Attacks on health facilities appear to be part of a deliberate war strategy in Ukraine and other recent conflicts, according to the head of the World Health Organization (WHO) health emergencies programme.

The WHO has verified 43 attacks on Ukrainian health facilities since Russia’s invasion on 24 February – and it expects further attacks as over 300 health facilities in conflict areas or under Russian control and a further 600 facilities within 10 kilometres of conflict.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday that there had also been 46 attacks on health facilities worldwide since the start of 2022, and people caught in conflicts in Tigray, Yemen and Syria were in extreme need of humanitarian assistance. 

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme, said that in these conflict zones, attacks on health facilities appeared to be deliberate – in complete violation of international law.

“We have never seen this rate of attacks on health care, and health care becoming a target in these situations. It’s becoming part of the strategy and tactics of war and it is entirely unacceptable,” said Ryan.

“Under international humanitarian law. conflicting parties are actually instructed to specifically take measures to avoid attacking or inadvertently destroying or hurting health workers or health facilities. They don’t bear responsibility not just to not attack. They actually bear responsibility to ensure that they don’t attack to identify those facilities, to deconflict those facilities and to ensure that they do not, as part of their prosecution of war, attack those facilities,”  he added.

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme.

Multiple conflicts out of the global eye

“Although Ukraine is the focus of the world’s attention, it’s far from the only crisis to which WHO is responding,” said Tedros.

“In Yemen, roughly two-thirds of the population – more than 20 million people – are estimated to be in need of health assistance. In Afghanistan, more than half the population is in need, with widespread malnutrition and a surge in measles among many other challenges. 

“And in Ethiopia, six million people in Tigray have been under blockade by Ethiopian and Eritrean forces for almost 500 days, sealed off from the outside world. There is almost no fuel, no cash and no communications. No food aid has been delivered since the middle of December and 83% of the population is food insecure,” said Tedros, who is from Tigray and added his family and friends were affected by the blockade.

Aid to Ukraine – but little for Tigray

WHO Director-General Dr Tedros Adhanom Ghebreyesus.

The WHO has been able to deliver about 100 metric tonnes of supplies to Ukraine, including oxygen, insulin, surgical supplies, anaesthetics and blood transfusion kits; oxygen generators, electrical generators and defibrillators.

However, it had only received $8million of the $57.5 million it needed to support Ukraine.

In contrast, however, it had only been able to airlift 33 metric tonnes of medicines and other supplies to Tigray in December – enough for 300,000 people – after being denied access to the territory since last July.

“We estimate that 2,200 metric tonnes of emergency health supplies are needed to respond to urgent health needs in Tigray,” said Tedros.

Treatment for 46,000 Tigrayan people living with HIV has been abandoned, as has treatment for people with cancer, diabetes, hypertension and tuberculosis.

“The situation in Tigray is catastrophic. The blockade on communications, including on journalists being able to report from Tigray, means it remains a forgotten crisis. Out of sight and out of mind,” added Tedros.

“Just as we continue to call on Russia to make peace in Ukraine, so we continue to call on Ethiopia and Eritrea to end the blockade, the siege, and allow safe access for humanitarian supplies and workers to save lives,” said Tedros.

Global COVID-19 cases rise again

Meanwhile, after weeks of global decline COVID-19 cases are on the rise again, especially in parts of Asia. 

“In the last week, we saw an 8% increase in cases detected with more than 11 million cases reported to WHO despite a significant reduction in testing that’s occurring worldwide,” said WHO COVID-19 lead Dr Maria van Kerkhove.

She ascribed the increase to the spread of the Omicron variant – particularly the BA.2 lineage which is “the most transmissible variant we have seen of the SARS Co-V2 virus to date” – in a context where restrictions were being lifted globally.

Ryan added that the virus would move from one “pocket of susceptibility” where immunity was waning to another.

“The likelihood is that this virus will echo around the world,” said Ryan. “It will pick up pockets of susceptibility and will survive in those pockets for months and months until another pocket of susceptibility opens up,” said Ryan. 

“This is how viruses work. They establish themselves within a community and they will move quickly to the next community that’s unprotected. If communities around the virus are well protected, the virus can sustain itself, even in small communities. It can stay there, it can rest there, and then wait until susceptibility grows.”

Image Credits: Markus Spiske/ Unsplash.

WTO members last week in session at the TRIPS Council, which has been debating a controversial proposal for an IP waiver on COVID products for over a year.

The World Trade Organization’s (WTO) Director-Genera, Dr Ngozi Okonjo-Iweala has “warmly welcomed” the breakthrough reached this week over a waiver on intellectual property for the production of COVID-19 vaccines.

“This is a major step forward and this compromise is the result of many long and difficult hours of negotiations. But we are not there yet. We have more work to do to ensure that we have the support of the entire WTO Membership,” said Okonjo-Iweala, in a statement on Wednesday.

The agreement reached between the European Union, India, South Africa and the United States – referred to in some quarters as “the Quad” – still needs to be put to all 164 WTO members, which typically decides by consensus.

However, the compromise now has good chances of being approved since EU countries had been the major opponents to the proposal by South Africa and India, submitted in October 2020, to waive IP on COVID-19 vaccines and other pandemic-related health products for the duration of the pandemic. 

Major concessions

South Africa and India had to make major conceessions  – both narrowing the waiver to only vaccines, as well as narrowing the list of countries that would be eligible to take advantage of the waiver on patents and other IP.     

“My team and I have been working hard for the past three months and we are ready to roll up our sleeves again to work together with the TRIPS Council Chair Ambassador Lansana Gberie (Sierra Leone) to bring about a full agreement as quickly as possible. We are grateful to the four Members for the difficult work they have undertaken so far,” said Okonjo-Iweala.

