Temperature, extreme heat and frost, and environmental disasters will increase in frequency, duration, and magnitude as the world warms, predicted a major new scientific report.

Climate change is now an existential health problem overshadowing all others, say scientists in a major report by the Intergovernmental Panel on Climate Change (IPCC) – the world’s largest and most comprehensive assessment of the state of the planet. 

Unprecedented changes in the Earth’s climate have been recorded in every region and the world is currently 1.09°C warmer than in the second half of the 19th century. The past five years have been the hottest on record since 1850.

The report links climate change with changing weather patterns, intensifying water cycles, rising sea levels, ocean acidification, thawing of permafrost, and increasing exposure to extreme heat. 

“The alarm bells are deafening, and the evidence is irrefutable: greenhouse gas emissions from fossil fuel burning and deforestation are choking our planet and putting billions of people at immediate risk,” said UN Secretary-General António Guterres in a statement in response to the report. “Global heating is affecting every region on Earth, with many of the changes becoming irreversible.”

The report, ‘Climate Change 2021: The Physical Science Basis’, was written by 234 scientists who are members of the IPCC Working Group I, and it was approved on Friday by 195 member governments of the IPCC. 

The landmark report is the first major review of the science of climate change since 2013, and the first instalment of the IPCC’s sixth assessment report, due to be released in 2022. 

“It has been clear for decades that the Earth’s climate is changing, and the role of human influence on the climate system is undisputed,” said Valérie Masson-Delmotte, IPCC Working Group I co-chairperson, in a press release. 

Temperature change projections from the IPCC report, which was published on Monday.

Extreme heat exposure threatens livelihoods and health 

Since 1970, global surface temperatures have risen faster than in any other 50-year period over the past 2,000 years, said the report. 

Changes in mean temperature and extreme heat and frost have already begun to occur and are expected to increase in frequency, duration, and magnitude as the world warms. 

It is “virtually certain” that hot extremes, including heatwaves, have become more frequent and intense across most regions since the 1950s, while cold extremes have decreased in frequency and severity, according to the authors.

Human-induced climate change is the main driver of these changes. 

“Heatwaves, floods, and droughts are taking thousands of lives, forcing displacement, and exacerbating food insecurity, hunger, and malnutrition,” said WHO on Twitter. “Climate change is the single biggest health threat facing humanity.”

Heatwaves can exacerbate respiratory and cardiovascular diseases, result in excess mortality, and cause power-shortages, leading to loss of health service delivery.

The health impacts from heatwaves can include dehydration, kidney diseases, respiratory disease, and heat stroke. 

Between 1998 and 2017, more than 166,000 people died due to heatwaves. The number of people exposed to extreme heat is rising – increasing by 125 million from 2000 to 2016.

If the world’s temperature warms by 1.5°C by the end of the century, populations will have a 1.6 times higher risk of experiencing extreme heat. This risk rises to 2.3 times higher risk at 2°C warming. If the world warms by over 3°C, the report projects that 80% of the world’s land area will be exposed to dangerous heat. 

Outdoor and manual workers are particularly at risk of the negative health impacts of extreme heat exposure.

“At increasing warming levels, extreme heat will exceed critical thresholds for health, agriculture and other sectors more frequently, and it is likely that cold spells will become less frequent towards the end of the century,” said the report. 

Extreme weather affects infrastructure, displaces people 

Changes in global monsoon precipitation have increasingly been observed since the 1950s, rising in some regions and falling in others as a result of greenhouse gas and aerosol emissions, said the report. 

Tropical cyclones have increased in frequency over the last four decades. The location in the western North Pacific where cyclones previously reached their peak intensity has now shifted northward.

“Human influence has likely increased the chance of compound extreme events since the 1950s,” said the report. “This includes increases in the frequency of concurrent heatwaves and droughts on the global scale; fire weather in some regions of all inhabited continents; and compound flooding in some locations.”

The annual occurrence of disasters has increased three-fold since the 1970s and 1980s, found a report by the Food and Agriculture Organization (FAO). Low- and middle-income countries (LMICs) bear the brunt of the disasters. 

Every year, environmental disasters result in 60,000 deaths, mainly in LMICs. There will likely be an increase in the number of people displaced by and suffering from injuries from extreme weather events.

Weather-related natural disasters destroy homes, infrastructure, medical facilities, and other essential services, disrupting health care delivery. 

Variable rainfall patterns and floods can affect the supply of fresh water, increasing the risk of diarrhoeal disease, respiratory infections, and affecting the transmission of vector-borne diseases. For example, residual water may serve as breeding grounds for disease-carrying mosquitoes. 

Climate change jeopardizes nutrition and food security

Today’s food systems are fragile and unequal, requiring widespread reforms in policies, farming practices, and financing.

Human activities have contributed to changing weather and precipitation patterns, along with agricultural and ecological droughts, impacting crop yields, nutrition, and food security.

“Several regions in Africa, South America and Europe are projected to experience an increase in frequency and/or severity of agricultural and ecological droughts, [while] heavy precipitation and associated flooding events are projected to become more intense and frequent in the Pacific Islands and across many regions of North America and Europe,” said the study. 

Climate change affects food production, availability, access, quality, utilization, and the stability of food systems.

As temperatures rise, crop yields are expected to decline, particularly in tropical and semi-tropical regions. Food security is already being affected in arid areas in Africa and high mountainous regions of Asia and South America. 

Rising temperatures and variable precipitation are likely to decrease the production of staple foods, particularly in LMICs. This will increase the prevalence of malnutrition and undernutrition, which currently cause 3.1 million deaths every year.

The loss of crop and livestock production from natural disasters can result in a total of 6.9 trillion lost kilocalories per year – the equivalent of the annual calorie intake of seven million adults.  

Increased carbon dioxide emissions lower the nutritional value of crops as temperatures rise. Previous studies by IPCC show that wheat grown at 546-586 ppm CO2 has 5.9% to 12.7% less protein, along with less zinc and iron. 

Almost 690 million people went hungry in 2019 and 45% of deaths among children under the age of 5 years are linked to undernutrition. These numbers could increase as climate change worsens food insecurity. 

“In a number of regions (Southern Africa, the Mediterranean, North Central America, Western North America, the Amazon regions, South America, and Australia), increases in one or more of drought, aridity and fire weather will affect a wide range of sectors, including agriculture, forestry, health and ecosystems,” said the report. 

Calls for urgent and large-scale actions to reduce emissions 

The report finds 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. 

Over the next 20 years, the global temperature is expected to reach or exceed 1.5°C of warming. 

