Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health and chair of the WHO Working Group on Sustainable Finance.

For a long time, the World Health Organization (WHO) has experienced immense financial stress resulting in numerous debates on how to remedy its economic woes. A working group set up earlier this year has been tasked with finding long-term solutions.

Each year the representatives of some 194 countries make demands on what work should be carried out by the WHO, but the money needed to carry out the requests is severely lacking.

Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health, and chair of WHO’s Working Group on Sustainable Funding, recalls explaining the situation to his daughter who asks what the money problem is.

“The family decides to have breakfast with lots of friends. We need to buy 20 buns from the bakery, and there’s a plan in place because we know our guests want different buns. I send my daughter to the bakery to buy 20 different buns but only give her enough money for two,” he says.

Without enough money, Kümmel’s daughter would have to beg for money on the way to the store. Some generous passersby might give her some change, but on the condition that she spends it on specific types of buns. She might be able to bring back home all 20 buns but to a large extent they will not be the ones ordered.

“It sounds absurd when we put it this way but the member states of the WHO, in the same way, do not provide the finances to fund their own priorities agreed to by these countries,” Kümmel told Geneva Solutions.

Increasingly, individual donors have been providing funding money for these “buns”, but often face criticism for financing projects that personally interest them.

Meanwhile, the funds needed to execute the activities of the ever-broadening agenda set by the World Health Assembly (WHA) are lacking. COVID-19 has revealed major discrepancies between the expectations of the WHO and its de facto ability. “The pandemic has shown that we need a strong WHO, now more than ever, and it is clear that it is not strong enough,” Kümmel said.

Sustainability lens

For years discussions have circled around WHO’s funding, prompting its Director-General, Dr Tedros Adhanom Ghebreyesus, to reflect on how these conversations have “remained rather abstract” in a report delivered to the Executive Board.

As a result, the WHO created the Working Group on Sustainable Financing (WGSF), which is tasked with finding long-term solutions to the body’s financial troubles.

Kümmel notes that although finances remain a popular topic amongst the organisation’s members, this is the first time a “sustainability” lens is being adopted. He adds that everyone shares the view that a stronger WHO is needed, which requires more stable sources of long-term funding.

The alternative, continuing with the status quo, poses a threat to global health security and the achievement of the Sustainable Development Goals.

“There needs to be a completely new approach to ensure the WHO has the right finances in place in order to fulfil the world’s expectations,” he says.

The WSFG is working on a proposal that will “enable WHO to have the robust structures and capacities needed to fulfil its core functions,” as highlighted in the meeting report. The final report and recommendations will be taken forward to the WHO’s executive board in January 2022.

Concluding their third and most recent meeting in June, the group has already explored different financing models, including other global health actors’ funding structures that could help recharge the WHO’s coffers, drawing on lessons from other health actors.

Adopting the Global Fund’s so-called replenishment model, for example, would mean raising funds in multi-year cycles. Kümmel says the WHO budget could at least be partially funded this way.

Dr Tedros addressing the WHO’s 149th Executive Board meeting

Since taking office in 2017, Ghebreyesus has made broadening the WHO’s funding base one of the organisation’s main priorities. In 2019, he announced plans to establish the WHO Foundation to secure funds from the public, individual major donors and corporate partners.

The launch of the independent grant-making body came amid controversy over former US President Donald Trump’s decision to halt funding from the US, the WHO’s single largest donor.  The move was later reversed by current President Joe Biden but it had already exposed the health organisation’s heavy dependence on a few major donors.

Approved for 2020-2021, the budget is $5.8 billion, which reflects a $1.4bn increase from the previous biennium, mostly needed for the Covid-19 response. About 16 per cent of this figure stems from mandatory payments known as assessed contributions, paid by its members, which over the last two decades or so, have remained flat at one billion US dollars.

The other way is through voluntary contributions, secured from governments, other UN agencies and the private sector, which make up the majority of the budget.

In recent years the top voluntary contributors, in addition to the US, have included the United Kingdom, Germany and the Bill and Melinda Gates Foundation.

Yet, private players such as the Gates Foundation have come under fire for having some of the most powerful and influential voices in global health, raising questions about the WHO’s independence.

Praise for ‘Big Philanthropy’ donors

Kümmel, however, believes “these voluntary generous donors should be praised because they provide the needed funding in the absence of member states”.

The vast majority of funds coming from the private sector go to the Polio Eradication Initiative, he points out.

“If the WHO didn’t receive these resources, we wouldn’t even be close to an eradication of polio because many member states just don’t put the money on the table,” he adds.

In the last 10 years, the UN health agency has depended heavily on voluntary contributions, which can include both flexible funds untied to specified causes as well as money that can only be spent on activities decided by the donor. Still, in 2018/2019, almost 70 % of the overall budget was financed by funds allocated for specific purposes.

The working group has considered whether the core mandate of the WHO should be fully funded by “un-earmarked” flexible contributions, which favours the organisation’s aspired ways of working, whilst also exploring the importance of expanding the WHO’s donor base.

Following the recommendations of the Independent Panel for Pandemic Preparedness and Response (IPPPR), who share the view that two thirds of assessed contributions should be dues paid by member states, the working group are toying with the idea of whether this figure should be at least 50 per cent, a proposal that has been put forward to the regional committees, which Kümmel expressed had been received constructively and positively.

In addition, the group has put forward to the regional committees whether member states would support and agree to the proposal on increasing assessed contributions as well as adopt an incremental implementation schedule at next May’s 75th WHA.

Contributions from all member states

For Kümmel, all member states should contribute regardless of their economic status. However, he agrees that some countries experience severe financial challenges, thus the current mechanisms in place ensure financial possibilities are accounted for.

At the moment each country is assigned a share of the assessed budget through the WHO’s scale of assessments proportional to the size of its economy, but ultimately it is up to member states to fork out the money, particularly if it is un-earmarked funding.

Coordinated efforts across regions are vital, especially when faced with health crises such as the Covid-19 pandemic. If paired with the loss of funds from major contributors, the results can be devastating.

In 2020, the US fell to the third largest donor position, providing about 8% of the overall budget in the first three quarters. Biden has since restored ties with the body and in February pledged $4bn to the WHO-backed COVAX initiative to boost the equitable distribution of COVID vaccines, however, the full effect of this is yet to be seen.

Germany has similarly reinforced its support to WHO’s work and fight against COVID. Earlier this month the WHO launched its new Hub for Pandemic and Epidemic Intelligence in Berlin. Germany has said it will make an initial $100 million investment to prop up the facility.

The Hub is said to focus on “collaborative intelligence”, where all 194 member states, scientific institutions and civil society could share information openly.

As the coronavirus has demonstrated, the world is not ready to rapidly spot and tackle potential pandemics. The working group believes preparing the health body against such future challenges with the appropriate resources is crucial.

“I think that it is quite clear that the strengthening of WHO post-COVID is a key priority for many countries including Germany. Member states who really want to strengthen WHO understand that ensuring sustainable financing to WHO is one of the key pillars of this,” Kümmel urged.