The WTO’s Ministerial Council (MC12), postponed from late November to the week of June 13, could potentially approve the waiver move – although the date of that meeting has also been cast into doubt due to the recent outbreak of war in the Ukraine. 

However, the draft text of the proposed compromise, published by STAT News Tuesday evening, has elicited dismay from both health activists and the pharmaceutical industry – for not going far enough, or for going too far.

Restricted to vaccines and certain developing countries

In essence, the compromise does three things:

  • Most critically, the new waiver would allow developing countries to not only manufacture, but also to export, generic versions of COVID vaccines that are still under patent protection. Currently, Article 31.f of the WTO Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement restricts such generic manufacture to health products that are “predominantly for the supply of the domestic market” – leaving low-income countries with no manufacturing base unable to import cheaper generic versions of products from abroad. 
  • However, the waiver would be limited to countries that exported less than 10% of the world’s vaccines in 2021. That effectively excludes well-established manufacturers in China, but not India, from waiver eligibility. 
  • In contrast to the original Indian-South African proposal, the new IP flexibilities are restricted to COVID vaccines, thus excluding COVID treatments such as new antivirals that are particularly important for countries with low vaccination rates, as well as tests, personal protective equipment (PPE) and other pandemic-related goods.

Adam Hodge, spokesperson for US Trade Representative Ambassador Katherine Tai, said late Tuesday that the “compromise outcome that offers the most promising path toward achieving a concrete and meaningful outcome” after a “difficult and protracted process”.

He and others cautioned that details of a final text were yet to be concluded. 

“While no agreement on text has been reached and we are in the process of consulting on the outcome, the US will continue to engage with WTO Members as part of our comprehensive effort to get as many safe and effective vaccines to as many people as fast as possible,” added Hodge.

The informal discussions, led by the WTO Secretariat, have been trying to break the deadlock between the India-South Africa waiver proposal (supported by the Africa and Least Developed Nations groups and others) and the EU’s counter-proposal.  

India-South Africa proposal had sought a broad waiver on all vaccines, tests and treatments, while the EU had pushed for technical modifications in the existing TRIPS rules. 

Medicines access activists and pharma leaders both express dismay 

Both activists and industry reacted with dismay to news of the proposed agreement. For example, the US-based consumer advocacy group, Public Citizen, called on WTO member states to reject the proposal.

“Among its key limitations: the proposal appears to cover only vaccines (not tests and treatments), cover only patents (not other important intellectual property barriers), be limited geographically, and further undermine current WTO flexibilities for compulsory licenses,” according to Melinda St Louis, director of Public Citizen’s Global Trade Watch division.

“It would be a mistake for WTO members to prematurely agree to a weakened waiver that provides political cover to the US and EU while not making any meaningful difference in increasing access to vaccines, tests and treatments. No waiver is better than a weak waiver designed solely to save face,” added St Louis.

Knowledge Ecology International also expressed disquiet, saying that the waiver may even restrict certain flexibilities that are already allowed by Article 31 of the WTO Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), regarding a country’s rights to manufacture and export generic versions of drugs or vaccines during a health emergency. 

“Countries are required to follow Article 31 of the TRIPS [agreement], which of course, is an existing and not a new flexibility, but with ‘clarifications’,” noted KEI’s Director, James Love.

However, those “clarifications”, also come with new obligations that could make Article 31 “more restrictive and burdensome”, such as a new obligation for a country to identify all of the patents to which it is applying an IP waiver, and to notify the WTO of its use of the waiver –  something not required for the issuance of compulsory licenses in general.  

On the other hand, the draft agreement makes a first-ever reference to a 2005 WHO/UNDP guidance on payments by developing countries to the original patent-holder, which embraces the concept of “tiered royalties”, based on a country’s ability to pay, and authored by Love himself.

Pharma says agreement sends ‘wrong signal’

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that “weakening patents now when it is widely acknowledged that there are no longer supply constraints of COVID-19 vaccines, sends the wrong signal”. 

“​​When the IP TRIPS Waiver was first proposed in 2020, it was to the wrong solution to the problem of scaling up manufacturing of potential COVID-19 vaccines which at the time had not yet even been authorized,” said the IFPMA.

“Now the problem of supply has been addressed thanks to unprecedented collaboration involving companies from industrialized and developing countries, the TRIPS Waiver is not only the wrong solution, it is also an outdated proposal, that has been overtaken by events.”

It added that the TRIPS waiver proposal is “political posturing that are at best a distraction, at worse creating uncertainty that can undermine innovation’s ability to respond to the current and future response to pandemics”. 

“The current proposals should be shelved; and the focus should be directed, to admittedly more difficult actions that will change lives for the better: supporting country readiness, contributing to equitable distribution, and driving innovation,” the IFPMA concluded.

The final text of any agreement would first need to be approved by the WTO TRIPS Council, and then go before the MC12 for final approval. 

The TRIPS Council last met on 9-10 March, but at the time failed to reach a compromise – although some sources noted that the were close to agreement as the “Quad” of India, South Africa, the United States and the EU scrambled to reach a deal.

According to a WTO statement on 10 March, the TRIPS Council had agreed to keep the agenda item on the IP waiver open – so as to enable the council to be “reconvened at short notice if substantial progress is made in the high-level talks”.  TRIPS Council approval would pave the way for a consensus agreement at the WTO’s Ministerial meeting, MC12. 

Mariupol Regional Hospital before it was bombed

Health workers, patients and civilians have been held hostage at the Mariupol regional intensive care hospital in Ukraine by Russian troops since Monday morning, according to the Media Initiative for Human Rights (MIHR).