“This report is a reality check,” said Masson-Delmotte. “We now have a much clearer picture of the past, present and future climate, which is essential for understanding where we are headed, what can be done, and how we can prepare.” 

The findings of the report “imply that reaching net zero anthropogenic CO2 emissions is a requirement to stabilize human-induced global temperature increase at any level,” said the authors. 

Emitting an extra 500 billion tonnes of carbon dioxide would leave only a 50-50 chance of staying under 1.5°C. The authors believe that 1.5°C of warming will be reached by 2040, but drastic measures to cut global emissions and reach net zero could slow or even halt the rise in temperatures.

“Stabilizing the climate will require strong, rapid, and sustained reductions in greenhouse gas emissions, and reaching net zero CO2 emissions. Limiting other greenhouse gases and air pollutants, especially methane, could have benefits both for health and the climate,” said IPCC Working Group I Co-Chair Panmao Zhai. 

“The message could not be clearer, as long as we continue to emit CO2 the climate will continue to warm and the weather extremes – which we now see with our own eyes – will continue to intensify,” said Corinne Le Quéré, Professor of Climate Change Science at the University of East Anglia in the UK and contributing author to the report. “Thankfully we know what to do: stop emitting CO2.”

It is too late for some of the effects of climate change, which are already irreversible for hundreds to thousands of years.

“If global net negative CO2 emissions were to be achieved and be sustained, the global CO2-induced surface temperature increase would be gradually reversed but other climate changes would continue in their current direction for decades to millennia,” said the report. 

“For instance, it would take several centuries to millennia for global mean sea level to reverse course, even under large net negative CO2 emissions,” the report said.

Messages to COP26 participants

The release of the report comes three months before a key climate summit, the 26th UN Climate Change Conference of the Parties (COP26), is set to be held in Glasgow. 

“The innovations in this report, and advances in climate science that it reflects, provide an invaluable input into climate negotiations and decision-making,” said Hoesung Lee, Chair of the IPCC.

“In my view, there are two key messages from the report for attendees at COP26. First, the report emphasises to climate negotiators – again – the need to reduce emissions further than currently looks likely in order to hit Paris targets,” said Nigel Arnell, Professor of Climate System Science at the University of Reading in the UK and a contributing author to the report. 

“Second, the report highlights – more urgently than the last report from 2013 – the importance of ramping up our collective efforts to adapt to our changing climate and increase resilience to more frequent and more extreme weather disasters in the future,” he said.

“Recent events have shown we are all exposed to climate risks,” Arnell added.

Extreme events are currently being felt across the globe, with wildfires in North America to floods in China, Europe, India, and parts of Africa, and heatwaves in Siberia.

Image Credits: Issy Bailey/ Unsplash, FAO.

Pakistani soldiers closing markets during the COVID-19 pandemic.

#COVIDReporting: For the past 18 months, Health Policy Watch’s team of global reporters has covered the COVID-19 pandemic. But the virus has also wreaked havoc with their personal lives. Over the next few weeks, we will bring you their stories.

ISLAMABAD – One evening in mid-March, I was at my office filing a report on developments on COVID-19 in Pakistan, when my mother called me.

“Your father is not well and asking you to reach home soon,” she said. Although she sounded calm, I felt uneasy and I dialed my father.

He told me that he was having difficulty breathing: “The situation is not good, come back home,” he said.

 It was an unusual instruction and alarm bells started ringing in my mind as I realised that he had probably contracted COVID-19 although he thought he was simply facing normal flu with fever and body aches.

The second COVID-19 wave had hit the country hard. Over 150 deaths were being reported every day and the health authorities had confirmed the presence of the Alpha variant, which is faster in transmission.

I asked my younger brother, Vyas Ali, to take our father to a clinic and made another call to my sister Nain, who is a doctor. 

Within an hour, all of us were in the clinic for his examination. As my father had a chronic problem of gout, the doctor conducted a detailed examination including a COVID-19 test and a CT scan.

Within 15 minutes, the doctor confirmed that he contracted COVID-19 and his oxygen saturation had fallen to 82% (normal is 90-100%). He recommended moving my father to the hospital if his oxygen dropped by two points.

We were aware that over a dozen family members have been exposed to the virus. We live in a traditional joint family system. Aside from my parents, my four siblings, and one-year-old niece live in our large household. 

It was a nerve-wracking night as we watched my father’s oxygen saturation levels dropping. All the hospitals were full and we were not able to find a single nurse who could install an intravenous drip to start his medication.

The next morning, Vyas and I searched for oxygen and also found a male nurse to assist him in an isolated room.

During the peaks of the first and second COVID-19 waves in Pakistan, the hospitals faced shortages of oxygen. After much searching, my brother and I found a small shop that rented oxygen cylinders and we were able to buy these to meet our needs.

Each oxygen cylinder lasted for eight hours and we managed to keep stocks for the uninterrupted supply. Along with the oxygen and medicines, my father also needed physiotherapy every 15 minutes to raise his oxygen saturation. 

All my siblings and mother tested positive

After the slight stabilisation in my father’s health, all the members of our household took their PCR tests for COVID-19. Shockingly, I, my four siblings, and my mother (a cardiac patient) all tested positive with COVID-19.

One by one, my mother, brothers and sisters started showing symptoms of COVID-19. Despite having close contact with all my COVID-19 positive family members, I did not develop any symptoms.

For 12 days, the entire house became an isolation center where my doctor sister and I nursed the entire family. My father and mother were oxygen-dependent and were also treated with Remdesivir injections. The rest of the family were on other medicine and fighting COVID-19 in different ways.

My siblings experienced COVID differently. One lost sense of taste and smell, while some coughed and had high fever. 

But the post COVID-19 effects on my parents were also tough as they experienced side-effects from the steroids they were taking and both remained bed ridden. and we sought a next phase of treatment after their recovery from COVID-19. To this day, my parents still feel weak and say the virus has made them “hollow from inside”.

The family ordeal did not end here. As our home was recovering from the virus, other family members including my aunt and uncle, other family members and friends all became infected with the virus.

As we had successfully managed to take our large family out from the critical point, they all sought our opinion and help to deal with the COVID-19. 

There was only one talk and topic on my mobile and that was COVID-19. 

However, in these difficult times, my friends and close aides also played a very supportive role from arranging medicines to providing moral support. 

After recovering from the virus, my siblings got vaccinated with the available Chinese vaccines – some with SinoPharm, a few with Sinovac and some with CanSino. My parents received Moderna jabs.

Aside from the health effects of COVID-19, there have been very severe economic effects from the lockdowns in my hometown of Hasanabdal ,which is around 45 km west of the capital, Islamabad.