“We are very supportive of constructive multilateralism in global health. WHO is the global health forum where everyone sits at the table, all 194 Member States, it has a broad global health mandate, and it is fully inclusive.”

This article was first published by Geneva Solutions.

 

Image Credits: WHO/ Violaine Martin, WHO.

German Health Minister Jens Spahn and German Chancellor Angela Merkel have staunchly opposed the TRIPS waiver.

More than 140 former heads of state and Nobel laureates have called on the three candidates in line to be the next German chancellor to declare themselves in favour of waiving intellectual property on COVID-19 vaccines and transferring vaccine technologies.

Germany is leading the European Commission’s refusal to accept the so-called TRIPS waiver proposal put forward by South Africa and India at the World Trade Organisation (WTO).

However, German elections on 26 September could unseat Angela Merkel’s ruling Christian Democratic Union Party, which has steadfastly opposed the TRIPS waiver – apparently in support of BioNTech-Pfizer.

In the letter, addressed to Annalena Baerbock, Olaf Scholz, and Armin Laschet, sent on Wednesday, the signatories stress that German support for waiving patents is vital to overcoming vaccine monopolies, transferring vaccine technology and scaling up vaccine manufacturing around the world to prevent millions more deaths from COVID-19.

Signatories include former French President François Hollande, former UK Prime Minister Gordon Brown, former Colombian President Juan Manuel Santos, former Malawian President Joyce Banda and Helen Clark, New Zealand’s former prime minister. 

Nobel prize winners include Professor Joseph Stiglitz, Professor Francoise Barre-Sinoussi and Elfriede Jelinek.

End the pandemic

They express deep concern with Germany’s “continued opposition to a temporary waiver of the World Trade Organization’s (WTO) intellectual property rules”, at a time in which “the artificial restriction on manufacturing and supply is leading to thousands of unnecessary deaths from COVID-19 each day”. Less than 2% of adults are fully vaccinated in low-income countries compared to almost 50 % in high-income countries.

The TRIPS waiver on COVID-19 vaccines, proposed by India and South Africa in October 2020, is supported by over 100 countries including the United States and France in doing so. 

“Having helped create the most successful vaccine technology against COVID-19, by overcoming pharmaceutical monopolies and insisting that the technology be shared, Germany has the ability to help end this pandemic,” according to the letter.

It also calls on the next Chancellor to ensure that German pharmaceutical companies openly and rapidly share life-saving mRNA vaccine technology with qualified producers around the world.

Commenting on the letter, New Zealand’s Clark stressed: “Germany’s support for a TRIPS waiver in the exceptional circumstances presented by COVID-19 would send a clear signal that all peoples should be able to benefit speedily from available vaccines and therapeutics. Widespread vaccination now and further scaling up of vaccine production will play a significant role in curbing the pandemic.”

Extraordinary power

Meanwhile, Nobel laureate Joseph Stiglitz, said that the new Chancellor of Germany will “hold extraordinary power to turn the tide on this horrific pandemic”. 

“Intellectual property rules are today locking out people across the world from the benefits of life-saving science – it is time for Germany to ensure the transfer of vaccine technologies and join the rest of the world in backing a temporary waiver at the WTO,” he added.

Earlier in the week, ​​Belgian Green Sarah Matthieu, a Member of the European Parliament, said that the European Commission’s opposition to the waiver is “economic”, based on lobbying and financial support from the pharmaceutical companies. BioNTech is a particularly big donor of Germany’s ruling Christian Democratic Union Party, she added.

“We continue to see the Commission really putting big pharma over people’s health. It continues to push its own proposal, that is, if I can say it bluntly, big air. It’s not going to change anything,” Matthieu told a media briefing on Monday organised by Medecins sans Frontieres (MSF), Health Action International, Public Citizen and Third World Network.

Although the European Parliament has passed a resolution in support of starting text-based negotiations on the waiver, this is continually downplayed by commissioners, she added.

The letter was coordinated by the People’s Vaccine Alliance, a coalition of more than 70 organizations including Club de Madrid, Global Justice Now and UNAIDS.

 

Image Credits: Clemens Bilan.

To address the climate impacts of livestock production, people need to halve their meat-eating, says the Meat Atlas 2021.

Twenty multinational meat and dairy conglomerates emit more greenhouse gases than Germany, Britain, or France, according to the Meat Atlas which was launched recently by Friends of the Earth and the Heinrich Böll Stiftung. 

A range of health issues associated with meat-heavy diets also require attention in the push toward more sustainable practices, according to the World Health Organization (WHO), ahead of next week’s UN Food Systems Summit scheduled for 23 September and the Glasgow Climate Summit, COP 26, which opens 31 October. 

Around 840,000 deaths annually are attributable to diets high in processed meats, and some 40,000 deaths are linked to diets high in red meats, according to the WHO’s Dr Maria Neira, Director of the Department of Environment, Climate Change and Health, in an interview with Health Policy Watch. 

Millions more premature deaths have been associated with people eating diets high in  saturated fats from meat, and not eating enough fruits, vegetables, fibre, legumes, and other plant-based foods. The consequences of this are malnutrition, hypertension, heart disease and other chronic disease ailments. 

“[We need to focus on] reducing the consumption of meat and increasing the consumption of plant-based foods, and at the same time [developing] more sustainable food systems, a better recovery from COVID-19, a strategy to tackle climate change, and promoting health,” Neira told Health Policy Watch.

For decades, the WHO has recommended replacing high saturated-fat, high-calorie meats and processed foods with unprocessed foods, fibre-rich foods, fresh fruits and vegetables.

Health and climate synergies

The health and climate synergies are elaborated on in WHO’s recent Compendium of guidance on health and the environment, which covers issues from air pollution to biodiversity, clean water and sanitation. 

“Current patterns of food production and consumption use much of the world’s resources on land and water and contribute significantly to climate and ecosystem change through for example deforestation, loss of biodiversity and GHG emissions,” according to the compendium. 

“This is aggravated by the fact that about one third of food produced for human consumption is wasted,” it adds.

“The expansion of industrial agriculture at the expense of nature puts our global health at risk,” according to the Meat Atlas. 

It calls on countries to “develop an action plan to promote less and better consumption and production of meat, dairy and eggs, to shift away from industrial farming, and to support better animal farming and healthy, plant-rich diets.”

Meanwhile, the WHO’s compendium provides over 400 interventions and recommendations for action to address the overconsumption of red and processed meat.

Neira argues that the world has to move to decarbonisation ”with a high level of ambition and speed”. This can be done through more regulation of meat producers, raising awareness about the health implications of high meat consumption, and shifting consumption decisions in favor of sustainability and health.

Impact on water and land

Livestock production produces 14.5% of the world’s greenhouse gas emissions, but also uses vast amounts of water. 

Agriculture uses some 92% of the global water footprint and 29% of this is used in animal production. Agriculture uses three times as much available fresh water than 50 years ago. 