Russian soldiers are using the hospital as a base to attack Ukrainian forces, and using the hostages as “human shields” according to MIHR, a respected human rights monitoring group in Ukraine.

“We received information from a doctor from the hospital. We can’t name him because of the threat to him. More information will be available after the person is safe,” the MIHR reported on its Facebook page.

Pavlo Kyrylenko, head of the Donetsk regional administration, also reported the hostage situation on his Telegram account.

Kyrylenko reported that a hostage had told him: “It is impossible to leave the hospital. There is heavy shelling. We sit in the basement. Cars have not been able to drive into the hospital for two days. High-rise buildings are burning around… Russians rushed 400 people from neighbouring houses to our hospital. We can’t leave. “

While the 550-bed tertiary hospital, the biggest in the Donetsk region, has suffered extensive damage, health workers have continued to attend to patients from the basement.

“I appeal to international human rights organizations to respond to these vicious violations of the norms and customs of war, to these egregious crimes against humanity,” said Kyrylenko.

Humanitarian groups have been appealing for days for a safe passage corridor to and from Mariupol. Some private cars were finally able to leave the city on Monday and Tuesday, the first time in 10 days. But Russian troops that have beseiged the city on all sides have not allowed relief workers to bring in desperately needed medical supplies, food or water.

Last week, Russian troops bombed the Mariupol maternity hospital, reportedly killing at least three people. A pregnant woman evacuated from the hospital and her baby later died from their injuries.

Mariupol’s deputy mayor, Sergey Orlov, told France24 on Tuesday that at least 2,358 people had been killed during the 11-day siege of the south-eastern city, and he had been fielding desperate calls from people trapped in basements without food or water.

‘Act of unconscionable cruelty’

The World Health Organization (WHO) has verified 31 attacks on health facilities between the start of the Russian invasion on 24 February and 11 March, resulting in 12 deaths and 34 injuries, of which 8 of the injured and 2 of those killed were health workers. 

“We call for an immediate cessation of all attacks on health care in Ukraine. These horrific attacks are killing and causing serious injuries to patients and health workers, destroying vital health infrastructure and forcing thousands to forgo accessing health services despite catastrophic needs,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus,  UNICEF Executive Director Catherine Russell and UNFPA Executive Director Dr Natalia Kanem, in a joint statement on Sunday.

“To attack the most vulnerable – babies, children, pregnant women, and those already suffering from illness and disease, and health workers risking their own lives to save lives – is an act of unconscionable cruelty,” they added.

“We must be able to safely deliver emergency medical supplies – including those required for obstetric and neonatal care – to health centers, temporary facilities and underground shelters.”

Intentionally attacking health facilities is prohibited under international humanitarian law. 

Unusual position of surrogates

Since the start of the war, more than 4,300 Ukrainian women have given birth, and  80,000 others are expected to give birth in the next three months. 

“Oxygen and medical supplies, including for the management of pregnancy complications, are running dangerously low,” according to the three leaders.

“Many pregnant women may need health care, medication and assistance on a daily basis or when complications with pregnancy occur. When medical facilities are not accessible, are destroyed, or health care personnel and medical product are scarce or unavailable, maternal health can be endangered,” according to Eszther Kisomodi and Emma Pitchford, the chief executive and executive editor respectively of the journal, Sexual and Reproductive Health Matters.

They also warned that many pregnant women might be in “particular and unusual situations” as Ukraine “is an international surrogacy hub, one of only a handful of countries in the world that legally allows foreigners to enter into surrogacy arrangements”.

https://twitter.com/thedalstonyears/status/1501861609446289410

“Being a surrogate is a job in Ukraine for many women, but not one that they can quit, or even put on hold. Very serious questions occur for all parties in this arrangement – for the pregnant women, the newborn child and the intended parents.”

The authors also highlight the precarious position of people with disabilities who cannot move easily, LBGTQ people in the face of hostile Russian forces, and people living with HIV in Ukraine, which has the second-highest infection rate in Europe.

The COVID-19 pandemic has killed 6 million people so far, but the next pandemic threat could emerge unnecessarily from pathogen resistance to life-saving antibiotics and other anti-microbial drugs. What steps do we need to take now to head off this growing threat?

For decades, antibiotics have been hailed as “wonder drugs” for their ability to turn life-threatening infections into treatable conditions.  By one estimate, antibiotics have extended average human life expectancy by more than 20 years since their discovery almost a century ago. 

But today, we are on the brink of losing this powerful tool – a warning that Alexander Fleming conveyed in his Nobel acceptance speech in 1945 for the discovery of penicillin, the world’s first broad-spectrum antibiotic: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops”.

He challenged listeners with a hypothetical illustration: “Mr X has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs X dies. Who is primarily responsible for Mrs X’s death? Why, Mr X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.”

 Sadly, this is not an imaginary exercise. It’s a grim reality. It’s the world we’re living in today. In a biologically dictated race to survive, bacteria evolve and eventually become strong enough to defeat the world’s current arsenal of antibiotics.  People acquire infections that can’t be treated.  The result is the antimicrobial resistance (AMR) crisis the world faces today. 

AMR: The stealth and silent pandemic

The most comprehensive estimate to date, recently published in The Lancet, shows that antimicrobial-resistant bacteria may have directly accounted for 1.27 million deaths in 2019. A further 4.95 million deaths were associated with AMR, making it a stealthy and silent pandemic.

How have we failed to heed Fleming’s warning about AMR?

There are many forces driving AMR. Perhaps one of the most important is the rampant over-prescription of antibiotics. According to the US Centers for Disease Control and Prevention (CDC), nearly one-third of all antibiotics prescribed in the US are unnecessary.  In India, the consumption of antibiotics more than doubled between 2000 and 2015, in part because these drugs are widely available over-the-counter without a doctor’s prescription. 

