Football star Didier Drogba and WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

Football star Didier Drogba aims to use his new position as the World Health Organization’s (WHO) Goodwill Ambassador for Sport and Health to promote healthy lifestyles, especially to young people.

“Many people do not have access to health services and non-communicable diseases such as heart disease, stroke, diabetes are rising globally,” the former Chelsea striker and Cote d’Ivoire captain told a media briefing in Geneva on Monday.

“Furthermore, the world faces grave, complex and evolving challenges in addressing poverty alleviation, climate change, and tackling COVID-19 recovery efforts,” said Drogba.

“In this role as WHO Goodwill Ambassador, I am determined to work in partnership with WHO, FIFA, civil society, the youth, the private sector, and other sector stakeholders to reach out to as many football fans as possible, using sport as a powerful educational and fun field to promote messages on the benefits of physical activity and other healthy lifestyles, and highlight the value of sports, particularly for youth.”

Previously, Drogba was a United Nations Development Programme Goodwill Ambassador, focusing on development issues in Africa between 2007 and April 2021, and has also taken part in various campaigns relating to healthy lifestyles, anti-malaria and HIV.

“Didier is a proven champion and game-changer both on and off the pitch,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

“We are pleased to have him playing on our team, and helping communities worldwide reach and score goals through sports for their physical and mental health and well-being. He will also support the mobilization of the international community to promote sports as an essential means for improving the physical, mental health and social well-being of all people, including in helping COVID-19 recovery efforts.”

Current global estimates show 80% of adolescents and a quarter of all adults, do not do enough physical activity. Regular physical activity, including through sports, helps lower blood pressure and reduce the risk of hypertension, coronary heart disease, stroke, diabetes, and various types of cancer.

Drogba’s announcement as a WHO Goodwill Ambassador was made during a ceremony to launch the “Healthy 2022 World Cup – Creating Legacy for Sport and Health” partnership between Qatar’s Ministry of Public Health and its Supreme Committee for Delivery and Legacy, WHO and world football’s governing body, FIFA.

Qatari Health Minister Dr Hanan Al Kuwari

 

Africa, Ghana
Accra, Ghana health worker displays used vial of COVID-19 vaccine in March 2021, at start of the African rollout of vaccines by the COVAX global facility first began. Distribution stalled only a month later as COVAX suppliers dried up.

Despite what some observes called an encouraging “change of tone”, this week’s round of World Trade Organization (WTO) debates over a proposed waiver on IP restrictions for COVID vaccines, treatments and other health products have concluded with no signs of substantive progress. 

Meanwhile, Médecins Sans Frontières lashed out again at the European Union on Friday, for what it described as “another misleading attempt” to undermine the waiver proposal – by focusing only on a narrow band of technical fixes to the current set of global agreements around IP.  

The waiver initiative has mustered strong support from over 100 low- and middle-income countries (LMICs) that see it as a way to jump-start more local medicines and vaccines production in countries that have only managed to immunise a small fraction of their population against SARS CoV2 – as compared to the 50%-70% coverage seen in rich nations.

It is just as sharply opposed by an EU-led bloc of high-income countries that maintain there are more powerful factors driving vaccine scarcity – including a sheer dearth of technical capacity in LMICs to quickly establish vetted vaccine manufacturing facilities.  

The WTO TRIPS Council, which manages the set of WTO agreements on the Trade-Related Aspecs of Intellectual Propery (TRIPS) now has just six weeks now to reach an agreement on the charged IP issue ahead of the WTO’s climactic 12th Ministerial Council (MC12) meeting that begins 30 November. 

Said one Geneva-based trade official observing this week’s rounds of negotiations: “Despite the change of language and tone shown by the delegations, … members’ positions on substance do not deviate dramatically from what he heard in previous TRIPS Council meetings. 

MSF says EU proposal for limited waiver, side-steps ‘trade secret’ barriers to LMIC production  

Germany has been one of the main opponents of the WTO IP waiver. Portrayed here, Health Minister Jens Spahn at WHO briefing in Geneva in July.

The latest EU proposal, leaked to the Huffington Post, remains focused only on a very limited waiver of some of the technical restrictions that currently limit countries’ ability to issue so-called “compulsory licenses” for the generic production of patented health products. In fact the EU position has changed little since its last formal proposal in June, which MSF described then as “weak and distracting’’.  

The EU arguments, spelled out in another document, reportedly leaked from the EU’s Directorate General of Trade (DG Trade), thus fail to address other critical IP areas that constrain access, such as “regulatory data and trade secrets”, MSF said. 

A broader waiver, mandating the release of such proprietary technologies, is needed “particularly in view of originator companies refusing to share their technologies,” asserted MSF in its briefing published on Friday. 

”As per MSF analysis, the new leaked EU document again focuses only on compulsory licensing on patents…” said the MSF statement. 