Three-quarters of all agricultural land is used to raise livestock and to grow the crops to feed them – but livestock corporations also drive water pollution, deforestation, pesticide use, and biodiversity loss.

While climate campaigners push for reducing meat consumption, the demand for meat is forecasted to continue to grow over the next decade, warns the Meat Atlas.

To meet this demand, meat production is becoming more industrialised, marginalising smaller meat and milk producers that represent more sustainable food production models.  

Antimicrobial resistance 

Industrial livestock production also increases the risk of zoonotic disease transmission and antimicrobial resistance (AMR), through inappropriate and largely unregulated agricultural practices.

Some 73% of the antibiotics sold worldwide are used on animals and the proportion of industrial animal agriculture that routinely uses antibiotics is rising. 

Antibiotics are used as growth stimulants in animals and can compensate for shortcomings in hygiene, management, and the care of animals in livestock production.

But the overuse or misuse of antibiotics in food-producing animals can lead to AMR in humans that cause longer illnesses, more frequent hospitalizations, and treatment failures. 

According to the ‘Meat Atlas’, half the chicken samples from major poultry producers in five European Union countries were contaminated with antibiotic-resistant pathogens.

“Antimicrobial resistance linked to the excessive and inappropriate use of antibiotics in animal and human healthcare leads to an estimated 33,000 human deaths in the EU every year,” said the Meat Atlas.

Zoonotic diseases

Freshly slaughtered animals and processed meat in a market in Wuhan, Hubei, China

Certain wild animals – including rodents, bats, carnivores and monkeys – are among those most likely to harbour zoonotic diseases that are harmful to humans, according to the Meat Atlas.

The coronavirus, which originates in bat populations, is an example. One of the most favoured hypotheses put forward by the WHO scientists investigating the origins of the SARS-C0V2 virus causing the current pandemic is that it came from wild animals.

Approximately 60% of all infectious diseases in humans are zoonotic and almost three-quarters of known zoonoses can be traced to wildlife, for example by people eating the meat of wild animals. 

The industrialized production of wild animals or domesticated livestock often serve as a  bridge for transmission, thus posing a “dire threat to global human health,” said the Meat Atlas. 

Emerging pathogens are crossing the animal-human barrier with increased frequency or greater impact.

The crowded conditions used to house animals in industrialised livestock production systems allow infections to easily mutate and jump to human hosts. In addition, the destruction of ecosystems to cultivate land for agricultural production is bringing people into closer contact with wild animals.

As consumption patterns shift towards more meat, the risk of contracting zoonotic diseases will increase.

Shifting to plant-based foods 

Trends in meat production (Meat Atlas 2021)

Shifting diets towards plant-based foods could help reduce diet-related non-communicable disease risks and global disease burdens of obesity, cardiovascular disease, and diabetes – and slow the rise in methane emissions associated with livestock production.

Plant-based and minimally processed foods “must be made available, accessible, affordable, safe, culturally acceptable and desirable to the whole population including the most vulnerable,” says the WHO’s compendium report. 

The world will need tailored approaches to curbing meat consumption, said Neira. 

“For more industrialised countries, we can move into stimulating the reduction of meat consumption and promoting healthy diets…[with] plant-based or unprocessed food,” Neira said. 

“A policymaker in a developed country…can go with more ambition on promoting [a plant-based diet], while in developing countries…we need to have a holistic view of their protein intake…and ensure that people will have access to foods that meet their protein needs every day,” she said. 

Interventions from health policymakers will require advocacy campaigns with clear arguments to “promote the importance of reducing meat consumption and increasing consumption of plant-based foods for the health of the people,” said Neira. 

“WHO will go to COP26 with a very strong report called the ‘Health Argument for Climate Action’ and we will put the focus on the health benefits that can be obtained be mitigating the causes of climate change and promoting a more sustainable food system from the beginning to the end,” said Neira.

Image Credits: Friends of the Earth and the Heinrich Böll Stiftung, Arend Kuester/Flickr, Meat Atlas 2021.

President Joe Biden speaking in Germany after a G7 meeting.

Pressure is mounting on US President Joe Biden to provide global leadership to ensure equitable access to COVID-19 vaccines in the face of the European Commission’s refusal to support a waiver on intellectual property rights.

Biden is expected to host a global leaders’ summit on COVID-19 alongside the United Nations General Assembly next week, and US officials are lobbying countries to support targets to end the pandemic centred on how to get 70% of people vaccinated by late 2022.

African leaders hope that Biden’s COVID-19 summit will lead to more equitable access to vaccines:

WHO & African Leaders Pin Hopes on Biden’s ‘Global COVID-19 Summit’ for ‘New Deal’ on Pandemic Response  

Negotiations over the suspension of intellectual property rights for COVID-19 vaccines, therapeutics and diagnostics, the TRIPS waiver, have stalled at the World Trade Organization (WTO) in the face of opposition from the European Union.

But if the US put forward a text on waiver, this would reinvigorate the talks, appealed South African trade ministry advisor Zane Dangor on Tuesday. South Africa and India are co-sponsors of the waiver.

“Action by the US will be particularly potent to shift the needle in the negotiations and make people come around the table and discuss these issues,” said Dangor, one of the key officials involved in the WTO TRIPS waiver negotiations.

In May, Biden took the world by surprise when he announced US support for the waiver proposal – although only in relation to COVID-19 vaccines. But the European Commission, particularly Germany, has refused to budget.

“The European Union would like to kick the discussions further down the road,” said Dangor, adding that the EU had made it known this week that it was not in favour of a decision on the TRIPS waiver being made at the upcoming WTO Ministerial on 30 November.

Zane Dangor, Special Adviser to South  Africa’s Trade Minister.

“We need commitment on a text from the US that can be tabled and negotiated with South Africa, India and other co-sponsors so that we can have an outcome and move to get to the business of actually ensuring that we get jabs in arms of those who need most and have equitable access,” Dangor told a press briefing organised by Public Citizen.

“Not only do we need to get the WTO waiver done, but we require vaccine recipes to be shared via broad tech transfer to speed expansion of COVID medicine supplies,” added Dangor.

In July, the World Health Organization (WHO) announced that it had established a “tech transfer hub” in South Africa to enable African companies produce mRNA vaccines – but the mRNA manufacturers, Pfizer-BioNTech and Moderna, have refused to join the hub.

Last week, in response to a recent Health Policy Watch question, Pfizer CEO Albert Bourla said: “I’m not sure what is the point of transferring technology that it is going to take years to transfer. And, by the way, this is what we do. I’m not sure I understand what they want, to give it someone else to do?”

European Commission counter-proposal is ‘big air’

Belgian Green Sarah Matthieu, a Member of the European Parliament, believes that the European Commission’s opposition to the waiver is “economic”, based on lobbying and financial support from the pharmaceutical companies. BioNTech is a particularly big donor of Germany’s ruling Christian Democratic Union Party, she added.