But there are ways to slow the march of AMR. Beyond promoting better stewardship for the appropriate use of antibiotics, reducing the risk of AMR also requires higher awareness among both doctors and patients; better access to diagnostics to guide the prescription of the right antibiotic at the right time; better sanitation measures; responsible manufacturing; and better surveillance by governments. But along with these steps, we must restock the antibiotics R&D pipeline with novel ones that have a better chance of overcoming current resistance.

Clearly, no single player or sector can tackle AMR alone. The scale of the challenge may seem daunting, but it has certainly galvanized action. As chair of the AMR Industry Alliance, the world’s largest life-sciences coalition gathering more than 100 biotechnology, diagnostics, generic and large research-based pharmaceutical companies and associations, I witness how every life-sciences industry sector contributes to co-creating solutions that make a difference.  

Industry’s fight against AMR

In February, the Alliance released its latest Progress Report reflecting the work the life-sciences industry is undertaking to address the threat of AMR, across four different areas: research and science, access, appropriate use, and manufacturing and the environment.  The report, based on independent, quality-assured research conducted by the not-for-profit policy research organization RAND Europe, analyses data from a survey of Alliance member companies.

It found that about four out of five responding companies are actively engaged in promoting better stewardship of antibiotics and the appropriate use of these drugs to guard against over-prescription. An even larger proportion – 85 percent of responding companies – are making significant contributions to the responsible manufacturing of antibiotics.

The report also found that the private sector remains one of the key funders of AMR-related R&D, with at least $1.8 billion invested by Alliance members. Alliance members contributed to R&D on 93 products or technologies spanning 54 antibiotics and antifungals, 12 vaccines, 13 diagnostic platforms and assays and 14 non-traditional or other products. Alliance members continue to conduct R&D on AMR priority pathogens. However, these funding levels are at risk given challenging market conditions for antibiotic development. This is where continued dialogue between industry and wider stakeholders will be needed to ensure a scalable and sustainable incentive system.

Four priorities for collaborative action

 While industry is making progress in many areas, contributions from and collaboration among all stakeholders is needed. There are four key priorities where AMR Industry Alliance members see scope for action:

 First, to support research and science, the AMR Industry Alliance calls for greater public-sector investment in R&D and a clinical trial infrastructure to promote better innovation in the development of new antibiotics. Continued public-private collaboration between and among universities, hospitals and pharmaceutical companies is also essential and should be expanded to include more biotech, diagnostics and generics manufacturers.

To create the market conditions needed to encourage the pipeline, particularly the later and more resource-intensive stages of clinical research, governments should implement so-called “pull” incentives. New antibiotics are typically locked away and reserved for when existing antibiotics become ineffective against antimicrobial-resistant infections. Pull incentives correct this marketplace flaw by rewarding new antibiotics according to their value to society, not merely how many prescriptions are written.  This enables companies to recover their investments, drawing even more financial and scientific resources into the battle against AMR.

Second, to make access more equitable, especially in low- and middle-income countries, all stakeholders should work together to improve the way antibiotics are ordered, purchased and supplied, including forecasting demand for key antibiotics, as well as the tendering process. This will strengthen manufacturing capacity and supply chains and broaden distribution channels to create a sustainable supply of quality-assured antibiotics.  These efforts should be supplemented by awareness campaigns that educate patients and the medical community about substandard or fake products in the marketplace.

Third, to encourage appropriate use of antibiotics and cut down on over-prescription, governments, health care providers and pharmaceutical and diagnostics companies need to work together on communications campaigns that raise awareness, reduce sales of antibiotics without prescriptions and curb the overuse of critical antibiotics by following the guidance provided by the WHO AWaRe classification.  Better surveillance of AMR through improved data collection and increased public reporting of infection rates and antibiotics use is also essential. 

Fourth, to promote responsible manufacturing, stakeholders should also work together to develop and implement international standards for responsible antibiotics manufacturing. The Alliance and our members have been actively working towards this objective, and in the absence of such standards, in 2018, established the Common Antibiotic Manufacturing Framework (CAMF), a set of guidelines to assess risk and reduce antibiotic emissions across global supply chains, as well as a list of Predicted No-Effect Concentrations (PNECs) to serve as discharge targets for manufacturers. Our Progress Report shows that Alliance members are acting on this guidance even as we pursue standards.

Silent no more

We still have a lot of ground to cover. In the six years remaining until the centenary of the discovery of penicillin, we need a strong showing of collective action to spur and sustain responsible stewardship and innovation against AMR. By doing so, we can make sure that future generations can continue to rely on these life-saving tools.

AMR won’t race across the world at the same speed as COVID-19, but its effects will be equally devastating. After far too much silence on AMR, the alarms bells are now ringing.  We can’t afford not to respond.

Thomas Cueni, director general of the IFPMA

Thomas B. Cueni is chair of the AMR Industry Alliance and the Director-General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).

 

Image Credits: IFPMA .

Unconscious and intubated Covid-19 patients are treated in Vila Penteado Hospital’s ICU, in Sao Paulo, Brazil.

The first session of the newly constituted Intergovernmental Negotiating Body (INB) to draft a “pandemic preparedness instrument” for the World Health Organization (WHO) began on Monday.

The six-member body, representing all WHO regions, is made up of Precious Matsoso (South Africa), Roland Driece (the Netherlands), Ambassador Tovar da Silva Nunes (Brazil), Ahmed Salama Soliman (Egypt), Kazuho Taguchi (Japan) and Viroj Tangcharoensathien (Thailand).