“It focuses on products, but completely excludes mention of underlying technologies, components, raw materials, process and methods that are also protected under intellectual property (IP) and are equally important to initiate production by other companies. The document would still require each country to individually file and apply compulsory licenses on each component, product, etc. making required international collaboration difficult and exposing governments to the risk of being sued by IP-holding companies

India describes EU proposals as “redundant”

Speaking at the closed TRIPS Council meetings on Wednesday and Thursday, India also stressed that EU proposals for relaxing the restrictions around countries’ right to issue “compulsory licenses” for patented products are anyway “redundant” because the “requirement to negotiate with the right holder of the vaccine patent does not apply in urgent situations such as a pandemic,” in any case. 

The EU retorted that its proposals are intended to provide more “legal certainty” about steps that can be taken in the context of the pandemic. “

The EU also cited “many points of convergence” on the more technical reforms that it has proposed to simplify existing compulsory license rules and restrictions, with respect to obligations vis a vis: notification, marking, labelling, remuneration, the coverage of multiple countries in one single compulsory license notification, and the issuance of a single compulsory license for multiple patents. 

One EU official was quoted as saying that it was: “difficult to understand how, on the one hand, some members underline problems with the use of the compulsory licensing because it is too cumbersome.  

“And on the other hand, whenever the EU tries to have a discussion about how to address these issues it is told that it is only repeating or reiterating what is already absolutely clear. 

“It is either one or the other, either everything is absolutely clear and can be used, or there are some issues that we can work on,” the EU official was reported as saying.

Access groups say high income countries failed to deliver 

Vaccine-sharing commitments by rich countries have not been fulfilled, leading to massive frustration.

The dispute over the IP waiver also has become a lighting rod for  the wider controversy around how high-income countries have failed to deliver on vaccines and medicines access to less affluent nations, observers say.  

After the massive buy-up of vaccines in late 2020 and early 2021 by a group of high and middle-income countries, the WHO Co-sponsored COVAX global vaccine facility was forced to rely almost exclusively on vaccines procured from the Serum Institute of India, for its massive vaccine distribution plan to LMICs.  Those supplies dried up in April, when India faced its own COVID crisis. 

Developed countries have since failed to deliver on big commitments made since to share their own excess doses – despite the risks that rich countries’ vaccine hoarding will simply lead to the wastage of hundreds of millions of doses by the end of this year.  

The net result has been that currently, less than 3% of Africans have been fully vaccinated – making it unlikely that Africa will reach the 40% global goal set by WHO for  vaccine coverage by the end of this year. 

And while pharma manufacturers, notably Moderna and Pfizer, have both announced new initiatives to manufacture more vaccine products in Africa – they remain only in initial stages of development – with actual production by Pfizer of 100 million doses in South Africa scheduled to start only next year – and Moderna’s more ambitious plan, even later. 

US administration – growing frustrations 

Greenpeace activists project messages outside Geneva’s WTO building in June, calling for approval an  IP waiver on COVID-19 health products.

Amidst the fraught European-LMIC dispute over the trade waiver, the US has still remained on the fence – saying earlier this year that it would support a waiver on vaccines – but not making concrete moves yet in the WTO council to advance that position. 

However, in domestic fora, the US Administration of Joe Biden has hinted at the possibility that it could invoke the US Defense Production Act to provoke pharma companies to produce more doses, more rapidly – pointing the finger at Moderna in particular. 

“The government played a very substantial role in making it that company, and that does up the ante on Moderna,” Biden’s Chief Science Officer, David Kessler said on Wednesday, referring to the US$ 10 billion invested in the company  for its mRNA vaccine development. 

“They understand what we expect to happen. This government hasn’t made a decision yet on what it will do. But we are waiting.”

Kessler was speaking at an online session, moderated by Yale law professor Amy Amy Kapczynski. 

According to a recent New York times investigation, only about 1 milion Moderna mRNA doses have reached low-income countries, as compared to 8.4 million for Pfizer’s vaccine – even though Moderna’s formulation is more temperature stable and thus more suited for LMIC conditions. 

Moderna’s slow expansion is viewed as particularly problematic in light of the fact that it is a clear vaccine front-runner – viewed as equal to, or possibly even better, than the Pfizer vaccine in terms of longevity of the protection that it offers to the SARS-CoV2 virus. 

Kessel linked Moderan’s slow expansion to the fact that its proprietory mRNA technology secrets are an asset that “they are reluctant to give up.”  

Even so, “there is a way to build, with Moderna and Lonza, significant capacity on continents like Africa and we expect them to do so,” he said. 

TRIPS Council members reconvening 26 October in small group sessions 

There remains however, “some reason for optimism”, insofar as members are “engaging with each other bilaterally”, the official added.   

After an inconclusive end to this week’s meetings, TRIPS Council members are set to resume a series of small group consultations on 26 October, in an effort to break the impasse.  The aim is to reconvene the TRIPS Council once again to sign off on a hoped-for agreement in time for the next WTO General Council meeting 22-23 November, and from there, an agreement at MC12.   

Image Credits: @WTO , WHO, @Airfinity/BBC , Maxime Gautier/ Greenpeace.

Zika virus under a microscope

Some 70 cases of Zika virus were identified in India’s Kerala State over the course of July – what represents the first cases to be reported in the southern Indian state, said WHO on Thursday.