“We continue to see the Commission really putting big pharma over people’s health. It continues to push its own proposal, that is, if I can say it bluntly, big air. It’s not going to change anything,” Matthieu told a media briefing on Monday organised by Medecins sans Frontieres (MSF), Health Action International, Public Citizen and Third World Network.

Although the European Parliament has passed a resolution in support of starting text-based negotiations on the waiver, this is continually downplayed by commissioners, she added.

Matthieu said that the German elections on 26 September may shift the power balance it that country and change the position of Germany on the waiver.

US Congressman Ro Khanna said that Biden had shown “strong leadership on the TRIPS waiver” but he now had to “convince our European allies, who are often fond of lecturing the United States about moral responsibility, to live up to theirs”.

Khanna added that the US had been “instrumental in the development of these vaccines”, including by “funding some of the critical research” and “providing purchase agreements that mitigated the risk for pharmaceutical companies”.

Although the US government has indicated it would only support a waiver for vaccines, Khanna told the MSF briefing that this should extend to therapeutics.

“More broadly, we need to have a better system for how we incentivize the production and distribution of drugs to the poor and for issues of that really affect large numbers of population,” said Khanna.

“A purely for-profit model of developing medicines may lead to an over-investment in acne treatment and an under-investment of treatment on some of the biggest diseases.

“Not only do we need a TRIPS waiver, but we need to think about how can we incentivize the development and the production of medicine that actually are affecting the urgent needs of many people in the United States and around the world.”

Waiver debate is about pharma profit, says Stiglitz

Professor Joseph Stiglitz

Nobel laureate and Columbia University economist Professor Joseph Stiglitz described the waiver debate as being about the ability of the drug companies to exercise monopoly power to get substantial profits, rather than a reasonable return on their investment.

“Drug companies’ concern is maximising profits. That’s their business model. And maximising profits means restricting supply because by restricting supply, you increase price, and by increasing price you increase profits,” he stressed.

Referring to Pfizer’s recent talk about selling its vaccine for $175 a dose, Stiglitz said this was based on the belief that there was going to be a vaccine shortage, which would enable the company to extract a monopoly price.

Like Khanna, Stiglitz stressed that the development of the COVID-19 vaccines was an international effort that had involved significant investment from various governments as well as scientists from around the world.

“Germany’s particular view on this is especially peculiar because the German company, BioNTech, has already sold its international rights to Pfizer so the waiver is not even going to affect its profits,” he said, describing the EU’s opposition to the waiver as “objectionable” and “unconscionable”.

Confusion about TRIPS waiver

Stiglitz stressed that there was also confusion about the TRIPS waiver.

“First, this is not the abolition of property rights. [Pharmaceutical companies] still get compensated for using their intellectual property rights. So, it’s not taking away their property rights. Its just saying we are in an emergency, and in this emergency, intellectual property rights have to be available more widely,” Stiglitz told the MSF  briefing.

“Secondly, it’s not even a change in the intellectual framework because, since the beginning of the WTO, we’ve recognised the principle of compulsory licenses. This is effectively just a compulsory license…  to lower transaction costs. Lower transaction costs in the midst of the pandemic, where there’s a kind of urgency that we don’t normally have, is absolutely essential,” he added.

“We’ve enacted voluntary licenses. The world has debated this. It debated it when the WTO TRIPS initially adopted it. It was really debated that in the context of HIV/AIDS, which reaffirmed the principle of compulsory licenses.”

“We are in the midst of what some people call the new cold war. On the one hand, there are authoritarian governments like Russia and China, and then, on the other hand, there are democracies. We would like the democracies to win, but we’re not putting a good face on democracy when we say our democracies put profits over lives.

“Russia has been very actively engaged in vaccine diplomacy. It’s made its vaccine available, say in a country like Argentina. But not only has it made its vaccine available, it’s actually actively engaged in transferring technology and enabling countries to build plants to produce the vaccine. And I’m afraid we’re losing this particular battle.”

Civil society groups demonstrate outside embassies of countries that oppose a temporary WTO patent waiver on COVID-19 health products.

Image Credits: CNBC, Munich Security Conference, Tadeau Andre/MSF .

Left-right: Strive Masiyiwa, AU COVID envoy, Dr Tedros Adhanom Ghebreyesus, WHO Director General, Dr John Nkengasong, Africa CDC diector

After months of frustrated efforts to unlock global vaccine supplies for the African continent, WHO and African Union leaders are now pinning their hopes on US President Joe Biden’s reported plan to call heads of state to a “Global Pandemic Summit” on the sidelines of the United Nations General Assembly, which opened today, as a way out of the current deadlock. 

Biden reportedly is circulating a plan to hold the summit on 22 September – with the aim of reaching a joint commitment to the vaccination of 70% of the world’s population by the GA session in September 2022, ensuring that “additional doses and adequate supplies are available to all countries”, according to a set of targets circulating among embassies, and obtained by the Washington Post.  

To achieve that, the Biden plan for the Global COVID-19 Summit also calls for “expediting delivery of approximately 2.0 billion previous committed doses..  including by converting existing dose sharing pledges into near-term deliveries, swapping delivery dates to secure earlier delivery of doses to LIC/LMICs, and eliminating cross-border bottlenecks in the supply of vaccines and critical inputs.”

But speaking at Tuesday’s press conference following two days of meetings in Geneva, African Union and African Centers for Disease officials stressed that the era of “pledges” for vaccine donations to Africa, needs to end and investments in African vaccine manufacturing to begin, as part of any ‘New Deal’ on pandemic response in low- and middle-income (LMICs) countries. 

“”We, as the African Union, are calling on a permanent structure,” said Masiyiwa, a billionaire entrepreneur and AU Special Envoy for COVID-19, “and this is something that we will be calling on to be put in place at this summit that President Biden is convening. 

“We strongly believe that the pledge architecture, where countries gathered together and made pledges….  has had its day.  Let us now have a permanent structure.  Vaccine sharing is good. But we shouldn’t have to be relying on vaccine sharing, when we can come to the table, put structures in place, and then say that we also want to buy.”  

Calls for new African vaccine facility

Professor Benedict Oramah, President and Chairman of the Board of Directors, Afreximbank

This should involve the creation of a new, and permanent African vaccine facility, supported by the African Union, World Bank and International Monetary Fund, said Professor Benedict Oramah, President and Chairman of the Board of Directors, Afreximbank. 

Afreximbank has provided financing for the continent’s purchase of some 400 million Johnson & Johnson vaccines – backed by the World Bank. But Benedict stressed this is only the beginning of a long road that will require the procurement of booster doses as well. And so a more permanent finance mechanism is needed for countries to manufacturer and purchase doses themselves – rather than being solely reliant on goodwill donations.  

While “thanking” COVAX for the role it has played in facilitating global COVID vaccine supplies, “going forward, we need the IMF to do the vaccine facility – to make it possible for countries to now access these vaccines through the structures put in place,” said Oramah.  Those structures should include domestic manufacturing and procurement financed through African mechanisms, such as “Afreximbank, providing the initial financing, and then they refinance it in a way that makes it possible for the current accounts to carry all this – while the World Bank continues to provide institutional structures that are required to effectively administer vaccines.”

