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

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

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

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

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

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

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

Calls for new African vaccine facility

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

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

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

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

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

Seth Berkley, CEO Gavi, The Vaccine Alliance

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

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

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

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

See related story

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

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

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

Strive Masiyiwa, African Union COVID-19 envoy

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

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

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

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

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

Countries’  export restrictions also holding up distribution 

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

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

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

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

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

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

WHO Director General Dr Tedros Adhanom Ghebreyesus

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

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

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

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

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

Image Credits: @WHO.

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

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

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

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

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

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

Strengthening WHO

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

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

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

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

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

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

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

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

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

Corporate influence

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

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

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

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

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

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

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

José Luis Castro is president and CEO at Vital Strategies

 

 

 

 

 

 

 

Image Credits: Matthew TenBruggencate/ Unsplash.

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

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

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

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

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

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

Authors admit data is ‘partial’

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

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

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

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

 

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

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

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

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

Boosting ‘might ultimately be needed’

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

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

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

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

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

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

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

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

 

Image Credits: Roger Starnes / Unsplash.

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

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

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

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

Increase taxes to decrease consumption

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

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

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

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

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

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

Engage women as advocates

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

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

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

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

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

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

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

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

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

Take on the Tobacco Industry

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

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

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

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

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

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

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

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

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

Princess Dina Mired

 

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

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

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

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

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

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

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

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

Decriminalization can open up access to services 

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

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

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

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

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

Banning pesticides, training healthcare workers, and decriminalizing suicide

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

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

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

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

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

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

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

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

Image Credits: WHO, WHO.

Integration of care is important for patients’ wellbeing.

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

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

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

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

Integrated care ‘is the future’

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

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

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

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

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

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

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

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

HIV, TB funding influences health system

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

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

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

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

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

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

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

 

 

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

Ethiopia vaccines
AstraZeneca COVID-19 vaccine arrive at Bole International Airport in Addis Ababa, Ethiopia, in March.

As Africa prepares to get even fewer COVID-19 vaccines than expected in the coming months thanks to the supply shortage at COVAX, the continent is also battling with vaccine hesitancy – exacerbated by the lack of vaccinated role models.

Africa could receive 155 million fewer vaccines than expected this year from the global vaccine platform, COVAX, which announced on Wednesday that it has had to cut its supply forecast by 25% as it has been affected by export bans, particularly from India, bilateral deals between manufacturers and countries, production challenges and delays in vaccine regulatory approval. (COVAX had previously said it will provide 520 million doses to the WHO Afro region by the end of the year.)

As a result, said Dr Matshidiso Moeti, head of the World Health Organization (WHO) Africa, the continent would have to continue to rely on economically crippling lockdowns, and other public health prevention measures instead of vaccinations to control the pandemic.

However, Moeti also conceded that the continent was facing vaccine hesitancy in some countries, notably the Democratic Republic of Congo (DRC) – which is also battling a meningitis outbreak.

“It’s true that vaccine rejection, denial, has been a strong feature of the response in the DRC,” Moeti told a WHO Africa media briefing on Thursday. 

“The demand was so little that the country, at some point had to redistribute some vaccine supplies that it had been provided for to other countries.

“Some surveys have shown that [vaccine hesitancy] has started to shift in other countries as the vaccines have been rolled out more and more people are interested now in getting vaccinated,” she added.

This was partly because people who have already been vaccinated can act as “role  models” to show that vaccines are safe, can prevent severe illness and death, she said.

Dr Matshidiso Moeti, head of the World Health Organization Africa region.

Only 20 African countries may reach 10% target this month

But vaccinated Africans currently make up a tiny minority.

“As of today, Africa as a whole has received around 138 million doses only,” said Dr Richard Mihigo, WHO’s Program Area Manager for Immunisation.

 “Only around 40 million people have received the two doses that are required to be fully vaccinated, and this represents merely 3% of the African population.When you look at sub-Saharan Africa, it’s around 1.7%,” added Mihigo.

Fewer than 20 out of the 54 African countries were likely to reach the WHO target of 10% of their population vaccinated by the end of this month, he added.