WHO provided no explanation as to why the report was first published months after the outbreak was initially identified. Subsequently, on 31 July, Maharashtra state also reported its first Zika laboratory-confirmed case, said the WHO’s Disease Outbreak News. Asked by Health Policy Watch why the first WHO report was delayed by five months, a WHO spokesperson said he could not provide an immediate response.

But the report follows warnings by Indian researchers that the spread of Zika virus amid COVID-19 in India represents a ‘rising concern.‘

The outbreak was first identified on 8 July when a 24-year old pregnant woman near Pune was diagnosed with the virus, said the WHO report.  Subsequent wider testing identified some 70 cases, including four additional pregnant women.

The WHO report followed upon another last week of a new Ebola virus case in the Democratic Republic of Congo’s North Kivu region – only a few months over the DRC’s last Ebola oubreak was declared over in May.

Zika (ZIKV) can cause large epidemics that strain public health systems, and pose big risks to diagnosis and treatment.  Diagnosis requires sufficient laboratory capacity to differentiate ZIKV disease from illness due to co-circulating aedes mosquito-borne viruses like dengue and chikungunya, according to WHO.

Although 60-80% of the Zika virus infected cases are asymptomatic or only have mild symptoms, ZIKV can cause microcephaly and congenital Zika syndrome (CZS) in newborns and infants. Moreover, although ZIKV is primarily transmitted by the Aedes species mosquitoes, it can also be transmitted from mother to foetus during pregnancy, through sexual contact, transfusion of blood and blood products, and organ transplantation, according to WHO.

A young child infected with Zika virus – affordable, rapid testing remains a challenge.

Zika virus first gained prominence in early 2015 when a major outbreak occurred in Brazil.  It spread rapidly to dozens of other Latin American and Caribbean countries, and in 2016 the outbreak was  declared by WHO to be a public health emergency of international concern (PHEIC).

In India, Zika virus disease cases/infections have been detected in Gujarat, Madhya Pradesh and Rajasthan states in 2018 (South-East Asian lineage).

While this marked the first time that the virus had been detected in the souther state of Kerala, WHO said, adding that “this event is not unexpected, given the wide distribution of the primary mosquito vector, Aedes aegypti, and competent vector, Aedes albopictus, in Kerala and Maharashtra states.”

Image Credits: ECDC – europa.eu, UNICEF.

In Pakistan, a healthcare worker listens to a child’s lungs for signs of tuberculosis.

Deaths from tuberculosis increased for the first time in a decade in 2020 due to the COVID-19 pandemic, according to the World Health Organization’s (WHO) 2021 Global TB report. 

The diversion of health resources to address COVID-19 led to fewer TB diagnoses as well as a drop in treatment last year. This is likely to result in even higher TB-related deaths in 2021 and 2022, warned the report, which was released on Thursday.

Over a million fewer people were diagnosed in 2020 than the previous year with the south-east Asia and Western Pacific region accounting for 84 % of the global reductions. India and Indonesia were responsible for more than half of the drop in case notifications in this region between 2019 and 2020. 

The most sobering part of the report was its warning that negative impacts on TB mortality and TB incidence in 2020 will be even worse in the next two years, with 2021 forecast to have even higher TB deaths while 2022 is likely to see the biggest impact on TB incidence. The pandemic and lockdowns have knocked TB’s elimination progress to 2012 levels. 

Fewer case notifications, dip in treatment 

Most 2020 targets set for TB elimination have been missed by almost all WHO regions. The WHO Europe region, which achieved and surpassed most of its 2020 targets, faltered when it came to TB notification and registered a dip in notifications. 

The number of new TB case notifications globally was 5.8 million in 2020, whereas the figure for 2019 was 7.1 million.

The huge drop in reporting and detection of TB between 2019 and 2020 points to a disruption in the supply-and-demand of TB diagnostic and treatment services, the report said. Fewer people were able to get access to resources due to lockdowns and fears of COVID-19, and the healthcare system also took a hit due to the diversion of resources. 

The WHO estimates that 4.1 million people who currently suffer from this deadly disease have not been diagnosed or have not officially reported to national authorities. The figure was 2.9 million in 2019.

India and Indonesia had previously been the main contributors to the uptick in TB notifications between 2013 and 2019 when their combined annual total number of notifications increased by 1.2 million in that period. However, all that was nearly erased between 2019 and 2020 when notifications fell by 0.7 million. 

According to the Indian Health Ministry’s 2021 Annual Report on tuberculosis elimination, reports and notification of confirmed TB diagnoses tumbled 38 % in March-April 2020 owing to the lockdown. Private notifications were down 41 % for the same period. 

At the press conference to launch the report, Katherine Floyd, Coordinator of the TB Monitoring and Evaluation Group in the WHO Global TB Programme, said that India has the highest TB burden in the world. In 2020, some 2.6 million people developed TB while half a million people died – one-third of all global deaths. 

Treatment, deaths and intervention

Based on the country-specific models for 16 countries that accounted for most of the global drop in 2020, the negative impacts on TB mortality and incidence will get worse in 2021 and beyond. 

The organisation estimated that approximately 1.5 million people died in 2020 from the air-borne disease, the first year-on-year increase in global deaths due to TB since 2005. 

The models of prediction for these figures have not considered the economic and nutritional aftermath of the Covid-19 that makes individuals more susceptible to developing TB diseases among those already infected with M.tuberculosis. 