Africa is region with lowest rates of vaccine coverage in the world 

Seth Berkley, CEO Gavi, The Vaccine Alliance

Among all LMICs, Africa stands out for its particularly low vaccination rates so far – with under 3.5% of its population vaccinated – as compared to 60-70% in some high-income nations, African Union also said, speaking at a WHO press conference in Geneva. Of 5.2 billion doses delivered worldwide, only a tiny fraction have reached Africa, noted WHO Director General Dr Tedros Ahanom Ghebreyesus. 

And as things stand now, COVAX, the global vaccine facility, only has sufficient doses in the delivery pipeline to vaccinate roughly 20% of the population in the 91 lowest income countries by the end of the year, using some 1.4 billion purchased and donated doses, admitted Gavi CEO Seth Berkley at the WHO press conference.  And it would hit 36% coverage by March, 2022.

That falls far short of WHO’s target of 40% vaccination by December 2021 and 70% by March 2022. 

To reach those targets, “the world needs 2.4 billion additional doses to go into low income countries to get us to 40% by the end of this year,” Said Bruce Aylward, a special WHO advisor on the pandemic. “Those doses exist,” he said, citing recent pharma statements to the effect that there are now sufficient doses for everyone to go around – including high- and low-income countries. 

See related story

Massive Increase in COVID-19 Vaccine Production May Mean Dose Surplus by Mid-2022, says IFPMA

I think the question we ask is: where are those doses if there are enough for everybody?” Aylward asked.  “And [the US Summit] next week is all about making sure there’s a clear path to ensuring they go to where they’re needed.”  

Barriers that have fouled vaccine access – both countries and manufacturers share blame

Strive Masiyiwa, African Union COVID-19 envoy

Speaking at the close of a two-day Geneva meeting, which also included Dr John Nkengasong, Africa CDC director and African Regional Director Matshidiso Moeti, the WHO and AU officials said that in they had reviewed in painstaking detail the various obstacles  in the way of African vaccine access – and ways to overcome them. 

The challenges have included export bans, including the interruption of supplies from India in March 2020 when the subcontinent experienced its own COVID surge, but also barriers on the exports of vaccines and their inputs to a complex supply chain, they noted. 

But the African officials also repeated longstanding complaints against rich countries for vaccine hoarding, as well as against pharma for preferential sales to high income countries of huge vaccine quantities – in excess of actual population needs. 

“We want to buy from the same manufacturers,” said Masiyiwa. “But to be fair, those manufacturers know very well that they never gave us proper access. They gave access on a very different basis. “When they knew that supplies were restricted at the beginning, there was no production… they [pharma manufacturers] had a moral responsibility to ensure that others also had access,” he said. 

“And we find this very sad. It’s very sad. We could have addressed this very differently. We as Africa will now address this through setting up our own manufacturing capabilities.” 

Countries’  export restrictions also holding up distribution 

But countries’ export restrictions on vaccines as well as the many vaccine manufacturing inputs also continue to foul deliveries – and these are poorly understood, Masiyiwa said. . 

“My principal job is to negotiate with suppliers, and the suppliers have over the last 8-9 months, made it clear that the biggest challenge that they face are export restrictions, export restrictions are being operated right across the board. So, if those export restrictions aren’t there, where are the vaccines, because the production is happening? 

“We’re not seeing the vaccines, and we are being told by the suppliers, they are facing export restrictions. 

He added that without resolving, “this issue around the movement of the various ingredients that drive production… we will not even be able to get manufacturing effectively set up.” 

“We need to get these restrictions removed, and we had a very constructive discussion around this issue with the WTO yesterday,” he said.

AU leaders call on India to remove its ban on AstraZeneca vaccine exports – now that domestic COVID surge has subsided

WHO Director General Dr Tedros Adhanom Ghebreyesus

Masiyiwa also appealed to India to resume its deliveries of AstraZeneca vaccines, produced by the Serum Institute of India – noting that the countries’ embargo on the export of vaccines, remains the most outstanding example of restrictions fouling distribution plans.  The SII vaccines were a centerpiece of COVAX and African countries – until exports were abruptly cancelled in March.  

“We understood that at the time why they were put in place, it was because there was that massive surge in India, and we were incredibly, incredibly sympathetic. But we do now urge our colleagues to show sympathy to us, because we are the ones facing difficulty now. We need to see some of those vaccines begin to come through.” 

Finally, both African Union and WHO officials repeated their call to countries to support a waiver on intellectual property on COVID vaccines and therapeutics,  currently being negotiated by the World Trade Organization – saying that this would help jump-start more manufacturing in developing regions. 

“American taxpayers, European taxpayers financed some of this intellectual property, and so it should be for the common good,” said Masiyiwa.  “So we ask for this IP to be made available.  It was a great miracle to have these vaccines, now let this miracle be available to all mankind”.

Added WHO’s Tedros:  “If it [a waiver] cannot be used now during this unprecedented condition or situation, then when is there a time when it can be used.”

Image Credits: @WHO.

Non-Violence, also known as The Knotted Gun, is a bronze sculpture by Swedish artist Carl Fredrik Reuterswärd at the United Nations Headquarters in New York.

The 76th session of the United Nations General Assembly (UNGA) opens today (Tuesday 14 September). The UN’s roots lie in determination that the horrors of World War II – millions of lives lost, economic devastation and genocide – should never happen again. 

This year’s General Assembly session is considering multiple global catastrophes, from climate change to the COVID-19 pandemic to growing political instability exacerbated and highlighted by the inequitable burdens of the pandemic. For each, we must consider important technical responses, but we will fail across all of them if we cannot strengthen global cooperation and multilateralism.

The official death toll of COVID-19 has climbed to 4.5 million, and the true toll is much larger, perhaps as high as 15 million lives lost. It’s a stunning indictment of decades of underinvestment in global health security and pandemic preparedness. Without significant progress, we will not only be unable to address COVID-19 sufficiently, we will also be left vulnerable to future threats that experts predict will happen more and more frequently.

The UN system exists because we need global cooperation to forestall disaster and create enduring prosperity by promoting peace and security, fostering strong bonds among nations, and promoting social progress, better living standards and human rights.

We are far from the founding threat and horrors of World War II, but global leaders must rekindle that determination to rise above national interests and face our 21st-century disasters together. 

Strengthening WHO

The World Health Organization (WHO) is the first line of defense against global health emergencies. The General Assembly has to provide greater momentum to the movement to give WHO more authority, independence and resources to quickly address emerging threats, and support its role of strengthening national health systems to prevent illness and deal with shocks. 

The WHO-endorsed idea of a Health Threats Council, to keep countries accountable and committed to working collectively on infectious threats, has merit.