However, Mihigo said that despite the COVAX shortfall, vaccine supply was fluid and the continent could still get the vaccines it needed to vaccinate 40% of Africans by the end of the year, WHO’s next target.

Meanwhile, Moeti stressed that increasing vaccine supply was the biggest priority for the country.

She noted that while COVAX had recently supplied around five million vaccines to Africa, three times as many doses – 15 million had been thrown away in the US due to wastage.

“This is enough vaccines to cover everyone over 18 years in Liberia, Mauritania, and the Gambia,” she observed. “Every dose is precious and has the potential to save a life.”

She noted that, while high-income countries have pledged to share one billion doses globally, and so far 120 million doses have been released.

Prioritize vaccine equity

“Manufacturers are now producing 1.5 billion COVID vaccine doses globally each month, and two billion doses are required to reach 40% of people in every country. If producing countries and companies prioritise vaccine equity, this pandemic, can be over quickly,” she noted.

However instead, COVAX had announced that its shipment forecast for the rest of the year had been revised downwards by 25% “in part because of the prioritisation of bilateral deals over international solidarity”, she said. 

“G20 Health Ministers this week expressed their support for the global 40% vaccination target. This goodwill needs to be accompanied by concrete actions and financing for the global fight against COVID-19, to succeed,” she added.

Image Credits: UNICEF, WHO.

COVID booster vaccines have gained traction in several countries – US, Israel, Germany, UK, and others, but low- and middle-income countries lag significantly behind in shots.

The World Health Organization (WHO) has called for its global moratorium on COVID-19 boosters to be extended until the end of the year to enable vaccines to be directed to countries that have not yet been able to reach their vulnerable citizens.

“A month ago, I called for a global moratorium on booster doses at least until the end of September to prioritise vaccinating the most at-risk people around the world who are yet to receive their first dose,” WHO Director-General Tedros Adhanom Ghebreyesus told the body’s media briefing on Wednesday.

“There has been little change in the global situation since then, so today I am calling for an extension of the moratorium until at least the end of the year, to enable every country to vaccinate at least 40 percent of its population.”

The WHO’s global target is for every country to vaccinate at least 10% of its population by the end of this month, at least 40% by the end of this year and 70% of the world’s population by the middle of next year – but the September target so far is likely to be missed due to the failure of rich countries to donate sufficient doses to low- and middle-income countries.  And current commitments to COVAX, the WHO co-sponsored global vaccine facility, are running several hundred million doses short of the 40% end-year goal. 

Dr Kate O’Brien

Dr Kate O’Brien, WHO’s director of immunisations, also stressed that there was neither scientific consensus nor enough evidence to support giving COVID-19 boosters.

“We’re not asking [countries] to withhold something for which there is a strong set of evidence,” said O’Brien. “The vaccines are holding up very, very well against the severe end of the disease spectrum. The actual focus of the vaccine programme is to prevent severe disease, hospitalizations and deaths, and we see in the evidence that, in fact, the vaccines are performing extremely well over time, and against the variants,” she said. 

According to a technical report issued by the European Centre for Disease Prevention and Control (ECDC) last week, “based on current evidence, there is no urgent need for the administration of booster doses of vaccines to fully vaccinated individuals in the general population” but that ”additional doses should already be considered for people with severely weakened immune systems as part of their primary vaccination”.

“We will continue to watch the evidence very carefully, but our expert advisory committees continue to see that there is not a compelling case to move forward with a generalised recommendation for booster doses,” added O’Brien.

No more promises, just vaccine delivery

Tedros hit out at high-income countries that have promised to donate more than one billion doses as “less than 15 % of those doses have materialised”. 

“Manufacturers have promised to prioritize COVAX and low-income countries. We don’t want any more promises. We just want the vaccines,” Tedros added.

Although 5.5 billion vaccine doses have been administered globally, 80% have been administered in high- and upper-middle-income countries, according to the WHO.

Reiterating his weekend appeal to G20 health ministers, Tedros said that “the world’s largest producers, consumers and donors of vaccines, the world’s 20 leading economies, hold the key to vaccine equity and ending the pandemic”.

They could do so by swapping their near-term vaccine deliveries with COVAX, fulfilling their dose-sharing pledges by the end of this month and “facilitating the sharing of technology, know-how and intellectual property to support regional vaccine manufacturing”, he added.