Many people have lost their jobs. Schoolteachers’ salaries have not been not paid and a number of businesses closed. 

During the lockdowns, my family ran charities to support the people who are struggling for their bread and butter. But the tough time we experienced as a family made us more enlightened in our vision of helping others in difficult times. 

It reaffirmed our commitment to helping people around us by arranging medicines, giving people medical advice and trying to find space for those who needed to be hospitalised. 

For more in our #COVIDReporting series, read:

COVID in NYC: Spending My Twenties in Isolation, Fearing Racial Attack

COVID in Delhi: ‘I was More Afraid of Suffocating Than of Dying’

 

Rahul Basharat is a journalist based in Pakistan, who covers health, climate, human rights and education.

Follow him on Twitter @TheRahulRajput

 

 

 

 

Image Credits: Mohammed Nadeem Chaudhry.

Gulshana Bano and women from her community have no say over child-bearing.

Gulshana Bano does not remember her exact age when she got married – probably aged 16 or 17, she recalls.

Now 27 years old and 10 years into her marriage, a frail and petite Bano has four children aged between the ages of four and nine with gaps of less than two years between each of them.

She is part of a tribal group known as the Gujjar-Bakerwals in the Indian-administered Kashmiri Ganderbal district who migrate by foot to warmer places twice a year.

She is also one of the hundreds of women who have no say over her reproductive rights, including family planning and are made to feel like  “child-making machines”.

Bano’s husband believes contraceptives are taboo as children come from God, while her elders believe that family planning interferes with nature.

For Bano and the women in her village, getting timely family planning is an uphill battle due to the stigma attached to the service. Most of them give birth to four to seven children, sometimes even more.

“In our community, it’s the men who take all the decisions including the right to give birth,” Bano says.

Married to a labourer who is against the use of contraceptives, she is likely to have even more children although the family is already struggling to survive on her husband’s meagre daily wage.

“I had to go to a main tertiary care hospital in Srinagar 60km away for my last delivery. The hospital nearby doesn’t have the necessary facilities and in many cases, they refer us to the city hospital,” says Bano.

“My last delivery was through a caesarean and I know that having more kids will affect my health, but I can’t do anything,” she says, adding that the women in her community do not even think about family planning.

Birth control is taboo and ‘God decides when children are conceived’

Birth control is taboo in Gujjar and Bakerwa communities and men believe God decides when children are conceived.

Talking about birth control is taboo. Women have little knowledge about contraception and no access to reproductive rights. As a result, they are forced to have a series of unplanned pregnancies.

“My husband says that the provider of children is God and we cannot stop it, so I don’t even discuss it further,” she says.

India’s National Health Policy 2017  made it mandatory for states to provide contraceptives at various levels of the health system. But these schemes are hardly accessed by the Gujjar-Bakerwal women, the third-largest ethnic group in the state of Jammu and Kashmir, and constitute more than 20%of the region’s population.

A survey conducted by Tribal Research and Cultural Foundation, a non-governmental organisation that works to promote the rights of tribal communities, revealed that more than 71% of the nomads were unaware of the schemes of the state and central government.

The foundation’s research found that tribal women are not exposed to education, don’t have access to modern facilities, and bear the “burden from unsafe sex which includes both infections and the complications of unwanted pregnancy,” according to the research. 

In Bano’s case, her husband has made it clear that he wants more children “so that they can take care of the cattle”. 

“We are told to have babies as long as we can,” she says.

The family lives in  a small two-roomed house built of stone and mud and it’s often a struggle to feed the six mouths in the household as her husband often struggles to find work.

“My husband earns a meagre amount as he is a day labourer. The lockdown months have been very tough as there were days and weeks where he couldn’t go to work. The amount he earns is not enough to feed the family,’ Bano says.

‘My husband will never agree to family planning’ 

Nagina Begum’s husband will never agree to birth control. She had three daughters in five years.

In the same village, Bano’s neighbour, Nagina Begum, 26, was married at the age of 16. She gave birth to three daughters in five years and says that her husband wants boys as well.

“Here in this village, we have no one to educate us of any methods of birth control. Even if I want it, my husband will never agree. I have three girls and he wants boys as well. We do not have the right to choose to give birth. Even our elders tell us not to come in the way of nature,” Begum says.

Begum and Bano face the same predicament when it comes to discussing contraceptives.

“First, I cannot talk to my husband about family planning or using any methods of birth control. Even if I tell him, he won’t agree. There is an amount of shame associated if we even mention using contraceptives. He wants more children and I cannot oppose him,” Begum says. “In our community, women are hardly educated and we only feel like child-making machines.”

The women do all the household work and even work in the fields.

In 2005,  under the National Rural Health Mission, the Indian government launched the Accredited Social Health Activist (ASHA) mission which empowered women’s health activists from the local communities  to promote awareness on health and its social determinants and to mobilise communities to support local health planning.

ASHA counsels women on “birth preparedness, the importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including reproductive tract infections and sexually transmitted infections and care of the young child.”

Responsibilities include educating couples about safe spacing (waiting for at least two years before planning another child) and family planning. 

“We have an ASHA worker in the village, but we were never counselled about any schemes by the government. The only time she comes is when a woman is pregnant. When I was pregnant and during different pregnancies, there was no one to counsel me about spacing between the children or family planning,” Nagina says. “These schemes don’t reach the poor.”

‘Keeping more children is a way to keep a human resource’

Javaid Rahi, the General Secretary of Tribal Research and Cultural Foundation, says that there are many factors responsible for women’s  lack of access of their reproductive rights.

“In tribal societies, having more children is a way to have human resources because they have animals like cows and buffaloes and they can’t afford a caretaker. So they use the human resource at their home. They want more children as they serve as human resources for them. For them, having more children is not a stigma. It is a strength for them, Rahi says.

The women of the tribal communities rarely have any say in household matters.

“A husband wants more than three or four children and if a woman can give birth to only two children, her husband marries again to produce more kids. They prefer to have more and more children as they also serve later to do different kinds of tasks at home and outside,” Rahi says.

“The marriage ceremony is very simple with little money needed. Even divorce is very easy,” Rahi adds.

The tribal community also marry off their children at a young age. Years back,  marriages used to take place when the girl was eight or nine years old, but now it has gone to 15 or 16, Rahi says.

Family planning among the tribal communities  is out of the question.

“The government brought in some schemes regarding family planning, but it is not looked at in a good way in the tribal people and it is even out of question. They feel it’s anti-faith and against God’s wishes,” says Rahi.