Funds to address global preparedness have already fallen short of pledges; the G20, an intergovernmental forum of 19 countries and the European Union, has not lived up to its commitment of providing $75 billion in international public funding to address gaps in pandemic prevention. 

The General Assembly session will undoubtedly provide a platform for many global leaders to make more pledges, but we must demand action. We will hold our applause for those who make concrete investments.

Until global vaccination rates are high, the virus will continue to circulate, and rapidly evolve new strains that threaten us all. The world’s richest nations have a 1.2 billion dose surplus, while other countries are receiving trickles. Africa’s vaccination rate hovers around 3%.

The assembly must push to operationalize the Access to COVID-19 tools (ACT) Accelerator and its COVAX Facility to its full capacity. 

Set up by WHO to guarantee fair and equitable access for countries through securing commitments from countries with access to vaccines to support those without, true support among rich countries for this effort has been anemic. 

Fewer than 15% of pledges to support COVAX are in place. 

Supporting greater vaccine equity must go beyond a charity model. The UN must generate enough pressure to drive technology transfer from few countries to many. In South Africa, a facility capable of making millions of vaccines lies dormant, and as intellectual property debates of this public good are dragged out, millions of people are dying of COVID-19.

Corporate influence

Addressing the power of corporate interests also lies at the heart of the UN Food Systems Summit, being held alongside the General Assembly meeting. 

The Summit will advance an agenda of promoting access to healthy foods, curbing unhealthy ultra-processed products, and protecting the rights of local farmers and indigenous people. 

This agenda is in peril. We join with the activists who are raising the alarm that global agro-industry and food corporations have too much influence over the agenda and that profits will win out over people. 

We must wrest control of food systems away from profit-driven corporations and return it to local food producers and communities. At both the General Assembly session and the Food Summit, we expect to see the voices of civil society, local food providers and indigenous people elevated. 

This will be essential to reducing the impact of non-communicable diseases, such as heart disease, cancer, and diabetes, which kill 41 million people each year and account for 71% of all deaths globally.

At Vital Strategies, we are working to reimagine public health as central to a sustainable world. Reimagining public health means putting the health agenda at the heart of our civic, social and commercial lives and building a global agenda where cooperation to improve the lives of billions is prioritized. 

Global governance and a UN. General Assembly that builds cooperative action are central to a world where everyone, everywhere can reach the full potential of a long and healthy life.

José Luis Castro is president and CEO at Vital Strategies

 

 

 

 

 

 

 

Image Credits: Matthew TenBruggencate/ Unsplash.

The current COVID-19 vaccines are effective enough against severe disease in the general population that boosters are “not appropriate” even for the Delta variant, according to an expert review by an international group of scientists from the World Health Organization (WHO), the US Food and Drug Administration (FDA) and international universities.

The review, which looked at current evidence from randomised controlled trials and observational studies published in peer-reviewed journals and pre-print servers, was published in The Lancet on Monday.

“Averaging the results reported from the observational studies, vaccination had 95% efficacy against severe disease both from the Delta variant and from the Alpha variant, and over 80% efficacy at protecting against any infection from these variants. Across all vaccine types and variants, vaccine efficacy is greater against severe disease than against mild disease,” according to a press release from The Lancet.

The “Viewpoint” article, led by Dr Philip Krause, of the United States Food and Drug Administration’s Offices of Vaccines Research and Review, and including a number of senior WHO scientists, concluded that results reported from the observational studies it had reviewed, vaccination had 95% efficacy against severe disease both from the delta variant and from the alpha variant, and over 80% efficacy at protecting against any infection from these variants. 

“Current evidence does not, therefore, appear to show a need for boosting in the general population, in which efficacy against severe disease remains high,” concluded the 18 authors, including Dr Ana-Maria Henao-Restrepo, WHO’s Head of Research and Development, Soumya Swaminathan, WHO Chief Scientist, and Mike Ryan, executive director of WHO Emergencies.

 “Taken as a whole, the currently available studies do not provide credible evidence of substantially declining protection against severe disease, which is the primary goal of vaccination,” said Henao-Restrepo, in a press release.

Authors admit data is ‘partial’

The article is based upon a review of nearly two dozen studies that looked at hospitalisation rates among vaccinated people, immune response to the vaccines in the laboratory and among clinical populations over time, and also studies on responses to the brand-new booster shots.

The authors also admit that the data is partial, and changing. 

That’s underlined by the fact that while the review included one paper on initial findings from Israel’s booster programme – one of the first in the world, it failed to note the results cited there, which found a 10-fold decrease in the relative risk of severe illness among people receiving the booster shot 12 days after receiving it, within a cohort of over 1.14 million vaccinated individuals, aged 60 and over. 

Even more recent data from Israel, which has called itself the “world’s laboratory” on vaccine boosters, reflects a stabilisation of infection rates and decline in hospitalised cases as the country experienced the highest infection surges, per capita, in the world. That decline has helped avert a crisis in intensive care and another lockdown, experts say, and can only be attributed to the aggressive administration of booster vaccines – which have now been administered to over one-quarter of the population.,

 

Restating positions already articulated by WHO publicly, the authors argue that instead of administering additional vaccines to people who have already been vaccinated, reaching the unvaccinated is the most important public health imperative as they are both the major drivers of transmission and at the highest risk of serious disease, according to the authors. 

“The limited supply of these vaccines will save the most lives if made available to people who are at appreciable risk of serious disease and have not yet received any vaccine,” added Henao-Restrepo, in the press release.  

Another argument for avoiding boosters right now, she said, is to enable wider vaccine distribution worldwide, so as to hinder the development of dangerous variants. 

“Even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated. If vaccines are deployed where they would do the most good, they could hasten the end of the pandemic by inhibiting further evolution of variants.” 

Boosting ‘might ultimately be needed’

The authors acknowledge that in the “changing situation” that “boosting might ultimately be needed in the general population because of waning immunity to the primary vaccination or because variants expressing new antigens have evolved to the point at which immune responses to the original vaccine antigens no longer protect adequately against currently circulating viruses”.

They also acknowledge that boosting may already be appropriate for “recipients of vaccines with low efficacy or those who are immunocompromised”.

However, the authors warn that there could be other untoward health risks if boosters are widely introduced too soon, as this could increase the chances of side-effects – and undermine vaccine acceptance.

“Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society. These high-stakes decisions should be based on robust evidence and international scientific discussion,” says Dr Soumya Swaminathan, WHO Chief Scientist and a co-author of the study.

They also note that, even if levels of antibodies in vaccinated individuals wane over time, “this does not necessarily predict reductions in the efficacy of vaccines against severe disease”. 

“This could be because protection against severe disease is mediated not only by antibody responses, which might be relatively short lived for some vaccines, but also by memory responses and cell-mediated immunity, which are generally longer-lived. If boosters are ultimately to be used, there will be a need to identify specific circumstances where the benefits outweigh the risks,” they argue.