WHO’s Bruce Aylward

Dr Bruce Aylward, the WHO representative on COVAX, said that despite promises made by the G7 and others, the global vaccine platform had to reduce its supply forecast this week as there had been a 25% reduction in the number of doses that will go through COVAX – unless there is urgent action by the world’s G20 countries and vaccine manufacturers. 

“People have come out and said, ‘Well, it’s only 100 million doses if we do boosters’, but we’ve just had to downgrade supply by a few 100 million doses. It makes a real difference in the face of scarcity,” added Aylward.

“To get all the world to 40% [vaccination] coverage in every single country requires two billion doses of vaccine,” he added.  

According to its latest Supply Forecast, COVAX expects to have access to 1.425 billion doses of vaccine in 2021 “in the most likely scenario and in the absence of urgent action by producers and high-coverage countries to prioritize COVAX”.

COVAX supply forecast, 8 September 2021

COVAX added that its work was being hampered by “export bans, the prioritisation of bilateral deals by manufacturers and countries, ongoing challenges in scaling up production by some key producers, and delays in filing for regulatory approval”.

Tedros ‘appalled’ by IFPMA comments

Tedros also lashed out directly at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), for comments made in an media briefing on Tuesday.

He complained that the IFPMA was calling for dose-sharing with poorer nations – but only after rich countries had vaccinated virtually everyone who wanted a jab.

“Yesterday, the IFPMA said that G7 countries now have enough vaccines for all their adults and teenagers, and to offer booster doses to at-risk groups, and that manufacturing scale-up should now shift to delivering global vaccine equity, including dose sharing,” said Tedros.

“When I read this, I was appalled,” said Tedros. “In reality, manufacturers and high-income countries have long had the capacity to, not only vaccinate their own priority groups, but to simultaneously support the vaccination of those same groups in all countries.

“We have been calling for vaccine equity from the beginning, not after the richest countries have been lower-middle-income- and lower-middle income countries are not the second or third priority. Their health workers, older people, and other at-risk groups have the same right to be protected. I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers,” Tedros said.

In the IFPMA statement, the pharmaceutical body stated that: “The biopharmaceutical industry continues to call for dose sharing and renew its commitment to work with governments to support their efforts.

“From now on, G7 countries have sufficient stocks of doses to vaccinate adults, teenagers and roll out boosters programmes to protect the most at-risk groups as well as substantially increase the number of doses available to low- and lower-middle-income countries. Political leadership is critical to enable dose deliveries as quickly as possible.

“Reducing the toll of the pandemic on lives and livelihoods requires equitable access to vaccines and country readiness for vaccination.”

WHO Director General Dr Tedros Adhanom Ghebreyesus.

Aylward, meanwhile, took a less combative position, recognising that vaccine inequity was no longer an issue of supply constraints.

“We had the IFPMA came out yesterday and said ‘Look, global production is 1.5 billion doses a month now’. The absorptive capacity of the world is less than a billion right now… So, the volumes are there. This is a fixable problem, but it’s only going to get fixed if the political will and the will of the manufacturers come together to solve it,” he said.

Israel, currently facing one of the highest infection rates in the world due to a Delta variant surge, has already implemented boosters shots for any residents who got their jabs more than five months ago.  And the White House has also announced it would begin offering boosters in September for everyone immunised eight months ago or longer – although regulatory authorities are still debating authorization of the plan. Several other countries including France, Germany, Thailand and the United Arab Emirates are offering boosters.

But Aylward noted that many other countries had already consulted the WHO on whether booster policies can be delayed. 

“Some countries may be going ahead with [booster] decisions, others may not. But our role is to make sure that we put forward the strongest possible arguments for the way out of this pandemic, and the way out is an extended moratorium because, since the last time we called for it, the equity gaps have got greater, the amount of vaccine available in low-income countries has gone down,” he added.

Recognise all WHO-listed vaccines

Tedros also condemned the refusal of some countries to allow travellers who have been fully vaccinated with a vaccine that has WHO Emergency Use Listing (EUL) entry on the basis that their vaccines have not been approved by their national regulators.