How do we get back on track? 

“Getting back to the levels that were achieved in pre-COVID times would depend on the key stakeholders, officials, funders and the understanding that these investments and continuation of TB services are needed as soon as possible,” said Dr Tereza Kasaeva, WHO’s Director of the Global TB Programme, in response to a question from Health Policy Watch.

She said that urgent actions and investments are key to address these gaps in TB’s progress and a full recovery of services is essential. 

Dr Osamu Kunii, Head of Strategy, Investment and Impact Division at the Global Fund to Fight AIDS, Tuberculosis, and Malaria, said that “we need a global effort to support replenishment of the global fund for next year.” 

He added that while the G7 and G20 members are having discussions on pandemic preparedness, we need to remind them that “fighting against TB is also very useful for future pandemic response.” 

Funding woes and missed targets 

The drop in people enrolled on drug-resistant TB treatment means that the target of treating 40 million people by 2022, which was adopted at the 2018 UN-High level meeting, is far out of reach.

“This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease,” cautioned the WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

Increases in both domestic and international funding for TB are urgently required, but provisional data suggest that allocations for 2021 will remain inadequate, according to WHO. 

“For more than a year now, we’ve been sounding the alarm over the growing number of people not being diagnosed and treated for TB,” said Dr Lucica Ditiu, Executive Director of the Stop TB Partnership.

“Unfortunately, today’s report confirms what we all feared—that more and more people are dying from TB. We now see more than 4,100 people dying from TB every single day. This is not a prediction; it is a reality. The COVID-19 pandemic combined with low political will and appallingly low levels of funding have reversed hard-fought gains in the fight against this age-old disease.”

Funding in the low-and middle-income countries that account for 98% of reported TB cases show an 8.7% decline last year 2020. The $5.3 billion spent in 2020 is less than half of the global target of $13 billion annually by 2022 and only 39% of the target amount estimated to be needed in 2020 in the Stop TB Partnership’s Global Plan to End TB, 2018–2022. 

The End TB Strategy targets for 2030 and 2035 cannot be met without intensified research and innovation, the report further said. 

There need to be more technological breakthroughs by 2025 so that the global incidence rate of TB could be accelerated to 17 % per year between 2025 and 2035. With the 2020 target for TB incidence missed, one will need to make bigger strides to meet the future targets. 

“If we had spent a fraction of the energy and money that governments and pharma have spent developing COVID-19 vaccines and then getting them to wealthy countries, we´d have stopped TB in its tracks long ago,” said Guy Marks, President of the International Union Against Tuberculosis and Lung Disease (The Union). 

“Instead, these devastating mortality numbers from the WHO Global TB Report indicate TB will return to being the biggest killer sooner than later. And that is a preventable tragedy.” 

The report lists priorities to meet the 2025 targets, including a TB vaccine or a new drug treatment for the nearly two billion people already infected, rapid diagnostics for use at the point of care, and simpler, shorter treatment for TB disease.

 

Image Credits: Stop TB Partnership.

South Sudan’s Minister of Health, Elizabeth Chuei, getting vaccinated against COVID-19.

Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region.

This means that the continent could have around 59 million cases and 634,500 deaths.

“We’re using a model to estimate the degree of under-estimation. Our analysis indicates that as few as one in seven cases is being detected, meaning that the true COVID-19 burden in Africa could be around 59 million people,” said Dr Matshidiso Moeti, WHO’s Africa executive director.

 “The proportion of underreporting on deaths is lower. Estimates such as around one in three deaths have been reported. Deaths appear to be low on the continent, in part because of the predominantly younger and more active population,” she told a media briefing on Thursday.

The case figure was extrapolated from country-based seroprevalence surveys while the mortality figure was reached on the basis of excess death statistics, said WHO’s team lead on operational partnerships, Dr Thierno Balde.

“With limited testing, we’re still flying blind in far too many communities in Africa,” conceded Moeti. 

The WHO recommends that member countries should perform 10 tests per 10,000 people each week yet around 20 countries – more than a third of African countries – do not reach this benchmark, said Moeti.

“Most tests are carried out on people with symptoms, but much of the transmission is driven by asymptomatic people. Estimates suggest that between 65% and 85% of COVID-19 cases are asymptomatic. The reported cases we see could therefore just give the tip of the iceberg,” she added.

Dr Matshidiso Moeti, WHO Africa Executive Director.

Community-based testing

The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries including Senegal.

“The community testing initiative is a radically new approach, which shifts from passive to active surveillance through working with communities, local authorities and hotspot districts,” said Moeti.

“We will use antigen detection, rapid diagnostic tests which are reliable, affordable, easy to use, and provides results in around 15 minutes.”

People living within a 100-metre radius of a case in various hotspots will be eligible for a free test and the WHO expects to reach over seven million people.

The WHO hopes that, by identifying potential spreaders early, countries will be able to break the chain of transmission and contain flare-ups – particularly as the continent expects a surge in infections during the festive season in December when there is a lot more movement of people.

“This community testing strategy is a key component in transitioning towards localised management of COVID-19 outbreaks,” Moeti stressed.