The two-day session will elect two co-chairs, as well as agree on the working methods and timelines of body “based on the principles of inclusiveness, transparency, efficiency, Member State leadership and consensus”, according to the agenda.

Meanwhile, almost 200 civil society leaders have asked the six negotiators to protect the process from any “undue influence of the private sector and its powerful lobbyists”.

In an open letter addressed the six negotiators, the leaders have asked the INB to pay attention to a number of issues including:

  • The multiple determinants of potential future pandemics, including the inherent injustice and structural inequities exacerbated by such crises
  • The interconnected dynamics of issues, including the unsustainable food production and livestock breeding, wildlife trading, resource-intensive lifestyles and consumption, destruction of ecosystems, antimicrobial resistance and soaring figures of cancer
  • The state of universal public health systems and their workforce 
  • Incoherent policymaking by Member States and the lack of international cooperation
  • Ensuring more inclusive engagement in the treaty-making process that balance the Member State-driven delicate diplomatic process and protect it from the undue influence of the private sector and its powerful lobbyists.

The letter has been facilitated by the Geneva Global Health Hub (G2H2), as a service to its members involved in this process.

Image Credits: Adnan Abidi/Flickr, Ninian Reid/Flickr.

A member of a Community Action Cell speaks to a woman outside her home in Kinshasa about the COVID-19 vaccine.

With fewer than 1% of its 90 million citizens vaccinated against COVID-19, the Democratic Republic of Congo (DRC) has resorted to training teams of “rumour-busters” to tackle misinformation about the virus in order to encourage more people to get the vaccine.

David Olela, communications lead for the DRC health ministry’s vaccination programme,  admits that his government had been “stuck”, with “no idea how to combat both the pandemic and the disinformation at the same time” until it got help from “infodemic experts”.

Health workers, religious and community leaders and journalists spread across the DRC’s vast landmass of around 2.3 million square kilometres have been trained to help combat misinformation.

“Having a local team trained in rumour management has helped us turn an anti-vaccine narrative into a pro-vaccine one,” says Olela, whose ministry is being supported by partners including the World Health Organization (WHO) and UNICEF. 

Rumours about pork in vaccines

Imam Famba Ali Huseini, leader of the Usoke Central Mosque in Kinshasa, is one of 30 imams who has been trained in the capital city.

“At the start of the pandemic, we were inundated with rumours and disinformation on COVID-19 and vaccines,” says Huseini. “In Kinshasa’s Muslim community, people feared the vaccine. Some thought Africans were being used as guinea pigs, and that the vaccines were made with pork gelatine.”

Part of their training involved a doctor explaining how the vaccine was made to show that no pig gelatine was involved. But more impressive for Huseini was learning that people in Muslim countries such as Saudi Arabia and Indonesia had accepted the vaccine. Around 10% of DRC citizens are Muslim.

More than 600 health workers have been trained in identifying and refuting myths surrounding the COVID-19 vaccine. Question-and-answer sessions on rumour refutation have also been organized in the national parliament, before 300 national and provincial representatives.

In addition, 144 media professionals have been trained in fact-checking and source reliability. This includes Congo Check, an online fact-checking agency, which has been exposing fake news about the pandemic and vaccines.

Hesitation to call out vaccine ‘hesitancy’

While none of the international agencies working in the DRC is willing to ascribe the low vaccination rate to “vaccine hesitancy”, it is evident that the country is facing a huge struggle to win people over to vaccines.

A survey conducted in November involving 74,388 people found that respondents were split equally between those that supported vaccinations and those who didn’t (see above).

For those who are not yet vaccinated, the main reason (28%) was that they “don’t believe in them”. The second most popular reason was that the person felt healthy (18%), followed by fear about vaccine side effects (13%).

But even the survey itself was met with apathy. It had tried to solicit the views of almost two million people and only got a 4% response.

In late 2020, an online survey of 4131 people conducted by researchers from the University of Kinshasa found that a quarter of respondents doubted the existence of COVID-19. 

However, 55,9% were prepared to be vaccinated. Among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) indicated they did not trust the vaccine. Some also believed it had been made to kill Africans (14,4%) or to sterilise people(5.9%).

SMS campaign to promote vaccines

A COVID-19 vaccination site in the Democratic Republic of Congo.

Overall, immunisation in the DRC is low even for well-established diseases, according to WHO and UNICEF. In 2019, 57% of people were vaccinated against Hepatitis B, 73% had the BCG vaccine against tuberculosis and only 59% had been vaccinated against polio.

UNICEF ascribes the low vaccine uptake to “chronic poverty, limited essential service infrastructure, disease outbreaks, recurrent armed conflict, massive displacement and the lack of a steady supply of vaccine doses”.

To address this, UNICEF and partners – including the mobile network operators Orange, Vodacom and Africell – launched an SMS campaign in late 2021 to support the COVID-19 vaccination campaign.

To start with, 16 million people in 15 priority provinces were sent messages encouraging them to get vaccinated by registering online by SMSing a toll-free number where they would get instructions in five main local languages. 

After four weeks, 54,000 people had registered and the government was able to prioritise delivery to areas where there is strong interest in getting vaccinated.

Bad history with COVID vaccine supply

But the DRC’s history with COVID-19 vaccines has been fraught from the start, and the supply chain problems affecting COVAX, the global vaccine access platform, did not help.

Within a month of getting 1.7 million Astra Zeneca vaccines from COVAX in March last year, the DRC stopped its vaccine rollout over concerns about blood clots. Three-quarters of these vaccines were then redeployed to other African countries to prevent them from expiring. 