Image Credits: Raihana Maqbool.

Population exposure to heat is increasing due to climate change. Globally, extreme temperature events are observed to be increasing in their frequency, duration, and magnitude.

Rising global temperatures caused by greenhouse gas emissions could lead to 83 million excess temperature-related deaths by 2100, projects a new study conducted by a researcher at Columbia University’s Earth Institute. 

The study, published last week in Nature Communications, is one of the first to calculate the mortality impacts of climate change in the kinds of integrated assessment models (IAMs) that are being used by climate economists and policymakers to calculate the social cost of carbon (SCC). 

Integrated assessment models are increasingly being used by governments to make decisions about different climate mitigation policy choices, such as shifting investments from coal to renewable energy, based on social costs and benefits that can be obtained. But health impacts relied on outdated studies and comprised a small portion of the overall impacts of climate change in these models – leaving health as the ultimate outlier in the climate debate.  

The study created an extension to the influential Dynamic Integrated Climate-Economy model (DICE) created by Nobel prize-winning economist William Nordhaus, adding an Endogenous Mortality Response (EMR). 

The DICE model “is currently one of the models used by the US government to estimate the social cost of carbon, which informs trillions of dollars of regulations in the US, and the US social cost of carbon number is also used by other countries and states,” Daniel Bressler, lead author of the study and a PhD candidate in the Sustainable Development program at Columbia University, told Health Policy Watch. 

DICE-EMR was used to create a new metric, the “Mortality Cost of Carbon (MCC),” which can be considered as social cost calculations.

“In the DICE model, optimal climate policy is an emissions plateau and gradual reductions starting in 2050. This results in 3.5°C warming by 2100. Thus, the DICE model suggests that the UN Paris target of 2°C is too expensive relative to the benefits of limiting warming, and instead the world should aim for 3.5°C,” said Bressler. 

“However, once I go through the exercise of updating the temperature-related mortality impacts to the latest science, while keeping all other parts of the DICE model the same, the optimal climate policy now involves large immediate emissions reductions and full decarbonization by 2050, resulting in 2.4°C warming by 2100,” Bressler added.

Pursuing a more stringent climate policy that includes full decarbonization and keeps temperature rise to 2.4°C, would save 74 million lives over the course of the 21st century, the paper concludes – and that is in terms of temperature-related excess deaths alone. Such deaths would fall from 83 million to 9 million if temperature rise is kept in check.

The research comes ahead of the next major climate conference – scheduled to take place in November in Glasgow – which will be a pivotal moment in the fight against climate change.

Mortality from climate change is in fact occurring as a result of a much wider range of factors than temperature alone. These include food insecurity, increased infectious diseases, air and water pollution, and deforestation, as well as deaths from extreme weather events. Such l health impacts have been assessed by the World Health Organization and other global bodies.

But those estimates rarely find their way into the kinds of mainstream models being used for climate policy decisions at national or global level – leaving large and critical human health impacts of policy choices as “outliers” in key climate decisions – even though it is people, first and foremost, who are impacted by climate change.  

“Although substantial advances in climate impact research have been made in recent years, IAMs are still omitting a significant portion of likely damages (13,14)” the paper states.

“Another major line of criticism is that a wide variety of climate damages—sea level rise, extreme weather, the direct effects of heat on productivity, agricultural impacts, and many more—must be monetized and summarized into a single number, and the relative contribution of these damages is often unclear (11,13,15).”

The Mortality Cost of Carbon (MCC) metric – does just that, connecting the dots between the broad climate and human health impacts.   

Real health impacts are still under-assessed  

Even so, the assessment remains limited to just assessing the impact of climate change on temperature-related mortality: the net effect of more hot days and fewer cold days. Many studies have shown that greater exposure to heat increases mortality through pathways such as dehydration, heart attack and stroke. The higher mortality from heat is expected to outpace the lower mortality from cold in most parts of the world.

As a result, the projections made are likely underestimates of total climate change mortality, due to the numerous other negative environmental impacts and secondary effects on health, livelihood, and wellbeing, Bressler notes. 

“Because I only project temperature-related mortality, you’d probably expect the mortality projections from the study to go up if we were able to capture other mortality pathways in the model,” said Bressler. 

“Climate change is likely to increase future mortality rates through a number of channels including the direct effects of ambient heat, interactions between higher temperatures and surface ozone formation, changes in disease patterns, flooding, and the effects on food supply,” said the study.

Climate change could rank sixth on Global Burden of Disease Risk Factors   

The model builds out projections for two heating scenarios – a baseline scenario in which the average temperature rise is 4.1°C by the end of the century, and the optimal DICE-EMR scenario in which temperatures would only rise by 2.4°C. 

The projected cumulative number of excess deaths from climate change in the DICE baseline scenario and the DICE-EMR optimal scenario.

In the case of 4.1°C, excess deaths would cumulatively reach 83 million, compared to nine million deaths associated with a temperature rise of 2.4°C.

“In total, we find that there are 83 million projected cumulative excess deaths between 2020 and 2100,” said the study, based on the baseline scenario. 

The business-as-usual scenario would leave climate change to rank sixth in terms of global burden of disease risk factors – even ahead of air pollution. 

“By the end of the century, the projected 4.6 million excess yearly deaths would put climate change 6th on the 2017 Global Burden of Disease risk factor list, ahead of outdoor air pollution (3.4 million yearly excess deaths) and just below obesity (4.7 million yearly excess deaths),” said the study. 

Mitigation costs and benefits compared from the health angle 

Based on those aggregate projections, the paper quantifies reductions in excess mortality that could be obtained by reducing one million metric tons (Mt) of carbon emissions per year.  

That is equivalent to the average annual emissions of 35 commercial airliners, 216,000 passenger vehicles, or 115,000 homes in the US. 

Each one Mt increase in CO2 emissions over 2020 levels is estimated to cause 226 deaths globally by the end of the 21st century – a decrease will save the same number of lives. 

The number of excess deaths from a marginal increase in temperatures is initially relatively modest but increases substantially with increasing temperatures.

Based on the model and its estimates, policy makers can then calculate the lives saved by climate mitigation measures – in terms of extreme heat exposures.  

For instance, replacing a coal-fired power plant with a zero-emissions alternative for one year could save 904 lives over the course of a century, the study projects.

Big disparities in deaths caused by emissions from rich and poor countries 

The study also points to the huge disparities between the huge carbon emissions of high-income and those in low-income countries. The lifetime emissions of 3.5 Americans – 4,434 metric tons of carbon dioxide – added to 2020 levels will lead to one excess temperature-related death by 2100.