Deaths lower in Africa

Despite the mortality undercount, WHO Africa officials said that deaths appear to be low on the continent.

Moeti attributed this in part to the continent’s “predominantly younger and more active population”. 

Balde added that the continent also had a relatively low prevalence of the co-morbidities such as diabetes and hypertension that had made COVID-19 fatal for many people.

“There are also some hypotheses mentioning the existence of viruses and linked to the coronaviruses that some Africans have been exposed to over the years,” added Balde.

However, only a minority of African countries have accurate statistics on excess deaths.

Zero vaccinations

Only three countries in the world have not yet started to vaccinate their citizens against COVID-19 despite WHO engagement and support, including the Africa states of Burundi and Eritrea.

However, Balde said that Burundi was expected to start to roll out vaccinations within the next few weeks as the country had recently joined the African Vaccine Acquisition Trust (AVAT) and signed a contract with COVAX.

However, he said that WHO was still working in Eritrea and doing advocacy “on all levels”.

Only 4.9% of Africans have been vaccinated against COVID-19, said Moeti.

Image Credits: UNICEF.

Marion Koopmans (centre) was part of the WHO mission to Wuhan and has also been selected for its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO).

The World Health Organization (WHO) has named 26 scientists to a new Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), which will take forward the work of the international expert group that led an initial  mission to Wuhan in January 2021, as well as investigating future pandemics.

Six of the scientists are associated with the original investigative mission to Wuhan.  That includes five of the nine original international team members dispatched to Wuhan: Marion Koopmans, Vladimir Dedkov, John Watson, Thea Fischer, Hung Nguyen.  In addition, Dr Yungui Yang, Deputy Director of the Beijing Institute of Genomics, one of eight Chinese team members, and a group leader of the original mission, also will serve on the new SAGO team.

They are joined by more scientists from the world’s powerhouse nations, including Inger Damon from the US Centers for Disease Control and Prevention and a leading Swiss biosafety expert,  Dr Kathrin Summermatter. Five Africans are also part of the new group including Kenya’s Dr Rosemary Sang. 

Peter Daszak, the controversial president of the US-based Ecohealth, who had been a prominent member of the first WHO mission, was notably absent from the list.  Pre-pandemic, Ecohealth had supported a series of coronavirus research projects at the Wuhan Institute for Virology (WIV), including what critics say was  “high-risk” collection of such viruses – leading to charges that Daszak had an inherent conflict of interest with an mission supposedly tasked with determining how the virus first leapt to humans – and whether it was the result of a lab biosafety or food systems failure.  

That first WHO mission yielded a report that was widely criticized as papering over Chinese data omissions. It also failed to carefully consider the hypotheses that the virus might have escaped from the Wuhan Institute of Virology (WIV) that was researching bat coronaviruses – a theory that dozens of experts around the world say remains just as plausible as the theory that the virus escaped somewhere along the food chain – until more evidence is gathered.

Original Missions report temporarily disappeared from WHO website

A Health Policy Watch search Wednesday evening on the WHO website for the names and affiliations of the original mission team, and their papers, yielded a “this page cannot be found” message.

After being alerted to the error, the correct link url was restored by WHO, which said that the omission had been due to an IT oversight, whereby “English versions of those pages were not republished during a web migration process.”

 

Fact of nature

The 26 scientists, selected from more than 700 applicants, according to the WHO, represent a wider range of disciplines than the previous group of only 17 members.  The new group includes experts in epidemiology, animal health, ecology, clinical medicine, virology, genomics, molecular epidemiology, molecular biology, biology, food safety, biosafety, biosecurity, and public health. 

“The emergence of new viruses with the potential to spark epidemics and pandemics is a fact of nature, and while SARS-CoV-2 is the latest such virus, it will not be the last,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, told a media briefing on Wednesday.

“Understanding where new pathogens come from is essential for preventing future outbreaks with epidemic and pandemic potential and requires a broad range of expertise. We are very pleased with the calibre of experts selected for SAGO from around the world, and look forward to working with them to make the world safer.” 

SAGO also will advise WHO on the development of a global framework into the origins of emerging and re-emerging pathogens, and on studies and field investigations into these pathogens.

As far as SARS-CoV-2 is concerned, SAGO will guide WHO on the next series of studies into the origins of of the virus, including “rapid advice on WHO’s operational plans to implement the next series of global studies into its origins”, according to the WHO.

Speaking at Wednesday’s briefing WHO’s Maria Van Kerkhove said that she expected the new SAGO group will also recommend more field missions to China – to comb first hand through markets, data bases and patient populations. 

Whether  or not China will agree is another matter. While Kerhkove said that China has expressed openess to more studies, Chinese officials have repeatedly asserted in recent months that the work of WHO is completed in China and that scientists should instead begin investigated possible sources of the outbreak in elsewhere in South East Asia or Europe. Tensions over the next stage of investigations were further exacerbated after the US administration of President Joe Biden administration tasked its own scientists to explore the theory abut a lab-based virus break – giving what had once been debunked as a conspiracy theory, much greater validity in the public eye. 