Aside from the WHO and FDA, other authors in the study were from the University of Washington (USA), University of Oxford (UK), University of Florida (USA), University of the West Indies (Jamaica), University of Bristol (UK), Universidad Nacional Autonoma de Mexico (Mexico), Wits Reproductive Health and HIV Institute (South Africa), Universite de Paris (France), and the INCLEN Trust International (India).

“WHO’s Strategic Advisory Group of Experts on Immunization,(SAGE), which develops WHO’s immunisation policy, is actively reviewing all the evidence including the data and this issue,” according to the Lancet press release, which notes that the paper does not constitute a formal policy position for WHO.

 

Image Credits: Roger Starnes / Unsplash.

Imagine you run a country and someone comes to you and says, “I have an idea for how you can make people healthier, reduce cancer by 20%, protect women and children, and even put money in your coffers for COVID-19 response, vaccines and recovery efforts.”

It sounds implausible, even absurd. And yet, there is one simple, evidence-based tobacco control policy that can have that kind of impact: implementing a 10% increase in taxes on tobacco products to decrease consumption. It isn’t easy: the tobacco industry has a long record of lobbying against tobacco taxes in country after country. But we have also seen how committed advocacy—especially by women—can make a difference.

COVID-19 has underscored the global threat of tobacco on health. Before the pandemic, one person died every 4.5 seconds from a tobacco-related disease. The pandemic has made smokers even more vulnerable, because smokers who contract COVID-19 have an increased risk of hospitalization and death. 

Nearly two years in, the coronavirus is driving the health community to build back better, reimagining a world in which health is central to our lives. But continuing to ignore the power of tobacco will prevent us from securing the healthy future we seek—and is a crystal clear area for urgent action.

Increase taxes to decrease consumption

The single most effective way to reduce tobacco use is for governments to increase taxes on products to make them less affordable. The World Health Organization’s (WHO) new technical manual on tobacco tax policy and administration chronicles how countries can reduce the $1.4 trillion-plus in health expenditures and lost productivity due to tobacco use worldwide. Yet, even though taxes have been proven to work, only 14% of the world’s population live in a country with sufficiently high tobacco taxes. 

Increasing tobacco prices by 10% have been shown to decrease consumption by 4% in high-income countries and 5% in low- and middle-income countries. What’s more, taxes can also be used to fund health. Taxation can not only encourage smokers to quit, and prevent youth from starting, but also generate revenue to strengthen health systems for everyone.

Calling for higher taxes during a global pandemic and economic austerity can be challenging. Citizens who have suffered significant economic losses and increased stress due to COVID-19 shirk from the word “tax”. 

Yet when citizens understand the win/win of health-focused taxes more broadly, they are largely supportive, especially when increases in tobacco taxes are linked with funding to a targeted public health benefit. 

The Philippines 2012 “sin tax”, a targeted tax on tobacco and alcohol products, is a success story that used revenue to fund a specific health care benefit, and resulted in 10.8 million more poor and near-poor families being covered by the National Health Insurance Program within five years of its adoption. 

As we’ve seen in the Philippines, if the public is able to see the connection between higher tobacco taxes and the direct benefits that affect their lives, they are more likely to support these policies.

Engage women as advocates

Women and children are most at risk from second-hand smoke.

In the fight against tobacco, building public support is key, and too often women are an untapped resource. As the mother of a cancer survivor, I can tell you firsthand what it is like to care for a child touched by disease. 

This experience led me to serve as the President of the Union for International Cancer Control and to take on my current work with the global health organization, Vital Strategies, helping to advance proven policies to reduce tobacco use across the globe.

There is no safe level of exposure to secondhand smoke, and women and children are disproportionately affected by other people’s smoke. Although women account for just over 9% of tobacco users worldwide, they account for about two-thirds of deaths from second-hand smoke. 

They often lack the power to negotiate for smoke-free homes or workplaces, where women and children need to be protected from exposure. Governments can help reverse these burdens by bringing women to the table to advocate for smoke-free legislation in all public places, and to rely on their participation to help push through such measures.

In Vietnam, where only 1.1% of women smoke tobacco yet an estimated 9.5% die from tobacco-related disease, women are taking action. The Vietnam Women’s Union, a network of 20 million, works diligently with the Ministry of Health to increase awareness of tobacco’s pernicious impact so that they and their families can live healthier lives. 

Their national initiative for smoke-free homes urges women across the country to encourage smokers to respect a voluntary smoking ban in the home and to support smoke-free public places. 

A specific focus on taxation – including advocating for a tobacco tax increase – kicked off in 2018 with a high-level workshop in partnership with the Vietnam Tobacco Control Fund, “Impacts of the Tobacco Tax Raise on Women and Children Health.” 

We need more efforts like this partnership to expand the role of women in efforts to protect everyone from the harms inflicted by tobacco.

Take on the Tobacco Industry

Many young people have taken to smoking during lockdowns despite graphic health warnings on packaging and bans on tobacco advertising.

Worryingly, sales of tobacco products during the pandemic have steadily increased, especially in countries with high rates of poverty. Seizing on the heightened demand – rooted in isolation, anxiety and mental health issues – the tobacco industry brazenly sought to get cigarettes listed as an essential item during early lockdowns. 

They succeeded in many places, including my own country of Jordan, where, despite a government-implemented ban on smoking indoors and in public spaces during the pandemic, surveys show tobacco use is still increasing. 

Despite graphic health warnings on packaging and government bans on tobacco advertising, many young people have embraced tobacco use during lockdowns.

We can’t continue with business as usual. It is up to governments to implement tobacco taxes—despite the inevitable pressure from the tobacco industry—as a well as a bans on tobacco advertising and promotion, well funded campaigns to inform about the harms of smoking, and restrictions on smoking in public places and work places. Politicians must advance these measures as part of a broader strategy to reduce the overwhelming burden of noncommunicable disease—including cancer, diabetes, and heart and lung disease.

The tobacco industry is a powerful force that time and again has prioritized profits over people. Yet we have the means to counter this insidious force. 

Increasing tobacco taxes will not only improve public health and reduce health care expenditures; it will also increase revenue at a time when so many governments seek to strengthen national health systems as they struggle with COVID-19. And engaging women in the fight against tobacco broadens the reach of anti-smoking campaigns. 

The global pandemic has illuminated how critical public health is to all our lives, granting governments an opportunity to act with a renewed sense of urgency. But they must seize the moment and garner the political will to protect the health and well-being of their citizens against the harms of tobacco.

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

Princess Dina Mired

 

Image Credits: Andres Siimon / Unsplash, Twitter: @FCTCofficial.

Leading suicide prevention organizations highlighted the need to decriminalize suicide and invest in suicide prevention strategies, as suicide causes one in every 100 deaths globally.

The leading international organization for suicide prevention has called for the decriminalization of suicide – as well as greater investment by countries in suicide prevention, including greater restrictions on access to common suicide tools such as toxic  pesticides and firearms. 

The appeals, by the International Association for Suicide Prevention (IASP) and endorsed by the World Health Organization (WHO), come on World Suicide Prevention Day, observed every year on 10 September. 