“WHO Emergency Use Listing follows a rigorous process based on internationally recognized standards. All vaccines that have received WHO Emergency Use Listing are safe and effective in preventing severe disease and death, including against the Delta variant,” said Tedros, urging all countries to recognize all vaccines with WHO EUL.

This follows reports that some European countries are still not allowing travellers vaccinated with Covishield, the AstraZeneca vaccine produced by the Serum Institute of India, to enter their countries – even though the European Union has approved the AstraZeneca vaccine made elsewhere.

 

Image Credits: Marco Verch/Flickr.

Vials of the Pfizer-BioNTech COVID-19 vaccine.

COVID-19 vaccine manufacturers are expected to produce 12 billion doses by the end of the year – almost half made by China – and there could be a vaccine surplus by mid-next year.

In addition, by the end of this month, around 500 million doses should be ready for “redistribution” from wealthy to low-and middle-income countries.

This emerged at a media briefing organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on Tuesday.

“By January 2022, there will be sufficient vaccines produced for every adult on every continent,” according to IFPMA.

“Modelling by Airfinity indicates that even if vaccine advisory committees and governments in G7 countries vaccinate teenagers and adults and decide to give boosters to at-risk populations, there would still be over 1.2 billion doses available for redistribution in 2021 alone. This means that each month for the foreseeable year, over 200 million doses would be, with effective planning, available for low- and lower-middle-income countries,” it added.

 

Describing the vaccine production increase as “absolutely extraordinary”, Rasmus Bech Hansen, CEO of research forecast group Airfinity, said that it had been “a surprise to pretty much everyone how fast China has scaled up vaccine production”.

Hansen added that, even when third booster shots for citizens in high-income countries were factored in, Infinity estimated that, “by the end of September, there will be around 500 million doses available in the US, UK, European Union and Canada that could be redistributed” through donations, swaps or reselling.

“In the last G7 summit, one billion doses were pledged [to LMIC] and it actually seems that these stocks will be available by the end of the year so G7 countries could meet those pledges,” he added.

IFPMA Director General Thomas Cueni told the briefing that ‘by June 2022, we expect that we will have more than 24 billion doses of COVID-19 vaccines available”.

IFPMA Director General Thomas Cueni

“At this point, vaccine supplies may actually outstrip global demand,” added Cueni. “Vaccine manufacturers are now producing 1.5 billion doses per month, and are expected to continue manufacturing at that scale on the basis of the most conservative protection projections.”

Hansen noted that 73% of the production increases were the result of pharmaceutical companies enhancing their in-house capacity, supported by an array of collaboration agreements within the industry – Affinity had counted 231.

Pfizer doses mostly allocated for next year 

Pfizer CEO Dr Albert Bourla said that his company had doubled its production capacity in the past six months and was on track to produce three billion doses by the end of the year, thanks to “sleepless nights, and a lot of effort from thousands of people”.

While it was testing a version of its vaccine that had been tweaked to combat the Delta variant, Bourla said this didn’t seem necessary as the current vaccine is highly efficacious.

One of the key challenges Pfizer faced in scaling up was access to raw material to make it’s mRNA vaccine.

“We literally created new suppliers” by giving companies financial, scientific and technical support, said Bourla.

However, in response to a Health Policy Watch question, Bourla dismissed joining the mRNA technology transfer hub established recently in South Africa by the World Health Organization (WHO) to assist Africa to develop its own mRNA vaccines.

Pfizer CEO Dr Albert Bourla

“I’m not sure what is the point of transferring technology that it is going to take years to transfer. And, by the way, this is what we do. I’m not sure I understand what they want, to give it someone else to do?” asked Bourla.

Pfizer expects to make four billion doses in 2022, but Bourla but urged all countries to place their vaccine orders as soon as possible.

“We have allocated doses already for this year and frankly, we have allocated a very big part of the doses that we are going to be producing next year also to countries that they have placed orders for these doses,” said Bourla, adding that 41% of this year’s production had been allocated to LMICs.

Bourla said most orders for 2022 were from high-income countries, with boosters fueling demand. While Pfizer would like to allocate at least one billion doses to LMIC for 2022, it had  yet to receive orders for this amount.