It calculates that while the lifetime emissions of 3.5 Americans will result in one death, it would take 146.2 Nigerians to cause a single death. Globally, the lifetime emission levels of 12 people cause one death. 

 

The excess deaths per average citizen’s lifetime emissions, calculated as 2017 carbon dioxide emissions production per capita multiplied by 2017 life expectancy at birth.

“[These findings] could well have a significant impact on climate change policies,” Richard L. Revesz, Professor at New York University School of Law and one of the US’ leading experts on environmental law and policy, told the New York Times. 

The rise in global temperature could be tempered by aggressive climate policies

The study predicts that global temperatures will rise by 4.1°C above pre-industrial temperatures by the turn of the century if trends in emissions continue on the current trajectory. This will cause the mortality rate to increase by 3.8%.

Mortality rises at an increasing rate as the global temperature escalates.  

“When global average temperatures exceed 2°C, the first derivative is quite steep and increasingly so as the world continues to warm,” said the study. “This gives societies a strong incentive to avoid scenarios where global average temperatures are especially damaging.”

According to Bressler, the study’s model can be used to assess the effects of policy changes, such as the pursuit of different emissions targets, on mortality. 

If the world undertakes far-reaching efforts to reduce emissions, the rate of global warming could be slowed, found the study.

The study compared the baseline scenario with the initial DICE model – consisting of an emissions plateau and then gradual reductions starting in 2050 – and the revised DICE-EMR model – involving large emissions reductions and full decarbonization by 2050.

The first is projected to result in 3.5°C warming by 2100, while the second would result in 2.4°C warming by 2100. 

Integrated assessment models (IAMs) assess the cost of reducing emissions and the damages from climate change. They can be used normatively to determine optimal climate policy.

“Optimal climate policy changes from gradual emissions reductions starting in 2050 to full decarbonization by 2050 when mortality is considered,” said the study. 

“My model shows that a significant number of lives can be saved from pursuing a more aggressive global climate policy,” said Bressler. 

“If the world undertakes the optimal emissions path in DICE-EMR and restrains global average temperatures to 2.4°C, we largely avoid the temperatures where marginal increases in temperature resulting from a marginal emission today are most damaging,” said the study.

Image Credits: Oxfam East Africa, World Meteorological Organizations, Nature Communications.

Innovation in COVID-19 treatments needs to be shared equitably.

Much more global attention needs to be paid to developing early therapeutics to protect patients with COVID-19 from “hospitalisation, intensive care, or worse”, according to a report from Drugs for Neglected Diseases initiative (DNDi) released on Thursday.

In addition, the few innovative treatments that exist are mostly available in high-income countries, and DNDi warns that the world risks “replicating the vaccine inequality that has become a defining characteristic of this global pandemic” 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, according to the 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.”

Change the governance of ACT-Accelerator

Describing the development vaccines as a success for science, but their rollout as a failure for access, the report proposes three main solutions to ensure that the COVID-19 “vaccine apartheid” is not replicated with therapeutics. 

The first is support for open drug discovery and development of “novel antivirals, host-targeted interventions, and repurposed compounds, as well as for robust testing of these options in comparable adaptive platform trials”.

Second, DNDi recommends that the governance structure of the Access to COVID-19 Tools Accelerator (ACT-A) be changed to provide for equal representation from LMICs. 

ACT-A houses the global vaccine platform, COVAX, which has recently faced criticism from African leaders for having a “charity” mindset rather than seeing LMIC as partners. ACT-A was set up by the World Health Organization (WHO) and others to ensure global access to vaccines, but it has been undermined by pharmaceutical companies selling their vaccines to wealthy countries first.

The report also urges ACT-A to address all intellectual property (IP) barriers and “improve transparency with respect to development, production, and supply of COVID-19 medicines, diagnostics, and vaccines”.

The third solution proposed by the DNDi report rests on securing “specific contractual commitments and enabling policies, such as a temporary waiver on IP”, to ensure equitable access to new and existing COVID-19 therapeutics. 

COVID could become endemic to Africa

“Great strides have been made in the development of new tools for COVID-19, especially vaccines, but the past year has made it painfully clear that access is the unfinished business of global health,” said Dr Bernard Pécoul, Executive Director of DNDi, the International non-profit organisation dedicated to developing safe, effective, and affordable treatments for the most neglected patients.

“We now have the opportunity to course correct with treatments and make the response to COVID-19 a model for equity, collaboration, and knowledge- sharing.”

Dr John Nkengasong, Executive Director of Africa Centre for Disease Control (CDC), recently warned that COVID-19 may become endemic to Africa unless the continent’s lack of vaccines was addressed.

“If we have a predictable supply of vaccines, we can break the backbone of this pandemic by the end of next year,” Nkengasong told a recent media briefing. “But if vaccines are not available to enable us to vaccinate at speed and at scale then, past next year we’ll be moving towards the endemicity of this virus on our continent and the consequences will be catastrophic.

“Our economy will continue to be damaged, the death rate will continue to increase. We will see the fourth, fifth, sixth waves, and it will be extremely difficult for us to survive as a people.”

Image Credits: DNDi.

Eleven African countries will this weekend start receiving their portion of the first batch of 400 million COVID-19 vaccines from Johnson and Johnson (J&J), the Africa CDC announced on Thursday.

Recipients include Togo, Lesotho, Ghana, Tunisia, Angola, Cameroon, Egypt, Botswana, Nigeria, Ethiopia and Mauritius, and they are part of pool purchasing facilitated by the African Union (AU) and African Vaccine Acquisition Trust (AVAT) to AU member states. Six Carribean communities including Jamaica, Barbados, Guyana, St Kitts & Nevis, Trinidad &Tobago and the Bahamas will also have doses delivered next week.

The delivery of the lifesaving drug comes as 32 of the continent’s 55 countries are battling a third wave of COVID-19 infections, 25 of which are experiencing a “severe third wave”.

However, the target of vaccinating 60% of Africa’s population by the end of 2022 might not be enough to protect the continent, Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC), said during the centre’s weekly COVID-19 briefing.

Africa will now need to vaccinate 75% to 80% of people, taking into consideration several factors, including the different virus variants and the continent’s population structure, according to Nkengasong. The initial target of 60% was partly based on the assumption that 40% of the population was 18 and under and that they would not need to be vaccinated as they will “immediately come down with a disease.”

“We now know that anybody is vulnerable now… those young people are falling sick and they are dying and that needs to be factored into a new projection,” said Nkengasong. However, he said that the continent will in the meantime aim for the 60% target after which a possible adjustment will be made based on “the biology and the pathogenesis of the variants”.