Famine in Tigray

Tigray refugees

Dr Tedros painted a bleak picture of northern Ethiopia, warning of “acute malnutrition rates at levels comparable to those we saw at the onset of the 2011 Somalia famine”.

This follows a year-long blockade of Tigray by Ethiopian government forces locked in an ethnic war, which has left up to seven million people facing hunger.

“An estimated 400,000 people are living in famine-like conditions based on the latest UN analysis,” Tedros, who is from Tigray, told the media briefing.

“Since the end of June, we have only had access to Tigray via one road through the neighbouring Afar region where movements are being severely restricted by official and unofficial checkpoints and roadblocks,” he said.

“The UN estimates that we need to bring in roughly 100 trucks of aid a day to meet basic needs in Tigray but since July, the UN has only been able to move 10% of this on the ground,” said Tedros.

Healthcare has almost collapsed as no medical supplies have been allowed into the region since July. 

Earlier in the month, the Ethiopian government expelled seven senior United Nations staff involved in humanitarian aid.

Image Credits: CGTN, Christine Nesbitt/ UNICEF.

The Indian government’s Subject Expert Committee (SEC) has recommended the use of the country’s home-grown COVID-19 vaccine, Covaxin, for children from the age of two.

This is the first vaccine in the world to be approved for such young children. Pfizer’s vaccine was recently approved for children from the age of 12 in the US.

India’s health ministry still has to approve the vaccine, which is the first to be  developed in India, by Bharat Biotech in collaboration with the Indian Council of Medical Research.

Covaxin has not yet been granted emergency use listing (EUL) by the World Health Organization (WHO), but a statement issued by the WHO on Monday about last week’s meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization stated that SAGE had reviewed Covaxin’s application.

 “A policy recommendation will be issued when the vaccine is Emergency Use listed by WHO,” said the report, seeming to indicate that such a listing is likely.

 

India’s decision comes after Bharat Biotech presented results from a trial involving 525 children to SEC in early October. According to the company, the vaccine provided 77.8% protection against COVID-19.

Permission to test the vaccine on children was given by India’s drugs controller general, Dr VG Somani, following trials on adults.

However, final results have yet to be published in a peer-reviewed journal and the Indian government approved Covaxin before its phase 3 trial was completed. However, phase 1 results published in the Lancet established that the vaccine is safe. 

According to the BMJ, Covaxin “is similar to CoronaVac (the Chinese vaccine developed by Sinovac) in that it uses a complete infective SARS-CoV-2 viral particle consisting of RNA surrounded by a protein shell, but modified so that it cannot replicate”.

Covaxin can be stored in a normal fridge at 2-8°C, and people need to get two doses around 20 days apart.

Each dose of Covaxin costs 295 rupees (around $4) versus $25-$38 for the Moderna vaccine and $36,30 for the Pfizer/BioNTech, according to the BMJ. This makes the Indian vaccine the cheapest purchased by any country in the world.

Covaxin is already being used in 21 states according to Suchitra Ella, co-founder of Bharat.

Meanwhile, the US Food and Drug Administration (FDA) is meeting later this month to discuss a request from Pfizer to review data for COVID-19 vaccination for children aged 5 to 11 years and consider emergency authorisation of the vaccine for this age group. ​​

mental health
Mental health services for children and adolescents have been disrupted due to COVID-19

The most systematic study to date of the COVID-19 pandemic’s effects on mental health suggests that it has caused an additional 53 million cases of major depressive disorder, 76 million cases of anxiety across 204 countries in 2020 alone, according to a new Lancet study. 

The study, published just ahead of World Mental Health Day, which was observed Sunday, found that countries most affected by COVID-19 had the largest increases in the 2 disorders studied, and women and younger people were the most affected. 

The Lancet study was one of several published last week that shed new light on mental health issues around the commemoration of World Mental Health Day, on Sunday. 

It included UNICEF’s State of the World’s Children report, showing that one in seven adolescents aged 10-19  lives with an undiagnosed mental disorder. 

A new WHO Atlas on Mental Health, meanwhile, pointed to the low levels of investments by countries in mental health prevention and treatment  – averaging only 2.1% of national health expenditures, worldwide, and amounting to only US$1 on average, per capita, in least developed countries.

Breaking the silence 

More than 13%, or 1 out of 7 adolescents globally has a mental disorder.

The UNICEF report, the first ever to focus on mental health, called for “breaking the silence around mental health.” 

“[Mental health] is an iceberg we have been ignoring for far too long, and unless we act, it will continue to have disastrous results for children and societies long after the pandemic is over,” UNICEF Executive Director Henrietta H. Fore said, in the report’s Foreword. 

The report underlines the need for a more comprehensive approach to promoting and protecting good mental health for children, including more regular and systematic assessment of mental health indicators as well as the performance of existing mental health services.   

Investment in children’s mental health negligible 

Investment in protection and care for children’s mental health remains negligible, despite widespread demand for action, the UNICEF report stated.

In terms of the broader public, just 52% of countries delivered the targeted mental health promotion and prevention programs—far short of the 80% goal for 2020, according to the new WHO Atlas.

This lack of investments means that health workforces, including community-based workers, are not equipped to properly address mental health across multiple sectors. 