“When it comes to the ability to pay, we implemented tiered pricing. High-income countries were receiving one tier of pricing, mainly the cost of a meal in their country. Middle-income countries received half of this price, and the low-income countries received doses at cost,” said Bourla, who is also IFPMA’s vice-president.

Johnson & Johnson has policy of technology transfer

Dr Paul Stoffels, Chief Scientific Officer for Johnson & Johnson

Dr Paul Stoffels, Chief Scientific Officer for Johnson & Johnson, said that his company had established a global vaccine manufacturing network across four continents with 11 manufacturing  sites

“We made a commitment to equitable access and committed by putting a billion doses forward for low and middle-income countries in the next 12 to 18 months,” said Stoffels, adding that over half the company’s vaccines would go to LMICs in the coming year.

“Our strategy of focusing on technology transfer brought us to partnering with Aspen Pharmacare in South Africa. Aspen is now fully in production and we anticipate that all supplies produced by Aspen from now on will go to COVAX countries and African Union. And we are also transferring our technology as we speak to BioE in India,” said Stoffels.

This follows a recent report by The New York Times that Aspen, which has a ‘fill and finish’ contract with J&J, had been exporting millions of vaccines to Europe while lagging behind in its African deliveries. The EU recently agreed to send these vaccines back to South Africa.

However, Stoffels warned that technology transfers are “highly technical by nature and highly complex”. 

“We need to work with many partners. Multiple steps are needed, including biological manufacturing, quality testing and release, regulatory inspections and controls. Most critical is the training of workforce and new technologies,” he added. 

Progress in therapeutics

Cueni reported that “a handful of authorised COVID-19 treatments are becoming standard of care for COVID-19 patients that have been hospitalised and are saving lives”. 

“Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni.

Some of the key treatments that have been authorised for emergency use include the anti-viral, Remdesivir (Gilead Sciences), Monoclonal IL-6 blocker, Tocilizumab (Roche), Monoclonal Casirivimab and  Imdevimab (REGEN-COV Roche Regeneron) and Monoclonal Sotrovimab (GlaxoSmithKline).

“Getting the therapeutic rollout right will be important for all countries to be able to benefit from future innovation, such as the anticipated oral outpatient COVID-19 therapeutic candidates,” he added.

Roche has been involved in 10 experimental treatments for COVID-19 “focused on preventing progression to mechanical ventilation and preventing death”– but testing these was complex and difficult, said its CEO, Bill Anderson.

Roche CEO Bill Anderson

One of these, tocilizumab (Actemra), is a monoclonal antibody that reduces inflammation by blocking the interleukin-6 receptor.

“As it suppresses the immune system, we thought, ‘you don’t want to give it to patients that are newly diagnosed’. It’s really for patients who’ve progressed to a severe illness where their immune system may actually be more doing more damage than good. So we had to run multiple studies. I think we’ve run ultimately, we’ve run seven pivotal studies,” said Anderson, adding that the first pivotal study had failed to show any results.

“Many people thought, well, that’s the answer. But we had seen enough to think, hmm, you know, I don’t think that’s a complete story. And ultimately, we’ve shown that Actemra does decrease need for mechanical ventilation and death quite significantly in hospitalised patients,” he added. 

But there are only so many facilities in the world capable of producing monoclonal antibodies, said Anderson, and the treatments needed large quantities.

“We ultimately did a partnership with Regeneron, which is a company that we compete with in many other fields, but we felt like they were farthest along,” added Anderson.

“We made an exceptional decision that we would not assert patent rights if companies could make a product of a biosimilar to Actemra and deliver it to LMICs, and that, in fact, it looks to be happening,” he added.

However, Anderson added that Roche was only prepared to support technology transfer to companies with the capacity to produce large amounts of monoclonal antibodies.

“Tech transfer is very laborious, and we can’t afford to take our people that are producing Actemra and that are also doing tech transfer with the existing external contracts, unless we have somebody who can produce large quantities.”

 

Image Credits: Twitter: @WHOAFRO, US Centers for Disease Control.

air quality

Over a third of the world’s countries – 37% – have either not created or are not enforcing legally mandated ambient air quality standards (AAQS), according to a new report released by the United Nation Environment Programme (UNEP).