Major vaccine announcement expected in the coming days

Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT)

Giving a breakdown of the vaccine deliveries, Strive Masiyiwa, the African Union’s (AU) Special Envoy on COVID-19 and the co-ordinator of the AU Vaccine Acquisition Task Team (AVATT), said that the J&J vaccine had been chosen because it is a single-dose vaccine, partly manufactured in South Africa, has a long shelf-life and it was the only vaccine available in large volumes.

This month, more than six million doses will be shipped to countries that have fulfilled all the AVAT requirements, including loan agreements with the World Bank and other global lenders. The deliveries will increase exponentially over the following months, with 10 million doses to be delivered from September until December. From January 2022, J&J has undertaken to deliver 25 million doses per month until the order is completed in September 2022.

A $2 billion loan facility provided by African Export-Import Bank (Afreximbank), which is the guarantor of the deal, has enabled African countries to purchase the J&J vaccines.

Said Nkengasong in a statement released on the rollout of the vaccines: “During the last months, we have seen the vaccination gap between Africa and other parts of the world widen, and a devastating third wave hit our continent. The deliveries starting now will help us get to the vaccination levels necessary to protect African lives and livelihoods.”

Masiyiwa said other vaccines will come from global vaccine facility COVAX, and bilateral donations from countries including the United States. He let slip that other donor governments have stepped up and that a “very good announcement” from a “major government” will be made in the next few days.

COVAX needs to improve its operation and be held accountable for its failures

COVAX
COVAX vaccine deliveries in Africa.

In the past week, Africa has recorded 273,000 new COVID-19 infections – a 14% average increase of new cases. Recorded deaths stood at 6,454, a slight decrease of 4%. As of 2 August, a total of 103 million vaccine doses have been procured in 53 member states of which 70.6 million have already been administered.

However, Nkengasong said only 1.58% of Africa’s population have been fully vaccinated with two doses.
Masiyiwa said that the continent would have had greater vaccination numbers if COVAX had honored its promises. “They (COVAX) told us in December they would have delivered 700 million doses, being 27% of our population [by August],” said Masiyiwa.

According to Masiyiwa, Africa was then going to pick up vaccine deliveries from August 2021 to September 2022.
This did however not happen, and around 79 million doses have been delivered to Africa so far by COVAX.
“And this is where the crisis is for us. This has not happened. We can all debate about how, where, who did what, how many committees, how many task forces, how many accelerators, you can create all those things, but this is where the rubber hits the road,” said Masiyiwa.

Asked whether the AU would call for the disbandment of the COVAX facility, Masiyiwa said they are seeking an improvement of “the way things are done” and for accountability from the facility.

Africa CDC agrees with WHO’s call for a moratorium on booster shots

Africa CDC director Dr John Nkengasong

Nkengasong, who got vaccinated in April and who is currently recovering from a COVID infection, said the organization supported the WHO’s call for a moratorium on a third booster vaccine shot until at least the end of September to ensure that vaccines reach those who need them most.

His stance is “vaccinate as many people as possible with the available vaccines”, before looking into booster shots. “We run the risk of creating more variants, maybe because we continue to accept sub-optimal pressure on the virus and it will mutate and then even continue to infect those who have received their vaccinations,” said Nkengasong.

“I’m a good example. I received a full dose of the vaccine in April, and look, I have a breakthrough infection. So again, the only way to stop this pandemic is to vaccinate many people…,” said Nkengasong.

Image Credits: WHO AFRICA, UNICEF/Khaled Akasha, UNICEF.

Raisa’s mother, Maria Isabelle Santos, (second from the right) at a nurses appreciation week in 2020.

#COVIDReporting: For the past 18 months, Health Policy Watch global reporters have covered the COVID-19 pandemic. But they have not been immune from its impacts on their personal lives – and the virus has wreaked havoc with their lives. Over the next few weeks, we will bring you their stories.

NEW YORK – I turned 24 a few weeks before New York City was shut down. 

I turned 25 a few weeks after the first vaccines were being rolled out. 

They say that your twenties are the most important, the most fun part of your life. When New York was hit by the first wave of the pandemic and was forced to lockdown, a year of my life was put on pause. 

Acceptance dinners for grad school, traveling with my friends, all on hold. 

I cannot say that it’s resumed in the exact way since then. There’s a hyper-awareness in all of us that things cannot be ‘back to normal’, despite what everyone likes to believe.

My parents, both nurses, were directly on the front lines of the pandemic. They were exposed to the constant suffering and death in their respective hospitals and departments, without any reprieve.  

My grandma was the most social person pre-COVID-19, with birthday parties and events numbering almost a hundred per gathering. Now my family and I fret over her constantly, worrying if it’s even okay for her to be in crowded spaces or go back to hosting parties.

And I’ve become hyper-aware that it has become increasingly unsafe to walk through the city that has been my home since I was born. 

I don’t just carry my mask with me when I walk through the boroughs. I have to carry pepper spray, and a perpetual apprehension that sets throughout my body, that I may be attacked because of my race.

Asian American attacks have increased by nearly 150% over the course of the pandemic. It’s disconcerting to cover news globally, and yet be exposed to a flood of articles on attacks and shootings, one right after another, that take place in my own city.

And some articles don’t even match the face to the name, reporting our deaths and our hurt without any empathy. 

How can America go back to normal after all of this, patting itself on the back and assuring the public that it’s safe now for everyone?

It wasn’t that our ‘normal’ was stalled when the pandemic hit. COVID-19 changed our sense of normalcy. We’re not given time to process the past year. We’re just cogs in a machine, working constantly from home or in the hospital, expected to push ourselves right up on our feet the moment the tiniest resemblance of the old life, pre-COVID, slips in. 

I’ve reported a lot on hidden pandemics, because COVID-19 uncovered many. But the hidden pandemic of mental health is a neglected one that shouldn’t be swept under the rug any longer. 

If only America realized that we need our time to grieve, especially when the truth is, the pandemic is far from ending.

It’s worsened by the fact that American exceptionalism knows no bounds. Reporting on COVID-19 from the global perspective for the past year has made me all-too aware that this exceptionalism extends to vaccinations and social distancing and what even is happening in other countries. 

Do anti-vaxxers who refused COVID vaccines know that the rest of the world is suffering? That my relatives in the Philippines have to travel here to get vaccinated, that thousands of people come here to get their shots when their own countries don’t have as many vaccines? Americans believe in their right to refuse something they label a preposterous conspiracy. The rest of the world doesn’t have that luxury. 

