been too many violations of women’s pregnancy and childbirth rights during this crisis, including outright suspensions of services. 

Too often, the response of governments and health facilities to the spreading pandemic quickly abandoned evidence-based, respectful care practices, without adequately considering alternatives – including via midwives and community-based care models – that could enhance infection prevention while also protecting such practices. 

But there is also good news. Around the world, women, healthcare providers and (some) decision makers have imagined and implemented solutions in response to these problems. These innovations, crafted in a time of crisis, hold very valuable lessons.

At the level of healthcare providers and facilities, damaging top-down changes that suspended rights and services were mitigated in some contexts by rapid adaptations to uphold respectful care in the face of COVID-19 challenges. 

Ban on birth partners

In Croatia, for example, staff at the small Čakovec General Hospital – which serves a population north of the capital Zagreb with a high proportion of Roma women – resisted banning birth companions at a time when 90% of the country’s hospitals did so. Instead, they decided to procure COVID-19 rapid antigen tests for both the expectant mother and her companion, to ensure that women could have birth companions and remain with their babies at all times – a correct and best practice for optimal health outcomes. 

In the Netherlands and in Mexico, midwives used hotels and newly-established ‘maternity homes’, respectively, for birth and postpartum care for healthy women with low-risk pregnancies. This minimised their exposure to COVID-19 and also ensured their autonomy during birth. 

Digital and telehealth alternatives enabled women to talk to doctors and other healthcare professionals via virtual consultations (UK), and facilitated self-care through YouTube videos (Japan) and online group birth preparation classes (mostly in high-income countries). However, this shift to online methods also exacerbated inequalities. One doctor in India noted that “the use of the phone, SMS and WhatsApp is a success for telemedicine, but only 30% of the people have a smartphone.”

For women facing intersecting barriers to accessing healthcare, it was community-based health workers, especially midwives, who stepped in and stepped up. 

In Mexico, groups of midwives in the states of Chiapas, San Luis Potosí and Oaxaca coordinated ‘care brigades’ to visit women in remote, predominantly Indigenous communities. In Alaska, Indigenous women have approved the return to traditional practices of being supported by a midwife to give birth at home, where they can speak their native language and have family nearby. Before the pandemic,they were often encouraged – or even required – to travel hundreds of miles south to give birth. 

In Croatia, Slavojka Aresnović, a midwife working on the island of Korčula, accompanied pregnant and birthing women on their precarious 100 kilometre ambulance journey over bumpy roads to the hospital in Dubrovnik on the mainland. 

Austerity measures threaten community-based care 

With COVID-19 far from over and growing disparities and inequities in health outcomes around the world, what can we learn from the solutions crafted during the pandemic about restructuring and improving the ways that maternity care is delivered? 

Countries around the world have long abandoned community midwifery services in favour of centralised care, but the pandemic has shown how dangerous it is to rely on a single form of care delivery during emergencies. It is past time to reinstate community-based models of care, including community midwifery services. Flexibility in healthcare delivery allows for adaptation during crises.

Midwives are often part of the community and therefore can be the last health professionals left standing to provide care during crises. Throughout the pandemic, midwives continued to provide culturally sensitive care, while also supporting autonomy and choice for women even as COVID-19 stoked fear and uncertainty. 

But midwives and community health workers need support to provide this critical care. 

As a first step, midwifery must be financed as an integrated part of a country’s health system and pandemic readiness. Ensuring that midwives are involved when essential public health policy and funding decisions are being made is also critical to building – and sustaining – equitable and women-centered models of care.

Right now, forthcoming post-crisis austerity measures threaten further cuts to maternal and reproductive health, and especially to community services, despite evidence that expanding midwifery services is a cost-effective model. In Mexico, pandemic-related austerity measures are already depriving existing traditional midwives and dedicated Indigenous women’s centres of essential federal funding. . 

As we manage the ongoing evolution of the pandemic amid inequitable vaccine rollouts, as well as the inevitable future conflict and climate disasters, we must not be complacent about violations of women’s and newborn rights – but we must also do more than simply fix what has failed over the past year. What women want are birth experiences and sexual and reproductive healthcare services that are centered on respect and dignity, where health professionals are supported to deliver that care. 

In the most precarious situations, it is community-based healthcare models, especially midwifery services, that uphold human rights and respectful, accessible and, ultimately, safe care for women and their families. As countries around the world ebb and flow toward reopening and rebuilding, it is time to reimagine and reinvest in models of care that we know and have seen work during COVID-19 and beyond. 

*The writers are from the White Ribbon Alliance for Safe Motherhood. This article is co-published with openDemocracy.

 

Image Credits: Elizabeth Poll/MMV.