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

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

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

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

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

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

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

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

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

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

Rise in substance abuse

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

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

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

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

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

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

Financial pressure drives stress in poorer countries

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

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

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

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

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

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

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

Invest in mental health services, says WHO

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

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

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

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

 

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

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

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

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

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

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

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

Finland becomes the first to test the medicines

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

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

Manufacturers of the drugs have donated stock to Solidarity Plus. 

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

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

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

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

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

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

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

Four targets to treat COVID infection

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

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

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

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

 

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

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

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

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

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

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

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

The four main goals of the summit are to: 

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

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

Key emitters miss deadline to deliver climate pledges

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leaders call for action and consensus at COP26

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

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

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

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

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

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

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

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

Fossil fuel from rich countries hurting lives in developing world

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

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

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

Image Credits: Commons Wikimedia, Brendan Cox / Oxfam.

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

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

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

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

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

Ban on birth partners

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

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

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

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

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

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

Austerity measures threaten community-based care 

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

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

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

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

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

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

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

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

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

 

Image Credits: Elizabeth Poll/MMV.

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

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

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

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

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

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

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

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

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

Extreme heat exposure threatens livelihoods and health 

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

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

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

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

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

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

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

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

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

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

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

Extreme weather affects infrastructure, displaces people 

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

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

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

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

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

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

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

Climate change jeopardizes nutrition and food security

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

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

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

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

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

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

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

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

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

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

Calls for urgent and large-scale actions to reduce emissions 

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

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

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

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

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

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

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

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

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

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

Messages to COP26 participants

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

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

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

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

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

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

Image Credits: Issy Bailey/ Unsplash, FAO.

Pakistani soldiers closing markets during the COVID-19 pandemic.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All my siblings and mother tested positive

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more in our #COVIDReporting series, read:

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

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

 

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

Follow him on Twitter @TheRahulRajput

 

 

 

 

Image Credits: Mohammed Nadeem Chaudhry.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘My husband will never agree to family planning’ 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Raihana Maqbool.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Real health impacts are still under-assessed  

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

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

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

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

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

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

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

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

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

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

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

Mitigation costs and benefits compared from the health angle 

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition, the few innovative treatments that exist are mostly available in high-income countries, and DNDi warns that the world risks “replicating the vaccine inequality that has become a defining characteristic of this global pandemic” if these are not shared with low and middle-income countries (LMIC).

To arrest the progress of COVID-19, there is a “clear rationale emerging” that strong antivirals combined with host-directed therapies (anti-inflammatories and immunomodulators) need to be given to patients during the first few days of infection, according to the report.

“Efforts are today rightly focused on identifying novel antivirals, additional repurposed therapeutics, and more affordable and adapted new approaches, such as second-generation monoclonal antibodies and other biologics,” it adds. 

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

Change the governance of ACT-Accelerator

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

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

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

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

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

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

COVID could become endemic to Africa

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

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

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

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

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

Image Credits: DNDi.

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

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

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

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

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

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

Major vaccine announcement expected in the coming days

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

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

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

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

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

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

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

COVAX
COVAX vaccine deliveries in Africa.

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

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

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

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

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

Africa CDC director Dr John Nkengasong

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

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

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

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