Suicide is among the leading causes of death worldwide. The COVID-19 pandemic has exacerbated the risk factors associated with suicidal behaviors and highlighted the grave need for national prevention plans, said Dr Rory O’Connor, President of IASP, in a statement. 

“Raising awareness of suicide can help to strengthen our understanding and reduce the stigma surrounding suicide,” he noted. “This in turn helps to break down the many barriers to people seeking help… [and] can also help create a more accepting society.”

Globally, 703,000 people die by suicide every year – accounting for one in every 100 deaths. Suicide causes more deaths than malaria, HIV/AIDS, breast cancer, or war and homicide. 

Among young people aged 15 to 29, suicide was the fourth leading cause of death in 2019. 

Decriminalization can open up access to services 

But suicide also is currently a criminal offence in 20 countries and those who have attempted suicide can be arrested, prosecuted, and punished with fines and one to three years in prison, found a new report published by IASP and United for Global Mental Health on 8 September.

“Criminalizing suicide is counterproductive,” said IASP. “It does not deter people from taking their lives, but it does deter them from seeking help in a moment of crisis. Suicide must be decriminalized.”

Decriminalization plays a pivotal role in amplifying access to suicide prevention services – removing stigma associated with people with suicidal thoughts or behaviours. 

This, combined with investments in mental health services and measures that restrict access to suicide “weapons,” can enable people to receive emergency lifesaving treatment – and facilitate the longer-term diagnosis and treatment of mental health conditions. 

“We cannot – and must not – ignore suicide,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, in a statement  in June. “Each one is a tragedy. Our attention to suicide prevention is even more important now, after many months living with the COVID-19 pandemic, with many of the risk factors for suicide – job loss, financial stress and social isolation – still very much present.”

Banning pesticides, training healthcare workers, and decriminalizing suicide

Earlier this summer, WHO published a comprehensive implementation guide for suicide prevention to encourage countries to develop national prevention strategies.  

WHO’s LIVE LIFE approach to suicide prevention includes four strategies: 

  • Regulations restricting access to means of suicide – including firearms as well as deadly pesticides that are often used for self harm in the developing world; 
  • Early identification, assessment, management, and follow-up of people affected by suicidal thoughts and behaviors; 
  • Fostering adolescent social-emotional skills; 
  • Educating the media on responsible reporting on suicide. 
WHO’s LIVE LIFE approach to suicide prevention.

“Suicide is an urgent public health problem and its prevention must be a national priority,” said Renato Oliveira e Souza, head of the Mental Health Unit at the Pan American Health Organization, in a press release. “We need concrete action from all elements of society to put an end to these deaths, and for governments to create and invest in a comprehensive national strategy to improve suicide prevention and care.”

Currently only 38 countries have a national strategy for suicide prevention. 

According to suicide prevention activists, there is a historic opportunity to push for reforms in light of the commitments to achieving the Sustainable Development Goals – one of which is the reduction of suicide – and the WHO Mental Health Action Plan 2020-2030. 

In low- and middle-income countries, countries have been called to ban or severely restrict access to acutely toxic and highly hazardous pesticides, which are often widely available on the market, and cause 20% of all suicides worldwide.  Globally, restricting access to firearms, reducing the size of medication packages, and install barriers at jump sites after other critical measures. 

Training for healthcare professionals in early identification, assessment, management, and follow-up is necessary to support those at risk of suicide. 

Image Credits: WHO, WHO.

Integration of care is important for patients’ wellbeing.

Health services in low and middle-income countries have yet to adapt to their growing burden of non-communicable diseases (NCDs) and still prioritise infectious diseases, according to a new report launched on Thursday by the NCD Alliance.

Treatment “silos” for HIV and tuberculosis need to be transformed into integrated universal healthcare services to better serve people in LMICs, many of whom are living with both infectious diseases and NCDs, according to the report.

“COVID-19 has brought about a greater recognition that the long-held distinctions between infectious and non-communicable diseases are not as clear cut as once thought – those with chronic conditions have a significantly higher risk of hospitalisation or death from the virus,” according to the NCD Alliance. 

The vast majority of people who have become seriously ill or died from COVID-19 had an underlying condition, particularly hypertension, cardiovascular disease and diabetes, it notes.

Integrated care ‘is the future’

“We urgently need a reset of healthcare delivery in poorer countries that actually reflects the needs of those who need it most,” said Katie Dain, CEO of the NCD Alliance. 

“Integrated care is the future of healthcare. The reality today is that ever more people are living with multiple chronic conditions. This needs to be better recognised in health systems. 

Dain added that infectious diseases and NCDs were entwined: “People living with HIV have a significantly higher risk of cardiovascular disease and some cancers. People living with TB are much more susceptible to diabetes and vice-versa. 

“Hypertensive disorders and gestational diabetes affect many pregnancies, risking potential lifelong health impacts for both mother and child if not effectively treated.”

“LMICs are experiencing a rapid transition from population disease profiles shaped by communicable diseases and conditions impacting mothers and their children, to those dominated by NCDs and injuries. Today, 85% of people dying from NCDs between ages 30 and 70 are in LMICs,” according to the NCD Alliance.

One in three diseases among the poorest billion people in the world are NCDs, according to the Lancet NCDI Poverty Commission.

Cardiovascular diseases account for most NCD deaths (17.9 million people annually), followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). These four groups of diseases account for over 80 percent of all  NCD deaths before the age of 70.

“Health centres that reflect this changing epidemiology are the future,” said Dain. “But this will also mean that we have to change the way we do business. The COVID-19 pandemic has been catastrophic for people living with NCDs and it is clear we need a health infrastructure in LMICs that is fit for purpose if we are to build back better.”

HIV, TB funding influences health system

The report’s lead author, Dr Gill Schierhout from the George Institute for Global Health, said that many LMIC health systems were still influenced by funding for HIV, TB, malaria and maternal health.

“The shape of this [funding] has critical impacts on the health care available – or not available – for the growing number of people who are living with NCDs in LMICs,” said Schierhout.

The report was based on an online survey that was sent to health workers in LMIC. Survey respondents identified that there were particular challenges posed by staffing siloes, and organisational ambivalence around the integration effort.

In addition, specialist managers of global health initiatives are sometimes “well versed in disease-focused areas, but not as well versed in whole-of-person care or primary health care. Therefore, programmes often struggle to gain the necessary management support”, according to the report.

However, the report documents a number of integration  successes. In Zambia, for example,  a cervical cancer screening has been integrated into an HIV care programme. It modelled that, for every 46 HIV-positive women screened, a woman’s life was saved who otherwise would likely have died of undetected cervical cancer.

More than a decade ago Ministers of Health resolved at the first UN High-Level Meeting on NCDs to “encourage the development, integration and implementation of vertical programmes, including disease-specific programmes, in the context of integrated primary health care”. 

“However, progress in this area has been patchy at best,” noted the NCD Alliance.

 

 

Image Credits: NCD Alliance, WHO/A. Loke.