But once concerns about blood clots had been addressed (found to be a rare risk outweighed by benefits), COVAX’s supply chain had dried up as India had halted the export of AstraZeneca vaccines manufactured by the Serum Institute of India, COVAX’s main supplier. 

The lack of a reliable supply of vaccines made it hard for the DRC to plan a rollout or prepare people for their arrival.

Now that a reliable stream of vaccines is available through COVAX, the DRC government is trying to speed up its vaccination programme but it has a lot of lost ground to catch up.

“Our objective is to enable 50 million Congolese to receive the vaccine by the end of 2022 and thus be better protected against the disease,” says Elisabeth Mukamba, director ot the Expanded Program on Immunization. “This innovative SMS pre-registration initiative is welcome and allows us to communicate more quickly and effectively, even in the most remote communities.”

Image Credits: Christian Mokili/ UNICEF, Gavi/2021/STARRY.

COVID-19 cases have surged to their highest in nearly two years in China.

COVID-19 cases reached their highest level in nearly two years in China on Sunday, with 1,437 cases on the mainland, according to China’s National Health Commission.

Cases have more than doubled since 10 March when 588 cases were recorded. This surge in cases, driven by the Omicron variant, has prompted the country, which has a strict zero-COVID policy, to impose fresh restrictions in provinces with a high infection rates.

It has already shutdown Jilin province which reported 895 cases on 13 March, and the mayors of Jilin city and the Jiutai district of the city of Changchun have been dismissed owing to the outbreak, according to a state-run news agency.

China has also imposed stricter restrictions on two other cities last week– Shenzhen and Shanghai. Shenzhen, which borders Hong Kong and is known to be a major hub for electrical manufacturing, is under a seven-day complete lockdown. The city, which has a population of 17.5 million people, has been brought to a complete standstill with businesses suspending operations, and public transportation halting their operations. 

According to one of China’s leading infectious disease experts, Zhang Wenhong,the domestic epidemic in China is “currently in the early stage of an exponential rise”.

He wrote on China’s microblogging site, Weibo, that if China opens up quickly now, it will cause infection of a large number of people in a short period of time. “Even a low case fatality rate will cause a run on medical resources and a short-term shock in social life, causing irreparable damage to society and families,” he said. 

Hong Kong’s high death rate

In the last 24 hours, Hong Kong reported 13,332 local cases had been diagnosed with Nucleic Acid Amplification Tests (most commonly PCR tests), while 19,095 fresh cases had been detected using the rapid antigen tests.

However, Hong Kong Leader Carrie Lam told a daily briefing that there were no plans to tighten the social distancing measures owing to the limited scope offered by the current measures in place. The country has so far witnessed 263,411 cases.

Hong Kong, like China, has a zero-COVID policy. Currently, it is compulsory to wear masks everywhere, no gatherings of more than two people are allowed, and schools and public venues are closed. 

While the former British colony has been struggling to manage an influx of patients at its hospitals, Hong Kong is slowly seeing a slowdown in the daily infection rate

According to Bloomberg, Hong Kong has registered the most deaths per million people globally in the week to 10 March. Some 286 deaths were reported on Monday. This takes the death toll to 43,279.

Meanwhile, Hong Kong opened its fourth community isolation facility on 13 March with over 1,000 beds and the region has also been working with the mainland authorities to build 90,000 isolation units to accommodate patients with mild or no symptoms, reports Reuters.

Low vaccination to blame 

Lam has blamed the low vaccination rate in Hong Kong as a factor in the high rate of deaths and infections.

“We have spent over one year to promote, encourage, coerce people to take the jab. But unfortunately, the entire society partly because of the low infection rate in the last year or so and partly because of anxiety and worries and so on, we have not achieved this high rate of vaccination, especially among the elderly,” Lam said at a press conference on Monday.

According to Hong Kong’s Department of Health, 89% of those who died in the fifth wave of Covid-19 had not received any dose of vaccination. 

Wenhong said that China must start implementing more complete, smart, and sustainable coping strategies like booster shots for the elderly and improved vaccination strategies, widely available oral drugs, affordable and widely available home testing kits, effectively trained and rehearsed hierarchical diagnosis and treatment strategies, along with better home isolation process. 

Image Credits: Flickr.

The mRNA vaccines (administered above) don’t affect fertility treatment for women or men.

The mRNA-based COVID-19 vaccines do not harm in vitro fertilization (IVF) success rates, according to a recent study, countering disinformation that vaccines could negatively affect fertility.

In contrast, the SARS-CoV2 virus has been found to negatively affect the quality of embryos for couples who are undergoing IVF treatments and sperm.

The peer-reviewed study, published in the journal Fertility and Sterility, involved 428 women aged up to 38 years of age – some vaccinated and some not – between January and August 2021. In total, the women went through 672 embryo transfers and around a quarter (23% to 26%) of the transfers led to pregnancies in all cases, regardless of whether the women were vaccinated or had been infected with COVID-19.

The study group was composed of 141 women either vaccinated with two mRNA coronavirus vaccines or recovered from the virus, and therefore all with COVID antibodies.

“One of the concerns raised by women of childbearing age around the world since the introduction of the coronavirus vaccine was that it could negatively impact IVF treatments,” said Prof Raoul Orvieto, director of Sheba Medical Center’s Infertility and IVF Institute in Israel.

“Many concerned women and mothers have approached us on this issue. This groundbreaking study shows that the vaccine does not affect a woman’s chance of getting pregnant using the frozen embryo transfer method.”

Early on in the pandemic, studies showed that pregnant women were at higher risk of developing severe COVID-19. As such, it was recommended by the World Health Organization that pregnant women get the jab. However, many women have hesitated, likely due to lack of information or misinformation about the safety of vaccines on fertility and foetuses.