The report, “First Global Assessment of Air Pollution Legislation” assesses national air quality legislation in 194 states and the European Union, and found  persistent policy, capacity, and implementation gaps to prevent more effective action against air pollution.

Approximately 60% of countries, accounting for 1.3 billion people, have no annual ground-based monitoring for fine particulate matter (PM 2.5), while at least 31% of countries with the ability to introduce sub-standards for ambient air quality standards (AAQS) have not done so. 

Unregulated air pollution continues to pose the greatest environmental threat to health. There are over seven million premature deaths every year due to the combined effects of outdoor and household air pollution – with millions more people falling ill from breathing polluted air, according to the WHO. More than half of these deaths are recorded in low- and middle-income countries.

UNEP calls for multi-sectoral action, in light of the report’s launch coinciding with International Day of Clean Air for Blue Skies, that can enable cleaner air for all. 

“Investments in air quality will [not only] enhance our health, but also job creation, energy efficiency, clean transport, sustainable agriculture, and green and resilient cities,” said UNEP Executive Director Inger Andersen, during a Tuesday launch event of the report. 

“We can’t clean the air overnight, and we can’t clean the air without the full engagement of every sector of society. But if we put the work in today, we can one day soon breathe easier.”

‘Lack of ambition’ in heterogeneous approach to air quality control

Eloise Scotford, one of the co-authors of the UNEP report

While the majority of countries (64%) embed AAQS in legislation, the global picture of national air quality is one of heterogeneity, with some cases of implementation masking a “lack of ambition”, said Eloise Scotford, Professor of Environmental Law at the University College London and one of the co-authors of the study.

Poor enforcement of air quality laws has led to 43% of countries lacking a legal definition of air pollution and only 51% of national air quality laws globally with explicit public health, or public and ecosystem health as their main objective.

“We found that processes for setting AAQS are often not transparent, or accountable, or accessible,” said Scotford, noting that standards could often be made more ambitious.

Although the heterogeneous approach to embedding air quality standards reflects specific air quality challenges and diverse legal cultures, in addition to acknowledging that there is no one-size fits-all approach to air quality control, this also risks masking weak ambition and legalizing unclean air.

In addition, only 33% of countries impose requirements on governments to achieve AAQS, indicating that the institutional responsibility on air pollution is quite weak and are the bare legal standards, added Scotford. 

The lack of level playing field for AAQS may keep the world at odds with the demanding requisites on global policies on climate change expressed in the 2015 Paris Agreement.

Legal standards need to be established

Figure 1 is a conceptual map explaining how legislative incorporation of AQS may sit within, and provide the foundation for a domestic “system of air quality governance”.

Regulating and controlling the different sources of air pollution remains a “coordination challenge”, according to Scotford, with the first step establishing legal standards for air quality. 

“Once you have legal standards for air quality, that’s really important. Ambition is important. But that is not enough. More needs to be done to have a full system of quality governance that is robust, to ensure the achievement of clean air.” 

The UNEP report notes that a robust system of air quality governance is one which: 

  • requires governments to develop and regularly review applicable air quality standards in light of public health objectives;
  • determines institutional responsibility for those standards;
  • monitors compliance with air quality standards;
  • defines consequences for failure to meet them;
  • supports the implementation of air quality standards with appropriate and coordinated air quality plans, regulatory measures and administrative capacity;
  • is transparent and participatory.

WHO air quality guidelines launching end of the month

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

In light of the launch of the UNEP report, WHO has announced that they will be launching their 2021 Air Quality Guidelines on 22 September.

These guidelines will serve as a global target for national, regional, and city governments to work towards reducing air pollution. 

WHO Director of Public Health, Environmental and Social Determinants of Health Maria Neira echoed UNEP’s calls for urgent and collective action in reducing air pollution.   

“It is time to stop with those fossil fuels. It is time to accelerate towards a very ambitious and quick transition to clean sources of energy. We need to do it for the economy, we need to do it for our society, but we also need to do it for our health. The more we postpone this transition, the more we will have death and disease on our shoulders.”

Image Credits: Flickr, UNEP, UNEP.