Most privileged Americans live in a bubble of selfishness, rushing to get back to their version of normal. But it isn’t that easy. 

Raisa Santos, who reports from New York City.

Raisa is pursuing her Masters in Public Health at the Columbia Mailman School of Public Health. As a daughter of Filipino immigrants, she has a special interest in immigrant health and international policy. In her free time, she reads and blogs about books, and enjoys writing fiction. 

 

This is part of our #COVIDReporting series:

See also: COVID in Delhi: ‘I was More Afraid of Suffocating Than of Dying’

An unprecedented surge in climate-related disasters, including wildfires and flooding, has been recorded since 2019. 

A new study, conducted by an international group of scientists, found that key indicators of the state of the climate crisis were reaching critical tipping points. 

The study, published in the journal BioScience, measured some 31 planetary vital signs, ranging from coal, oil, and gas consumption to carbon dioxide emissions to ocean acidity to fossil fuel subsidies. 

The researchers compiled a set of global time series related to human actions that affect the environment and climatic responses, which include sea level change and surface temperature change. 

Out of the 31 planetary vital signs tracked, 18 were at new all-time record lows or highs. 

“There is growing evidence we are getting close to or have already gone beyond tipping points associated with important parts of the Earth system,” said Dr William Ripple, Professor of Ecology at Oregon State University and co-author of the study, in a statement.

In the past two years, there has been an unprecedented surge in climate-related disasters, with extreme flooding in South America, Southeast Asia, and Europe, record-breaking heatwaves and wildfires in Australia and western US, and devastating cyclones in Africa, South Asia, and the Western Pacific.

According to the study’s authors, governments have consistently failed to address the “overexploitation of the Earth,” which is the root cause of the current crisis.

Trends in potential drivers of climate change

Carbon dioxide, methane, and nitrous oxide all set new year-to-date records for atmospheric concentrations in 2020 and 2021. In April 2021, carbon dioxide concentrations reached 416 parts per million, the highest monthly global average concentration ever recorded. 

In addition, the year 2020 was the second hottest year on record. The top five warmest years have all occurred since 2015. 

The study also found that glacier thickness set a new all-time low in 2020 and minimum Arctic sea ice was at its second smallest extent on record. Glaciers are currently losing 31% more snow and ice per year compared to 15 years ago. 

Time series of climate-related responses, which include sea level change and surface temperature change.

Ocean pH reached its second-lowest yearly average value on record, threatening marine life with increased acidification. The ocean absorbs approximately 30% of the carbon dioxide that is released in the atmosphere, which has far-reaching impacts on aquatic ecosystems, human health, and food systems. Billions of people worldwide rely on food from the ocean as their primary source of protein.

Another concerning pattern noted was that the annual forest loss rate for the Brazilian Amazon reached a 12-year high of 1.11 million hectares destroyed in 2021.

Among the numerous worrying trends, there were a few bright spots in the study’s findings.

Fossil fuel energy consumption has decreased since 2019, along with carbon dioxide emissions, and air transport, likely due to the COVID-19 pandemic. Although projections for 2021 estimate that these measures will rise again.

Solar and wind power consumption increased by 57% between 2018 and 2021.

Fossil fuel divestment increased by US$6.5 trillion between 2018 and 2020, while fossil fuel subsidies dropped to a record low of US$181 billion in 2020.

Time series of climate-related global human activities, which include fertility rate and fossil fuel subsidies.

Calls for ‘transformational system changes’

“The updated planetary vital signs we present largely reflect the consequences of unrelenting business as usual,” said Ripple. “A major lesson from COVID-19 is that even colossally decreased transportation and consumption are not nearly enough and that, instead, transformational system changes are required.”

Priorities at the national and international level must focus on enacting immediate and drastic reductions in greenhouse gas emissions, particularly methane. Methane is emitted during the production and transport of coal, natural gas, and oil and it results from livestock and agricultural practices. 

The authors call for changes in six areas:

  • eliminating fossil fuels and shifting to renewable energy sources;
  • cutting black carbon, methane, and hydrofluorocarbons;
  • restoring and protecting the Earth’s ecosystems to restore biodiversity;
  • switching to mostly plant-based diets, reducing food waste, and improving cropping practices;
  • moving from overconsumption to ecological economics and a circular economy; and
  • stabilising population growth by providing voluntary family planning and supporting education and rights for women and girls

“By halting the unsustainable exploitation of natural habitats, we can simultaneously reduce zoonotic disease transmission risks, conserve biodiversity, and protect carbon stocks,” said the study. “So long as humanity’s pressure on the Earth system continues, attempted remedies can only redistribute this pressure.”

“Given the impacts we are seeing at roughly 1.25°C warming, combined with the many reinforcing feedback loops and potential tipping points, massive-scale climate action is urgently needed,” said the study. 

The world may have already lost the opportunity to limit warming to 1.5°C, a goal set out in the Paris Agreement, said the authors.

In the context of the major upcoming climate conference – the 26th UN Climate Change Conference of the Parties (COP26) – the authors recommend a three-pronged approach at the international level.

First, the world needs the global implementation of a significant carbon price, secondly, there needs to be a global phase-out and eventual permanent ban of fossil fuels, and the third intervention is the development of climate reserves to protect and restore natural carbon sinks and biodiversity, said the authors. 

“Implementing these three policies soon will help ensure the long-term sustainability of human civilization and give future generations the opportunity to thrive,” said the study. The study was a follow-up to one published in 2020, which nearly 14,000 scientists have signed across 153 countries, calling for urgent action to tackle the climate emergency.

Image Credits: UNDP, BioScience.

Palestinian medics attend to a young man injured during clashes with Israeli security forces in Jerusalem on 10 May

More than 700 healthcare workers and patients have died, and more than 2000 have been injured in attacks on health facilities across 17 emergency-affected countries and fragile settings since December 2017, according to a new WHO report released on Tuesday. 

Countries at risk included Ethiopia, Yemen, Syria, Mozambique, Nigeria, occupied Palestinian territory, Myanmar and the Central African Republic. 

“We are deeply concerned that hundreds of health facilities have been destroyed or closed, health workers killed and injured, and millions of people denied the healthcare they deserve,” said Altaf Musani, WHO Director of the Health Emergencies Interventions, in a Tuesday briefing on the report. 

This three-year analysis is based on data from the WHO’s Surveillance System for Attacks on Healthcare (SSA), which monitors attacks on healthcare workers, patients, facilities, and healthcare transport, the resources that they affected and their immediate impact on health workers and patients. 

The Surveillance System for Attacks on Health Care recorded data across 17 emergency-affected countries and fragile settings.