Additional analysis from the UNICEF report indicates that the annual loss in human capital arising from mental health conditions in children aged 0-19 is US $387.2 billion.

The Lancet, UNICEF call for increased mental health investment

The Lancet, in an editorial, echoed UNICEF’s calls for increased government and worldwide investment.

“We urge governments and international organisations to increase their commitment, investments, and actions to prioritise child and adolescent mental health,” the statement read. 

“In addition to expanding the capacity of mental health and psychosocial services to respond to the rise in demand, more investment is needed to promote mental health, especially through parenting programmes and schools.”

Investing in school-based interventions that address anxiety, depression, and suicide provide a return on investment of US $21.50 for every US $1 invested over 80 years. 

“Mental health is a part of physical health – we cannot afford to continue to view it as otherwise,” said Fore. “For far too long, in rich and poor countries alike, we have seen too little understanding and too little investment in a critical element of maximizing every child’s potential. This needs to change.”

Suicide, the fourth leading cause of death for 15 – 19 year olds

Tragically, almost 46,000 children and adolescents between the ages of 10 and 19 end their own lives every year – about 1 every 11 minutes.

 

The cost of how mental disorders impacts human lives is incalculable, with families, schools, and communities deeply affected by suicide – the fourth leading cause of death among 15 – 19 year olds. 

Every year almost 46,000 children and adolescents between the ages of 10 and 19 end their own lives – about 1 every 11 minutes. 

‘Increased Urgency’ in the aftershocks of pandemic 

During the COVID-19 pandemic there has been increased recognition of the importance of mental health

The synergism of the The Lancet study, UNICEF report, and WHO Atlas has shown how the COVID-19 pandemic has created an increased urgency to strengthen mental health care in most countries.

“The risk is that the aftershocks of this pandemic will chip away at the happiness and well-being of children, adolescents and caregivers for years to come – that they will pose a risk to the foundations of mental health,” the UNICEF report reads. 

Image Credits: WHO/NOOR/Sebastian Liste, UNICEF, AMSA/Flickr.

A woman in Africa’s Sahel region shows how her maize corn ears have dried up in a drought, which are occuring with greater frequency in the world’s most food insecure regions as a result of climate change.

A sweeping World Health Organization report on Climate and Health, published just ahead of a critical Glasgow climate conference (COP 26)  that begins 31 October, has declared that “the burning of fossil fuels is killing us” –  the bluntest denunciation to date by the global health agency of societies’ fossil fuel addiction. 

“Climate change is the single biggest health threat facing humanity,” adds the report, whose publication was accompanied by an open appeal to governments, signed by some 300 health organizations representing 45 million health workers worldwide – two-thirds of the global health workforce.  

The “COP26 Special Report on Climate Change and Health” provides little in the way of brand-new data on a much-discussed issue.  But it is the boldest yet of WHO’s recent statements on increasingly alarming trends – leading to more extreme heat episodes, fires, floods, and droughts, and air pollution – which in turn create a cascade of health effects. 

“There are 45 million plus health care professionals who are witnesses to the health emergency that is unfolding in plain sight,” said Howard Catton, CEO of the International Council of Nurses. 

Health professionals, including WHO staff, demonstrate for clean air and climate action outside of the Geneva United Nations headquarters in 2018.

“They see and work with young … and old people struggling with respiratory disorders caused or exacerbated by poor air quality and pollution… people with heatstroke, exhaustion and hypothermia,” said Howard Catton, CEO of the International Council of Nurses, which played a major role in mustering the health community to its appeal for action. 

“They support people who are not coping with extreme temperature changes from heat stroke and exhaustion to hypothermia….

“And they see and experience extreme events and disasters like flooding and forest fires which resulted from spreading infectious diseases, including vector borne diseases, the contamination of food and water that people can’t avoid. 

“They see that the impact is not just on people’s physical health, but on their mental health, depression, anxiety, grief, isolation symptoms of post traumatic stress disorder,” he added.

“The planet has become the patient.” 

An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors.

Reducing climate change could save 5.6 million lives annually from air pollution-related deaths

Despite its harsh tone, the report provides no new estimate for how many lives a year are being lost to climate change directly, said Dr Diarmid Campbell-Lendrum, one of the leaders of the report.  He acknowledged that the most recent WHO study estimated projected deaths from climate change at around 230,000 people a year by the year 2030 – which admittedly only looked at a “small proportion of the ways in climate change affects health.”  Those estimates also omitted a critical issue, the impacts of extreme heat on health – which is increasingly affecting not only older people but also workers in construction, agriculture and other outdoor occupations.  

Diarmid Campbell-Lendrum, Head of WHO Climate Change Unit

Even so, dramatically reducing the burning of fossil fuels, as well as domestic burning of wood and biomass for cooking and heating, would slash deaths from air pollution by 80%, saving some 5.6 million lives a year, said Dr Maria Neira, Director of WHO’s Department of Environment, Climate and Health, which coordinated the report.  

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

“One of the things that has become very clear in the past few years is this compounding nature of the climate crisis,” added Campbell-Lendrum referring to the synergies. “We have increasing extreme heat also combining with other vulnerability factors. We have urbanizing populations, we have older populations, we have populations living with other previous [health] conditions.”