“Unfounded claims in popular media linked a possible correlation between the SARS-CoV-2 vaccine and potential infertility,” the authors wrote in the study. “Such false claims by anti-vaccine activists aim to incite fear and deter public opinion from vaccination, so jeopardizing the vaccination plan and the end of the pandemic.

“Our results refute such claims and strengthen the notion that the SARS-CoV-2 vaccine is safe and should be recommended to fertility-seeking couples,” the authors continued.

Multiple studies, one result

There has been a range of recent studies examining the impact of COVID-19 and COVID-19 vaccines on fertility in both men and women.

A study published in the medical journal Reproductive Biology and Endocrinology in May 2021 proved that there was no difference in ovarian stimulation and embryological variables during IVF cycles conducted before and after receiving the Pfizer vaccine.

A separate study of 129 women published in the medical journal Human Reproduction suggested that the Pfizer COVID-19 vaccine has no negative effect on a woman’s ovarian reserve. Women’s Anti-Müllerian hormone (AMH) levels were tested before they received their first shot of the vaccines. They received the second dose three weeks later and then were tested again three months after that. AMH levels were unchanged while COVID-19 antibody levels climbed.

Finally, two separate studies examining the impact of the Pfizer vaccine on male sperm showed that it does not have an impact. In a study of 43 male patients undergoing in vitro fertilization between February and March 2021, the sperm of each subject was examined against itself before and after vaccination, and researchers saw no difference in the sperm parameters.

A team of researchers from the University of Miami also studied semen volume, sperm concentration and total amount of moving sperm. In their study, published in the JAMA journal in June, they found no declines in any of the parameters after vaccination.

“In this study of sperm parameters before and after two doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men,” the study’s authors wrote. “Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters.”

“There is nothing we have seen to suggest any negative impact on fertility at all,” Orvieto told Health Policy Watch.

But COVID-19 can harm fertility

Orvieto said that in his first study, he looked at IVF before and after infection. While there was no direct effect on the IVF outcome, the virus did affect the ratio of top-quality embryos for up to three months after disease. In the first three months, only around 30% of embryos were top quality compared to 60% before or after that period.

“The production of eggs and sperm lasts for around three months and can be hampered by inflammatory responses, like the ones that occur as a result of a viral infection, which is the case with COVID-19,” Orvieto said. “Our study indicated that the quality of embryos producers during an IVF procedure for a couple in which one of the partners had previously contracted COVID-19 was significantly lower, and lead to a lower chance of successful implantation.”

He told Health Policy Watch that he would recommend couples wait three months after one of the partners’ had contracted COVID-10 before IVF treatments.

Other studies found up to a 50% decrease in sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis. And there have been reports of up to 25% of men who have had COVID-19 having a sperm impairment from the disease.

“If couples are choosing not to vaccinate it is because they are reading fake news,” Orvieto said.

He added that his team has gathered what is believes to be all the information needed now to justify vaccination for fertile men and women now. The next thing would be to wait three or four years and see if there are any long-term effects of vaccination or infection on fertility.

Image Credits: Wish FM Radio.

2nd Anniversary of COVID-19

Two years after the World Health Organization declared the novel coronavirus outbreak a global pandemic on 11 March 2022, the developed world’s long-time fixation on the SARS-CoV2 virus, which has killed 6 million people, has suddenly shifted away from health to the war in Ukraine and sharply rising geopolitical tensions. 

Meanwhile high-income countries have dropped restrictions as their citizens clamour for a return to normalcy. Low-income countries, including many in Africa, are still encountering resistance to COVID vaccine campaigns. 

While African Union countries have been eager to see more technology transfer to the continent to increase medicines and vaccine production– some countries may also be quietly questioning if COVID vaccination should be prioritized over the fight against other deadly disease threats – from cholera to Lassa fever.

And at the same time, as global health leaders point out, the pandemic is not over…. yet. 

Some countries in WHO´s Western Pacific region, notably South Korea and Malaysia, are facing a surge in cases. 

And a new “recombinant” virus variant, including features both of the deadly Delta variant and the infectious Omicron, has been identified in France. More virus variants could emerge in regions where vaccination rates remain significantly lower than the global average, WHO and other experts have continuously warned.

“This pandemic is not taking a break, despite the fact that we have this war, despite the fact that many countries are facing challenges… Unfortunately, this virus will take opportunities to continue to spread,” said Dr Maria van Kerkhove, WHO’s COVID-19 lead, during Wednesday’s WHO briefing.

Ukraine conflict ‘perfect storm’ for COVID surge 

The conflict in Ukraine is likely to lead to a surge in COVID cases.

The conflict in Ukraine is likely to lead to another surge in COVID, which will be nearly impossible to track as surveillance systems fall apart, others warn.  

The “low levels of vaccination and very low levels of getting booster doses and the social disruption is just a perfect storm for seeing the surge in cases,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University Mailman School of Public Health, speaking to USA Today. 

“It will all be lost in the noise,” said Dr Eric Toner, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. “Assuming that the hospitals are able to even track admission data, there’s going to be a much bigger influx of people with war injuries than there would be COVID patients.”

A surge in deadly tuberculosis could be another element of fallout from the war in Ukraine, WHO and others have warned, given the large wave of migration and the breakdown in routine surveillance and treatment systems.  Ukraine, like neighboring Russia, has a high TB burden although it has made significant inroads in the past few years in combating the disease.  

Low testing rates also create opportunities for new variants to spread 

WHO Director General Dr Tedros Adhanom Ghebreyesus

Speaking in a press briefing on Wednesday two days ahead of the pandemic anniversary date, WHO’s Dr Tedros Adhanom Ghebreyesus noted that although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases as the virus continues to evolve.