One out of six incidents leading to loss of life for health worker or patient in 2020 

The surveillance reported a record-high 1029 attacks on health care in 2019, with the number of reported attacks during the first quarter of 2020. 

But despite fewer reports of incidents in 2020, these incidents were associated with a higher proportion of deaths than in previous years, with the proportion of attacks on health care resulting in at least one loss of life reaching 17% (one in six incidents resulting in deaths).

This year, there have been 603 attacks on healthcare workers in 14 countries with emergencies, resulting in 115 deaths and 281 injuries of healthcare workers and patients. 

Overall, health personnel is the most frequently affected health resource. In 2018 and 2019, attacks on health care impacted health personnel in about two thirds of reported incidents. In 2020, reported attacks affecting health personnel were less frequent than in previous years, while attacks affecting health facilities became more frequent.

‘Ripple effect’ on health workers and health system

The changes in fragile, conflict-affected, and vulnerable (FCV) settings were related to different contexts.For example, attacks in the Deomocratic Republic of the Congo’s (DRC) were related to the country’s second largest Ebola outbreaks in 2018 and 2020. Meanwhile, the 2018-2019 demonstrations in the occupied Palestinian territories’ (oPt) Gaza Strip accounted for two thirds of all reported attacks in 2019. 

Following these crises, reports on attacks on health care became markedly less prevalent. 

The impact of these attacks “reverberates on health workers’ mental health and willingness to report to work, on the communities’ willingness to seek healthcare and also drastically reduces resources for responding to health crises, among others,” noted Musani. 

The “ripple effect of a single incident is huge”, he said, and has “long-term consequences for the health system as whole.”

While the tireless work of health care workers has been championed during the pandemic, these workers have been, for the most part, largely absent from the mental health discourse.

The analysis has shown that healthcare workers are the most affected resource, with over two-thirds of attacks in 2018 and 2019 and over half in 2020 affecting health personnel, rather than facilities or supplies.  

This “worrying data”, says Musani, “goes well beyond claiming lives.”  

COVID-19 shifted pattern of health facility attacks 

The COVID-19 pandemic has further compounded the challenges faced in these FCV settings, causing a shift in patterns of violence. 

Attacks affecting health facilities, transport, and patients have become more frequent after the onset of the COVID-19 crisis.

This has brought unprecedented attention to the acts of violence health response is exposed to, with the report emphasizing that “changes in patterns of attacks on health care are to be expected whenever a major event or crisis of any kind occurs.” 

WHO calls on relevant parties in conflicts to “ensure the establishment of safe working space for the delivery of healthcare services, and equitable, safe access to healthcare, free from violence, threat or fear.”

“During the COVID-19 pandemic, more than ever, health care workers must be protected and respected, and hospitals and health facilities and transportation, including ambulances, should not be used for military purposes – essential conditions for the continued delivery of critical health services,” said Musani. 

 

Image Credits: www.laprensalatina.com, WHO.

Director-General Dr Tedros Adhanom Gheybreysus

The World Health Organization (WHO) has called for a moratorium on COVID-19 vaccine boosters until at least the end of September to enable a minimum of 10% of the population of every country to be vaccinated.

Making the appeal at the WHO’s COVID-19 media briefing on Wednesday, Director-General Dr Tedros Adhanom Gheybreysus said support for the moratorium from the G20 countries was vital as they are “the biggest producers, the biggest consumers and the biggest donors of COVID-19 vaccines”.

Israel started to offer third booster shots to people over the age of 60 this week, while Germany and the UK intend to do so soon. Bahrain, the United Arab Emirates and Thailand already offer boosters to fully vaccinated people.

“It’s no understatement to say that the course of the pandemic depends on the leadership of the G20 countries,” said Tedros, as he called on these countries to “make concrete commitments to support WHO’s global vaccination targets”.

Tedros called on “everyone with influence – Olympic athletes, investors, business leaders, faith leaders, and every individual in their own family and community – to support our call for a moratorium on booster shots until at least the end of September”.

https://twitter.com/NCEMAUAE/status/1422588310388723718

Not enough evidence for boosters

WHO special adviser Dr Bruce Aylward described the moratorium as a call for “global solidarity around the goal of catching up with the rest of the world” with immunisation.

“The entire world is in the middle of this pandemic and, as we have seen from the emergence of variant after variant, we cannot get out of it unless the whole world gets out of it together,” added Aylward. “With the huge disparity in vaccination coverage, we’re simply not going to be able to achieve that. By now going into third, fourth doses or whatever in areas that already have high coverage, we just will not be able to catch up.”

However, Aylward said organ transplant recipients were an “exceptional case” and boosters could be considered to be part of their “primary series’ vaccinations as their level of immunity was still low after two doses.

Meanwhile, Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals, said that while a few countries had started to administer boosters, a number of others were contemplating this – despite the lack of evidence to support boosters.

“We don’t have a full set of evidence around whether this is needed or not,” said O’Brien.

“We need instead to focus on those people who are most vulnerable, most at risk of severe disease and death to get their first and second doses, and then we can move on to how to advance programmes as the evidence gets stronger, and as supply is assured and we have much higher coverage for those first doses in much greater percentages of populations in every country around the world.”

A number of trials are underway at present to test boosters, including Pfizer vaccines that have been tweaked to address the Delta variant.

Health Policy Watch has produced a three-part series on vaccine boosters looking at the global country positions on boosters, boosters in immuno-compromised people and the need for field-based evidence to balance laboratory evidence.

Dr Mariangelo Simao, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals

Pfizer, Moderna price increases are in response to ‘demand not costs’

Commenting on the news that both Pfizer and Moderna had increased their COVID-19 vaccine prices, Dr Mariangelo Simao, WHO’s Assistant Director-General for Access to Medicines and Vaccines, said this appeared to be demand-driven rather than related to production costs.

“Both manufacturers, Pfizer and Moderna have increased their manufacturing capacities. They have diversified manufacturing plants, and we understand that they have also increased efficiency in the production lines,” said Simao.

“This would, in a normal market situation, lead to a decrease in price not an increase in price. So what we have is clearly a market where the demand is very high in comparison with the production,” added Simao.

“The WHO urges companies to keep prices down. There are many countries around the world that cannot afford any higher price. It’s urgent that we think about this in terms of affordable pricing in times where there is increased manufacturing from those two mRNA, producers, and more efficient production lines as well.”

Over the weekend, the Financial Times reported that Pfizer had increased its price per shot from around $18.50 to $23, while Moderna doses had increased from around $22.60 to $25.50.