And while the most heavy health burden from climate change tends falls upon people living in low- and middle-income countries whose homes, food security and livelihoods are more directly impacted by more extreme weather, people in high-income countries are feeling, more and more, the impacts of climate-related drought, fires and flooding, and extreme heat – as evidenced by the wildfires, flooding and heat extremes, seen over the past two years in countries ranging from Australia, to Germany and the United States. 

 … Populations that we thought were relatively immune from climate change, those living in developed countries are in fact much more vulnerable than we thought, including to things like heat stress,” Campbell-Lendrum said. 

Template for Greener COVID Recovery   

The report calls for sustainable, health urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling, and public transport.

Billed as a template for action in 10 critical areas – from healthier cities to healthier energy supplies – the report strikes a forward-looking note, citing the solutions available if only sufficient money and political are invested in the climate issue.

The report zeroes into more detail on four key areas of action:  

  • Healthier energy systems; 
  • ‘Reimaginging’ urban environments, transport and mobility – a major source of climate emissions and air pollution in cities;
  • Promoting healthy, sustainable food systems that deliver more nutritious diets with a smaller carbon footprint than current meat- and processed food heavy diets. 
  • Protecting and restoring natural biodiversity, which is essential to the regeneration of   clean water, clean air and food production systems.   

The emphasis, said Neira, should be on the positive benefits that can be generated for people with the right set of climate actions.

“The positive message on the health argument is that whatever you do to tackle the causes of climate change will have enormous benefit for the health of the people,” Neira pointed out – and that argument goes beyond the 5.6 million lives that could be saved from cleaner air. 

“If you do the transformation that is needed in terms of sustainable force food systems, the healthy diets that will result, will prevent as well 5.1 million deaths every year. Plus, all the benefits will come from transport, physical activity. Our society needs to understand that tackling the causes of climate change …probably have a big opportunity,” Neira stressed, adding that whatever investment is spent would be far outweighed by the savings obtained in human lives, productivity and healthcare costs.

Presently, however, as economies around the world continue to pump billions into economic recovery from the COVID pandemic, monies still aren’t being invested into climate-friendly economic stimuli, Campbell-Lendrum pointed out:

“We still see that about 80% of those are investments according to the OECD, are either neutral or harmful for the environment, we have to bring that balance more towards a greener recovery.”

Greening the health sector

The report calls to build climate-resilient and environmentally sustainable health systems and facilities.

The report also calls upon the health sector to start greening its own backyard – by creating more sustainable and climate resilient health facilities.

“If the health sector was a country it would be the fifth largest climate emitter in the world,” declared Neira, referring to the very high carbon footprint of health facilities in most developed countries – second only to the leisure industry in terms of building energy and water demand.

The same facilities are also major generators of plastic and other types of waste from the use of single use health products – often unavoidable. At the same time, facilities in low- and middle-income countries may lack adequate access to electricity and safe water supplies for hygiene and basic health care operations, like maternal and newborn delivery.  Extreme heat in poorly designed and ventilated facilities create huge risks for women in labour, increasing risks of haemorrhage, as well as their newborns – and particularly premature babies – who are more vulnerable to dehydration and lack adequate physiological mechanisms for heat control.

“This report shows that there are ways to limit climate change that can also improve our wellbeing,” said Cheryl Moore, Director of Research Programmes at Wellcome Trust, which has made climate change one of its premier strategic priorities: 

“We’ve spent too long thinking about these issues in isolation; now is the time to focus our efforts on a global, unified strategy to safeguard human health, and that of the planet. It will require all of us working together – now and for the decades to come.”

Image Credits: Commons Wikimedia, Pablo Tosco/Oxfam, WHO, Planetary Health Eastern Africa Hub, WHO/Bill & Melinda Gates Foundation.

Inactivated COVID-19 vaccine candidate produced by Beijing Institute of Biological Products and Sinopharm Group.

The World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) has recommended that people over the age of 60 who received the Chinese Sinovac and Sinopharm vaccines, should get a third shot – possibly with another vaccine.

“The use of a heterologous platforms vaccine for the additional dose may also be considered based on vaccine supply and access considerations,” according to a preliminary report from last week’s SAGE meeting, an indication that the experts believe that stronger immune responses may be initiated when a different vaccine is used.

“When implementing this recommendation, countries should initially aim at maximizing two-dose coverage in that population, and thereafter administer the third dose, starting in the oldest age groups.”

Scrupulously avoiding calling them boosters, SAGE also recommended that third doses should be offered to “moderately and severely immunocompromised persons” as part of “an extended primary series”.

SAGE also reviewed Bharat Biotech’s COVID-19 Vaccine, Covaxin, and would issue a policy recommendation when the vaccine is Emergency Use Listed (EUL) by WHO – an indication that EUL is close.

SAGE also recommends that all countries consider implementing seasonal influenza vaccination based on the burden of disease, the cost-effectiveness, competing public health priorities, and programmatic feasibility. 

For countries implementing seasonal influenza vaccinations, SAGE recommended prioritising health workers, people with chronic medical conditions, older adults and pregnant women.

 

Image Credits: Sinopharm.