Just as significantly, he noted that ¨we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed.”

He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID 19 should be offered in addition to professionally-administered testing services.

“This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros.

Overall, reduced testing also reduces the ability to track virus trends, including the emergence of new variants.  

In Africa, WHO, Gavi, The Vaccine Alliance and the African Union have been working to build stronger COVID vaccine uptake in countries lacking strong health systems, with some success. 

However, sources have also have told Health Policy Watch, that some countries are becoming reluctant to aggressively push ahead with COVID vaccination campaigns when they face so many other challenges. 

Meanwhile, it remains a question if wealthy donor nations, many of them European, will respond quite as positively to the new GAVI Ask for some $16.8 billion for 2022 to fund vaccine distribution and health system uptake in low-income countries, primarily Africa, now that the Russian attacks on Ukraine have evolved into such a major humanitarian crisis that will also demand billions from donors to address.

Ultimately, the Russian invasion of Ukraine, more so than COVID fatigue, could sabotage the ¨pandemic dividend¨ that WHO and other health agencies might have hoped to have obtained in terms of convincing policymakers to focus more on health investments and in building stronger health systems.   

That, despite the fact that as Howard Catton, the head of the International Council of Nurses points out in an op-ed, “health, peace, and prosperity are inseparable.”  (see related Health Policy Watch story).

Attempts to return to normalcy amidst rising cases in some regions

Meanwhile, despite rising case rates in Asia as well as in Europe, countries continued to relax their COVID-19 restrictions, with most European countries having dropped “COVID certificate” requirements for entering domestic venues such as restaurants, while states in the United States are dropping mask requirements and other restrictions . 

Ireland and Hungary -this week joined Iceland, Norway, and Slovenia in lifting all of their COVID-19 restrictions.

“From March 6, 2022, travelers to Ireland are not required to show proof of vaccination, proof of recovery, or a negative PCR test result upon arrival. There are no post-arrival testing or quarantine requirements for travelers to Ireland,” the statement of the Irish authorities reads.

Similar to Ireland, the Hungarian authorities revealed that all incoming travelers, including those not vaccinated or recovered from the virus, are now permitted entry without testing rules. 

“It is possible to enter the territory of Hungary by public road, railway, water, and air traffic – regardless of citizenship and protection against the coronavirus,” the Hungarian authorities stated.  

This followed a major relaxation of restrictions in most other countries of the European Union as well as the United States and the United Kingdom several weeks ago.

“Today is not the day we can declare victory over COVID because this virus is not going away,” UK Prime Minister Boris Johnson said on 21 February, when he announced an end to England’s remaining legal curbs and most free testing.

The UK announcement came after Johnson said the nation had passed the peak of Omicron, and could now complete the “transition back to normality” – although since then cases in the UK have begun to rise again.

Many states in the US also have decided to lift mask requirements and other restrictions, with California becoming the first state to shift to an “endemic” approach to the coronavirus. 

However, US President Biden vowed, in his State of the Union address, to never give up the fight against COVID-10.

“I know some are talking about living with COVID-19,” the president said. “But tonight, I say that we never will just accept living with COVID-19.”

South Korea is experiencing an uptick in COVID cases, reporting more than 100,000 a day.

Further to the east, South Korea, which has recently been reporting more than 100,000 new cases a day, has started to ask people who test positive for COVID to look after themselves at home, so the country can redirect resources to the most vulnerable. As of 10 March, the country has reported 327,549 new cases. 

Pandemic restrictions – which include a six-person cap on private gatherings, a seven-day quarantine for international arrivals, mask mandates in public spaces, and vaccine passes for a range of businesses – will remain in place until at least 13 March.

Japan has, however, announced that it is easing border restrictions to allow more international students and visa holders in the country beginning in March, while cases decline.

One of the most COVID-restrictive countries, Australia opened up its borders to international visitors for the first time in nearly two years.  Travelers must still show proof of full vaccination to enter Australia without having to quarantine in a hotel, and they must provide a negative coronavirus test that was taken within 24 hours of departure.

.COVID-19 Delta-Omicron ‘recombinant’ in Europe

Dr Maria van Kerkhove

Meanwhile, Dr Maria van Kerkhove said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark.

“The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said van Kerkhove.

“There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants.

“We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway.

The evidence for the Delta-Omicron recombinant virus had been shared by the France-based NGO Institut Pasteur via the research consortium Global Initiative for Sharing Avian Influenza Data (GISAID). Additional investigation and analysis is needed to determine if the recombinant originates from a single common ancestor, or multiple similar recombination events. 

Said WHO Chief Scientist Soumya Swaminathan, in a tweet: “We have known that recombinant events can occur, in humans or animals, with multiple circulating variations of SARS-CoV-2. Need to wait for experiments to determine the properties of this virus. Importance of sequencing, analytics, and rapid data sharing as we deal with this pandemic.”

Image Credits: Prachatai, Christopher Dunstan Burgh/Flickr, WHO EB 150, Sharon Hahn Darlin.

lviv
A volunteer helping a woman at the train station in Lviv.

(LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states.

The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. 

There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data.

Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. 

Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed.   

The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. 

Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. 

In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. 

He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly.  

He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.”

The volunteer response 

On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. 

There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country.

So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. 

It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. 

This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. 

“This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people.

Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy.

Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. 

The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war.

This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to.

The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate.

Need for a professional response

While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine.

Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian.

HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. 

While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response.

“Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added.

For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. 

“We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added.

An uncertain future

While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. 

Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. 

People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine.

For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. 

Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” 

There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland.

Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. 

“I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said.  

Edited by Eric Reidy.

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This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe

Image Credits: Sam Mednick/TNH.